Monoclonal plasmacyte cell tumor (MPCT ; also known as extramedullary plasmacytoma) is a rare disease, which arises most commonly in the head and neck. Many reports have suggested the head and neck region to be most common site for MPCT, thus head and neck surgeons should be aware of its clinical manifestations. We recently treated 4 patients, 3 with an MPCT in the nasosinudal legion and 1 patient with an MPCT in the larynx and mesopharyngeal regions, and investigated the diagnostic utility of the clinical features and examinations, in addition to the efficacy of these treatments. All of the patients presented symptoms that involved the local regions of the tumor, but there were no specific findings related to the clinical features or imaging that allowed for the differential diagnosis of MPCT. All cases were diagnosed by a pathological examination. The MPCT patients underwent combination treatments involving surgery and irradiation, and we were able to select an effective method for achieving the local control of MPCT.

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We have treated three cases of neck squamous cell carcinomas with an unknown primary. After more than two years, the palatine and the lingual tonsils were identified as the primary sites metastatic to the neck by tonsillectomy and biopsy, respectively, in two of the patients. In both of these cases, the primary sites and neck metastatic nodes were HPV-positive. One case showed a cystic metastatic lymph node. The remaining case was still considered to have neck squamous cell carcinoma with an unknown primary after more than five years and was HPV-negative. A thorough investigation of oropharyngeal sites, specifically the palatine tonsils and the lingual tonsils, should be performed in patients with cystic metastasis to the neck from an unknown primary tumor and/or HPV-positive cancer with an unknown primary.

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Cetuximab (Erbitux^®) is a monoclonal antibody specifically bound to Human Epidermal Growth Factor Receptor (EGFR) that produces an antitumor effect by blocking the signaling pathway via EGFR in tumor cells. We examined four cases involving the administration of Cetuximab for recurrent head and neck cancer treated at our hospital. The results indicated a 50% response rate in terms of effectiveness. As to adverse events, we noted leukopenia and skin disorders, which were successfully treated conservatively. It is therefore necessary to make appropriate preparations for infusion reactions in the case of an emergency.

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This report describes our experience with a case of central adrenal insufficiency resulting from stress caused by head and neck cancer and its corresponding treatment. The patient was a 62-year-old male who visited our hospital with a chief complaint of neck swelling. As a result of close investigation, he was diagnosed with right neck lymph node metastasis of unknown primary cancer. Based on the tumor size and positional relationship with the neck vessels, one-stage surgery was judged to be difficult ; therefore, chemoradiation treatment was first started. Hyponatremia was observed after the initiation of therapy. According to the laboratory results, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) was suspected. The restriction of fluids and salt intake temporally improved the laboratory values ; however, hyponatremia (113 mEq/ℓ) again occurred after right neck lymph node dissection. Treatment for SIADH was ineffective. An endocrine examination revealed reduced adrenocorticotropic hormone (ACTH) and cortisol levels, and the patient was diagnosed with central adrenal insufficiency, after which corticosteroid administration rapidly improved the electrolyte abnormalities.

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From 1999 to 2008, three patients were referred to Osaka General Medical Center for an evaluation of enlarged neck lymph nodes. Two cases showed cystic lymph nodes. Neck lymph node biopsies were required for confirmation of the diagnosis. The thyroid lesions were histologically found to be papillary carcinoma in all cases. Total thyroidectomy or hemithyroidectomy with isthmus resection accompanied by neck dissection were carried out. In all cases, minimal lesions less than 1.0cm in diameter were not detected by CT or PET/CT, but were detected by a pathological examination of specimens subserially sectioned at 2.5 to 3mm intervals. We stress the clinical significance of cystic node metastasis from papillary carcinoma of the thyroid.

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