We report a case of carcinoma of the lower lip with superior vena cava syndrome(SVCS)due to secondary metastasis to the mediastinal lymph nodes. The patient, a 77 year-old woman, was referred to our department to treat a tumor in the right side of the lower lip. Histologic examination of a biopsy specimen revealed a well-differentiated squamouse cell carcinoma. The tumor was abraded by en bloc excision surgery with bilateral neck dissection under general anesthesia. Further histological evaluation of an excised specimen revealed a diagnosis of pN2c. Six months later the cancer recurred locally in the left corner of the patient' s mouth, and the tumor was removed surgically. Eight months later, edema suddenly developed on the left side of the face, neck, forearm, and back of hand, accompanied by dizziness. A computed tomographic scan of the patient' s chest revealed metastasis to the left mediastinal lymph nodes, with occlusion of the left internal jugular vein, brachiocephalic veins, and respiratory tract. The occulded veins were attributed to compression of the superior vena cava by a metastatic tumor. SVCS should be considered whenever edema of the face appears after neck dissection.
Ultrasonography is most extensively used for preoperative imaging as part of the diagnosis of oral and maxillofacial lesions. 1 In recent years, shear wave elastography has been shown to be an effective technique for the objective and quantitative diagnosis of cervical lymph node metastases of oral carcinoma. 2,3 Intraoral ultrasonography has been used to assess features of tongue cancer, including the border, size, location, depth, vascularity, and histological findings of the mass. 4,5 Strain elastography (performed together with intraoral ultrasonography) is relatively new to sonographic imaging, and the use of intraoral strain elastography for tongue cancer has been recently reported in the literature. 6,7 Computed tomography (CT), 8,9 magnetic resonance imaging (MRI), 10 and ultrasonography 11 can be useful for the preoperative evaluation of palatal lesions. However, to the best of our knowledge, intraoral strain elastography of pal-atal lesions has not been extensively described in the literature. This report describes 2 clinical cases in which strain elastography was used to assess palatal tumors in conjunction with intraoral ultrasonography, CT, and MRI.
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