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PET/CT diagnostic value in suspicion of palatine tonsils’ lymphoma recurrence

100%
Kaczmarczyk D., Boniukiewicz A., Zagacki D.
Polski Przegląd Otorynolaryngologiczny
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2022
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vol. 11
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issue 2
14-17
EN
Introduction: Diffuse large B-cell lymphoma (DLBCL) is a non-homogenous group of neoplasms of the lymphatic system in terms of morphology, genetics, and clinical aspects. The follow-up of patients treated for lymphoma includes the following examinations: clinical, laboratory, and imaging. According to the recommendation of the National Comprehensive Cancer Network (NCCN) from 2020, the observation of patients with DLBCL is mostly based on the PET/CT examination with 18F-FDG, especially when suspecting the extranodal lymphoma recurrence. Aim: The aim of the study was to define the predictive value of the PET/CT examination in the evaluation of the recurrence of DLBCL in the palatine tonsils. Material and methods: The analysis of the medical documentation of patients treated in our Department was performed. Research material included patients with suspicion of local recurrence of DLBCL in the palatine tonsils. Thirty-three patients were included in the study: 22 women and 11 men. The age range was 23–73 years with a mean of 53 years. Results: The confirmation of the local recurrence of DLBCL in the histological examination was obtained in 11 patients – 7 women and 4 men aged 58–73 years (μ= 65.4). SUVmax in the palatine tonsil in those patients ranged: for the right tonsil 3.6–9.5 (μ=6.0), and for the left tonsil 3.8–9.5 (μ = 6.1). The second group of the patients did not present any local recurrence of DLBCL in the palatine tonsils. The histological diagnosis was chronic tonsillitis. The age of those patients ranged from 23 up to 73 years (μ = 43.1 years). SUVmax ranged: for the right palatine tonsil 2.8-27.7 (μ = 8.62), for the left palatine tonsil 3.8–27.4 (μ = 8.60). The sensitivity of PET/CT in the recurrence assessment in our study was 100%, while the specificity was 33.3%. The additional predictive value was 0.33.
2
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Gastric carcinoma metastasis to the palatine tonsil – case report

100%
Kaczmarczyk D., Zagacki D., Braun M., Morawiec-Sztandera A.
Polski Przegląd Otorynolaryngologiczny
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2020
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vol. 9
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issue 1
51-54
PL
Cel: Celem pracy jest przedstawienie rzadkiego przypadku guza migdałka podniebiennego, będącego przerzutem oraz pierwszym objawem raka żołądka. Opis przypadku: Przeprowadzono retrospektywną analizę dokumentacji medycznej. 44-letni mężczyzna został skierowany do Kliniki Chirurgii Nowotworów Głowy i Szyi Uniwersytetu Medycznego w Łodzi z powodu niebolesnego guza migdałka podniebiennego. W badaniu laryngologicznym stwierdzono obecność 2-centymetrowego guza migdałka podniebiennego prawego. Węzły chłonne szyjne nie były powiększone. W wykonanej BAC stwierdzono podejrzenie raka. Pacjent został zakwalifikowany do tonsillektomii prawostronnej. W badaniu histopatologicznym obecny był naciek gruczolakoraka (G2). Ze względu na brak korelacji obrazu klinicznego i wyników histopatologicznych, wykonano badanie PET-CT, w którym stwierdzono: masywny naciek żołądka, guz lewego nadnercza oraz zwiększony wychwyt 18-FDG w przyaortalnych węzłach chłonnych. Wykonano gastroskopię z biopsją guza żołądka. Badaniem histopatologicznym potwierdzono gruczolakoraka wykazującego ten sam immunotyp, co guz migdałka. Pacjent został zakwalifikowany do leczenia paliatywnego. Zmarł 6 tygodni od postawienia rozpoznania. Przerzuty do migdałków podniebiennych z odległego ogniska pierwotnego są niezwykle rzadkie. Zazwyczaj ognisko, pierwotne miejsce zlokalizowane jest w okolicy głowy i szyi. W naszym przypadku przerzutowy guz prawego migdałka był pierwszą oznaką raka żołądka.
EN
Aim: The aim of the study is to present a rare case of metastatic tumor localized in pharyngeal tonsil being the first symptom of gastric carcinoma. Case report: Retrospective analysis of medical documentation was performed. A 44-years-old men was referred to the Department presenting a complaint of enlarged right pharyngeal tonsil. The mass was not painful. Patient reported tobacco smoking (20/day) for many years. In the intraoral examination a 2 cm right palatine tonsil was present. There was a slight asymmetry between tonsils. Local lymph nodes were not enlarged. FNAC was performed stating suspicion of carcinoma. Patient was qualified for the tonsillectomy under general anesthesia. Histopathological finding was adenocarcinoma (G2) infiltration. Due to no correlation of clinical presentation and histopathological finding PET-CT examination was performed revealing massive gastric infiltration, tumor of the left adrenal gland, increased 18-FDG uptake in epigastrial and para-aortic lymph nodes. Gastroscopy and biopsy was performed. Histopathological material confirmed adenocarcinoma presenting the same immunotype as tonsillar. Patient was qualified for paliative treatment. He died 6 weeks after stating the diagnosis. Metastases to the pharyngeal tonsils constitute rare disease entities. Mostly the primary site is localized in the region of head and neck. In our case the metastatic tumor of the right tonsil was the first sign of the gastric cancer.
3
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Extramedullary plasmacytoma in the head and neck region – presentation of two cases

100%
Zagacki D., Golberg M., Neskoronna-Jędrzejczak A., Kaczmarczyk D.
Polski Przegląd Otorynolaryngologiczny
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2023
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vol. 12
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issue 4
46-50
EN
Introduction: Plasma cell tumors might be present in two types: as solitary lesions (plasmacytoma) or disseminated throughout the body – multiple myeloma. The former most commonly develops in the bones containing bone marrow, rarer in different soft tissues (extramedullary plasmacytoma). Case report: The first case is a 53-year-old man with a tumor of the left side of the larynx. The CT scan revealed a tumor on the left side of the larynx causing destruction of the thyroid cartilage. Oligobiopsy results – differential diagnosis included lymphoma and plasmacytoma. Based on histopathological examination and additional tests, the diagnosis was made: extramedullary myeloma. The patient was referred for further treatment to the hematology department, where he was qualified for chemotherapy and radiotherapy. The second case is a 27-year-old man with chronic rhinitis that does not respond to antiinflammatory treatment. The MRI examination revealed a pathological mass of a hyperplastic nature with enhancement after contrast administration. An endoscopic tumor biopsy was performed. Histopathological examination revealed a plasma cell tumor. The correlation of the performed tests allowed for the diagnosis of extramedullary ameloblastoma of the maxillary sinus. The patient was referred for IGRT radiotherapy treatment. Discussion: Extramedullary plasmacytoma (EMP) accounts for about 3% of all plasma cell neoplasms. It is a locally invasive submucosal tumor presenting a tendency for recurrences; however, in about 16% of cases it may progress to multiple myeloma. The treatment of choice in case of EMP is radiotherapy or chemo-radiotherapy. Pan-London Haemato-Oncology Clinical Guidelines for Plasma Cell Disorder (2020) defined diagnostic criteria for extramedullary myeloma, which are also presented in the paper.
4
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Actinomycosis of the right maxillary sinus mimicking the recurrence of adenoid cystic carcinoma – case presentation

88%
Ziemliński J., Boniukiewicz A., Braun M., Zagacki D., Kaczmarczyk D.
Polski Przegląd Otorynolaryngologiczny
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2022
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vol. 11
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issue 2
53-57
EN
Introduction: Adenoid cystic carcinoma (ACC) is a rare malignancy originating from the salivary glands. It accounts for about 1–5% of all malignancies in the head and neck region. It was first described in 1853 and 1854. The main prognostic factors are tumor extension, degree of malignancy, lymph node metastases, infiltration of neural tissue and the margin of healthy tissues. Actinomycosis is a specific inflammation caused by gram-positive anaerobic bacteria Actinomyces israelii. It was first described by Von Hacker in 1885. These bacteria co-create the bacterial flora of the oral cavity, throat, digestive tract and genitourinary system. Infection with this pathogen triggers formation of abscesses and fistulas. Case report: A case of a 75-year-old woman treated for ACC is presented. During the follow-up examination, the patient presented symptoms of a local recurrence of ACC, which was suspected until the second histopathological examination that pointed to actinomycosis of the right maxillary sinus. Conclusion: Due to frequent recurrences of ACC after treatment, follow-up in these patients should be long-term, and any worrying symptoms should be diagnosed for potential recurrence.
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Malignant tumor of the peripheral nerve sheaths in the parotid gland – a case report

76%
Movila A., Didora V., Zagacki D., Braun M., Morawiec-Sztandera A., Kaczmarczyk D.
Polski Przegląd Otorynolaryngologiczny
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2020
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vol. 9
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issue 1
PL
Wprowadzenie: Guzy ślinianki przyusznej stanowią ok. 6% nowotworów głowy i szyi. Najczęstsze z nich to: gruczolak wielopostaciowy i guz Warthina. Schwannoma jest zmianą wywodzącą się z komórek osłonki nerwów obwodowych (lemocytów, komórek Schwanna); najczęściej dotyczy tułowia i głowy, wyjątkowo rzadko obserwowany jest zaś w śliniance przyusznej. 9% Schwannoma pochodzi z osłonki nerwu twarzowego, stanowiąc od 0,5–1,2% wszystkich guzów ślinianek. W literaturze opisano 80 przypadków wewnątrzśliniakowych Schwannoma. Transformacja złośliwa dotyczy 14%. Złośliwe Schwannoma (MPNST) stanowią od 5% do 10% wszystkich mięsaków tkanek miękkich. Nowotwory MPNST o wysokim stopniu złośliwości są agresywne, z tendencją do wznowy oraz przerzutowania. Opis przypadku: Prezentujemy opis przypadku 84-letniej pacjentki, która zgłosiła się do Kliniki Nowotworów Głowy i Szyi UM w Łodzi z powodu bolesnego guza lewej okolicy przyusznej. Wspomniana zmiana pojawiła się 6 miesięcy przed hospitalizacją. W badaniu przedmiotowym stwierdzono policykliczny guz o ograniczonej ruchomości, skóra nad guzem była lekko zaczerwieniona, węzły chłonne niepowiększone, funkcja nerwu twarzowego zachowana. W BACC atypowe komórki wrzecionowate, budzące podejrzenie rozrostu złośliwego. Chora została zakwalifikowana do leczenia operacyjnego. W znieczuleniu ogólnym usunięto płat powierzchowny ślinianki przyusznej wraz z guzem i zmienioną skórą. Po zabiegu nie stwierdzono porażenia nerwu twarzowego. Przebieg pooperacyjny prawidłowy, pacjentka wypisana do domu w 8. dobie po zabiegu w stanie ogólnym i miejscowym dobrym. Wynik badania histopatologicznego materiału pooperacyjnego: dobrze odgraniczony wrzecionowaty guz z polami martwicy, profil immunohistochemiczny: S100+; Ki67 40–50%. Rozpoznanie – MPNST. Pacjentka została skierowana na konsultację radioterapeutyczną. Z uwagi na wynik pooperacyjny oraz zaawansowany wiek, nie zaproponowano leczenia adiuwantowego. Chora pozostaje w obserwacji 1 rok. W badaniach kontrolnych nie stwierdzono wznowy.
EN
Introduction: Neoplasms of the parotid glands constitute about 6% of head and neck tumours, the most common of which are: adenoma multiforme and Warthin’s tumor. Schwannoma is benign, encapsulated tumor of the nerve cells (lemocytes, Schwann cells), most often it occurs in the trunk, head, extremely rarely observed in the parotid gland. 9% Schwannomas derives from the facial nerve sheath, constituting from 0.5–1.2% of all salivary gland tumors. The literature describes 80 cases of intraparotid Schwannoma. Malignant Schwannoma (MPNST) account for 5% to 10% of all soft tissue sarcomas. Highgrade MPNST tumors are aggressive, with a tendency to relapse and metastasis. Case report: We present a case report of a 84-year-old female patient presented to the Head and Neck Oncology Clinic of the Medical University of Lodz, due to the painful tumor of the left parotid region. The tumor appeared six months before hospitalization. During the physical examination, there was a polycyclic tumor with reduced mobility, the skin on the tumor was slightly red, lymph nodes uninvolved, facial nerve function preserved. BACC revealed tumour tissue composed of sheets and spindle-shaped cells. The patient was qualified for surgical treatment. Under the general anesthesia the superficial lobe of the parotid gland along with the tumor was removed. After the procedure, no facial nerve palsy was found. The patient did well post-operatively and was discharged home on the 8th day after surgery. Immunohistochemical staining showed the tumour cells to be diffusely and strongly immunoreactive for S-100 protein and Ki67 40–50%. Strong and diffuse staining for S-100 protein were consistent with the malignant peripheral nerve sheath tumour (MPNST). The patient was referred for radiotherapy, due to the postoperative outcome and advanced age, no adjuvant treatment was proposed. The patient has been in observation for 1 year. No relapse was found in the follow-up studies.
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