Solitary giant neurofibroma of the neck subjected to photodynamic therapy: case study

Abstract

Photodynamic therapy (PDT) - the fourth modality - has been successfully used in the management of early and advanced pathologies of the head and neck. We studied the effect of this modality on a giant solitary neurofibroma of the neck. A 70-year-old Caucasian female presented with left neck pain and disfigurement associated with slight shortness of breath and dysphagia. Examination revealed a large mass in the neck with no neurovascular compromise. Magnetic resonance imaging (MRI) reported a heterogeneously enhancing mass extending from the left angle of the mandible to the base of the neck. A core biopsy was performed and histopathological examination revealed a disorganised array of peripheral nerve fascicles. The patient elected to receive photodynamic therapy as the primary intervention. The multi-disciplinary meeting approved the treatment plan. The photosensitizing agent was mTHPC (0.15 mg/kg), which was systemically administered 96-hours prior to ultrasound (US)-guided light delivery to the mass, which was undertaken under general anaesthesia. Recovery was uneventful. Post-PDT follow-up showed that the patient's pain, dysphagia and shortness of breath issues had improved. The disfigurement of the neck caused by the mass was no longer a problem. Three months post-PDT, MRI revealed a significant reduction in the neurofibroma size. PDT was proven as a successful primary intervention for this pathology. However, higher evidence-based studies are required before this therapy can be proposed as a replacement to any of the other conventional therapies.

Figure 1

PDT of neurofibroma. A: Intra-operative image showing the large mass of the left neck. B: Intra-operative ultrasonography assessing the centre and periphery of the lesion as well as any neurovascular involvement or involvement of hollow organs. C and D: On-table US images showing the neurofibroma and its boundaries. E: Needle insertion into lesion prior to fibre insertion. F and G: light delivery to initiate the photochemical reaction.

Figure 2

Axial MRI scanning of neurofibroma of the neck. A: Baseline MRI showing a large lesion of the left neck compressing the nearby hollow organs, causing a slight breathing and swallowing compromise. B and C: three months post-PDT scans, slightly upper and lower to the pre-PDT scan level, showing significant shrinkage with an increase in airway patency.