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Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases

January 22, 2016  |  Petros Koltsidopoulos, MD, PhD; Konstantinos Chaidas, MD; Paschalis Chlopsidis, MD; Charalambos Skoulakis, MD, PhD


We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Intratonsillar metastasis of EBV-positive nasopharyngeal carcinoma

January 22, 2016  |  Matthew R. Naunheim, MD, MBA; Linda N. Lee, MD; Harrison W. Lin, MD; Peter M. Sadow, MD, PhD; Daniel G. Deschler, MD


We present the case of a 47-year-old man with a history of Epstein-Barr-virus-positive nasopharyngeal carcinoma who developed a metastasis to the palatine tonsil. To the best of our knowledge, this is the first reported case of an intratonsillar metastasis of a nasopharyngeal carcinoma. The aim of this report is to emphasize the importance of vigilant surveillance in patients with nasopharyngeal carcinoma. This case also demonstrates that an atypical metastatic pattern can raise suspicion of a local disease recurrence.

Laryngitis obscuring an anterior glottic mass

January 22, 2016  |  James D. Thompson, MD; Jaime Eaglin Moore, MD; Robert T. Sataloff, MD, DMA, FACS

Anterior masses, such as the one seen in this case, can cause glottic insufficiency and vocal strain.

Management of a cocaine-induced palatal perforation with a nasal septal button

January 22, 2016  |  Matteo Trimarchi, MD; Vittoria Sykopetrites, MD; Mario Bussi, MD


A cocaine-induced midline destructive lesion (CIMDL) is a rare consequence of cocaine insufflation that involves the nose, sinuses, and occasionally the palate. Palatal perforations compromise swallowing, mastication, and speech. An obturator prosthesis can be used to overcome these complications. In selected cases, a nasal septal button is a good alternative for the sealing of a palatal perforation, especially when surgery is not indicated, such as in cases of persistent cocaine abuse. Abstinence from cocaine is the most effective long-term management option for patients with a CIMDL, and surgical correction of the defect should be postponed until the patient stops sniffing cocaine and the lesion becomes stable. We describe the case of a 39-year-old cocaine abuser whose oronasal communication was plugged with a nasal septal button, which resulted in an immediate alleviation of his oronasal reflux.


January 22, 2016  |  Ashley E. Kita, MD; Jennifer L. Long, MD, PhD

Hemangiomas can occur anywhere blood vessels are present; they have been observed in deeper tissues such as the larynx, muscles, liver, and brain.

Clival lesion: Atypical osteomyelitis vs. a neoplastic process

January 22, 2016  |  Mike C. Butterfield, MD; Juan S. Gomez, MD; Ngoc Ly, MD; Enrique Palacios, MD, FACR

The differential diagnosis of a clival lesion includes malignancy, infection, meningioma, and chordoma. In this patient, a recurrent neoplasm was suspected because of his medical history and the imaging findings

Slag injury to the tympanic membrane

January 22, 2016  |  Emily Marchiano, BA; Robert W. Jyung, MD

The presence of slag can be confirmed on CT, which can be used to evaluate damage to the ossicles and the proximity of the foreign body to nearby structures such as the carotid canal.

A case of lipoma arising in the eustachian tube

January 22, 2016  |  Jonathan Dabiri, MD; Georges Choufani, MD; Isabelle Delpierre, MD; Sergio Hassid, PhD


We report a case of a lipoma inside the eustachian tube, an extremely rare location for this lesion. To the best of our knowledge, this is only the second such case that has been described in the literature. The patient was a 47-year-old man, a fighter pilot, who was referred to our hospital with a 3-year history of (1) fullness in the right ear secondary to recurrent serous otitis media and (2) right ear pain, which was especially acute during flights. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging detected the presence of a well-encapsulated lesion inside the eustachian tube; macroscopic and radiologic findings identified the mass as a lipoma. The lesion was completely removed via transnasal endoscopy. Histopathologic evaluation confirmed the diagnosis of lipoma. The patient's postoperative course was favorable, and he was able to fly again without any ear complaints. Radiologic examination is useful for the diagnosis and preoperative evaluation of this benign tumor. Lesions located in the lower part of the eustachian tube can be easily removed via a transnasal endoscopic approach.

Urbach-Wiethe disease in a young woman: A case report

January 22, 2016  |  Stefanie Jansen, MD; Gero Quante, MD; Jan-Christoffer Luers, MD; Dirk Beutner, MD


Urbach-Wiethe disease (lipoid proteinosis) is an autosomal recessive disorder that is characterized by a general thickening of the skin and mucous membranes. We report the case of a 22-year-old woman with lipoid proteinosis who presented with hoarseness, poor dentition, and skin lesions, and we discuss the management of this rare disease.

A study of language development and affecting factors in children aged 5 to 27 months

January 22, 2016  |  Nuray Bayar Muluk, MD; Birgül Bayoğlu, MSci; Banu Anlar, MD


We conducted a study to assess the factors that affect language development in infants and toddlers using data obtained during developmental screening. Our study group consisted of 505 children-244 (48.3%) boys and 261 (51.7%) girls, aged 5 to 27 months. The children were divided into four age groups: group 1, which we designated as the “6 months” group (age range: 5 to 7 mo); group 2, designated as the “12 months” group (11 to 13 mo); group 3, designated as the “18 months” group (17 to 19 mo); and group 4, designated as the “24 months” group (23 to 27 mo). In addition to demographic data, we compiled data using the Denver II Developmental Screening Test, as well as neurologic examination findings and medical histories. At 6 months, the social item “Works for toy out of reach” was positively related to all language development items. Two gross motor development items-“Pull to sit, no head lag” and “Lifts chest with arm support”-were related to the “Turns to sound” and “Turns to voice” items, respectively. Overall, children whose mothers had higher education levels and who were living in higher socioeconomic areas showed significantly greater language development, as did boys, specifically. At 12 months, higher maternal ages, some gross motor development items, and some social items were related to better language development, and children living in higher socioeconomic areas had a significantly increased ability to pass the “4 words other than mama/dada” item. At 18 months, the ability of girls to pass the “4 words other than mama/dada” item increased, and children who passed the “4 words other than mama/dada” item did not pass the “Throws ball” gross motor item. At 24 months, children whose mothers were older had better “Combines 2 words” and “Speech half intelligible” items, girls had better “Comprehends prepositions (such as under/above)” skills, and boys had better “Shows 4 parts of doll” skills. We conclude that language items appear to change together with gross motor items and social development, and that they can be influenced by a family's socioeconomic level. However, as children get older, language development diverges from gross motor development.