Figure 1 CT scan showing tumor of the left vocal cord.
Figure 2 Left. Patient’s midface after right partial nasal ablation with resection of the right nasal bony and cartilaginous pyramid, lobule and anterior septum and after 4 further resections. Right. After right residual nasal ablation with resection of the left bony and cartilaginous nasal pyramid, as well as resection of both frontal beaks and ethmoid cells. Visible metal prosthesis for preliminary care with nasal epithesis.
Figure 3 MRI scans show the infiltration of the nasopharyngeal carcinoma in the right maxillary sinus, the orbit, the optic nerve, the right retropharyngeal space and the anterior skull base. Left. Level of the orbit; Right. Level of maxillary sinus.
Figure 4 CT scan of the head and neck shows the infiltration of the oropharyngeal carcinoma in the parapharyngeal space, deep tongue muscles and mandible.
Case No |
1 |
2 |
3 |
4 |
Age*/Sex |
52/Male |
47/Male |
54/Female |
50/Male |
Comorbidities |
Hepatitis B |
Hepatitis B |
Hepatitis C, cardiac arrhythmia, bipolar disorder, renal insufficiency |
None |
CD4†/HIV RNA‡; § |
21/4.90 |
87/4.23 |
703/0.67 |
44/5.88 |
CD4†/HIV RNA‡; II |
245/<1.70 |
600/<1.70 |
<250/<1.70 |
146/<1.70 |
<250 CD4†; ¶ |
21 |
0 |
72 |
45 |
Tumor Site |
Larynx |
Nose |
Nasopharynx |
Oropharynx |
HPV/p16 |
Negative |
Negative |
Unavailable |
Negative |
cTNM |
T3N0M0 |
T2N0M0 |
T4N1M0 |
T4aN2bM0 |
*Years; †cell count/µL; ‡log10 copies/ml; § at cART initiation; II at cancer diagnosis; ¶ time (in months) of less than 250 CD4 cells/µL direct before cancer diagnosis;
Table1 Patients’ demographic and tumor characteristics
Case No |
Primary treatment |
Specific disease characteristics |
Specific treatment related event |
1 |
Laryngectomy and bilateral SND* II-IV |
2nd primary |
2nd primary |
2 |
Partial nasal ablation |
Perineural and lymphovascular spread |
Repeated R1 Resections |
3 |
None due to multiple comorbidities |
None |
None |
4 |
Tumor resection, left MRND†, right SND* |
None |
R1 Resection; Acute abdomen |
* Selective neck dissection; † Modified radical neck dissection;
Table 2Treatment course of the disease
Case No |
Further course |
Relapse § |
Survival § |
1 |
Total thyroidectomy |
No relapse II |
21 II |
2 |
1. Diagnostic cervical lymph node exstirpation in level Ib |
5 |
34 |
3 |
Refusal of treatment |
No treatment |
17 |
4 |
1. Adjuvant RCTH ‡ |
26 |
30 |
† Modified radical neck dissection; ‡ chemoradiotherapy; § in months; II until December 2017
Table 3Further course and outcome of the disease