Castleman disease of the parotid gland in a pediatric patient: A case report

October 17, 2014     Sudesh Kumar, MS, DNB; Rashid Al Abri, MD, FRCS; Nasreen Abdul Kadir, MD; Dilani Lokuhetty, MD


Castleman disease, also called angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Affected patients usually present with mediastinal lymphadenopathy; sometimes other groups of lymph nodes are involved, with or without associated systemic manifestations. We report a case of Castleman disease involving the intraparotid lymph node in a 15-year-old boy who presented with a 3-month history of a painless swelling of the right parotid gland. Fine-needle aspiration cytology of the mass revealed only reactive hyperplasia. The diagnosis of Castleman disease was established on histopathologic examination of the resected mass. We discuss the clinical course, histopathologic features, radiologic characteristics, and management of Castleman disease of the parotid gland in a pediatric patient.

Introduction Castleman disease was first described by Castleman in 1956 in a group of patients who presented with a thymoma-like mass in the anterior mediastinum.1 Its etiology is unknown, and it can easily be misdiagnosed because of a lack of specific presenting clinical features and distinguishing radiologic characteristics. Although surgery is...

Distal nasolacrimal duct showing the valve of Hasner

October 17, 2014     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

Recognition of the location of the nasolacrimal duct opening is important to prevent its damage while performing an intranasal inferior meatal antrostomy or creating a window transantrally in the inferior meatal wall during a Caldwell-Luc procedure.

Basal cell carcinoma of the external auditory canal

October 17, 2014     Nai-Wei Hsueh, MD; Min-Tsan Shu, MD

Basal cell carcinomas of the EAC are known to be locally aggressive, although they are not associated with regional lymph node metastasis.

Carcinomas of the external auditory canal are rare, and they are associated with a relatively poor prognosis. Among these tumors, basal cell carcinomas are less common and less aggressive in nature.

A transoral surgical approach to a parapharyngeal-space pleomorphic adenoma

October 17, 2014     Christopher Schutt, MD; Joehassin Cordero, MD, FACS


It is relatively difficult to gain surgical access to pleomorphic adenomas of the parapharyngeal space. Since the lateral border is the mandible, gaining access to them can put several important neurovascular structures at risk. A number of surgical approaches have been developed to overcome this difficulty, and each has its advantages and disadvantages. We report the case of a 59-year-old woman with a parapharyngeal-space pleomorphic adenoma that was accessed via a transoral approach. Transoral approaches are controversial and rarely used. However, we feel that for a selected group of tumors, this approach provides clear benefits by decreasing cosmetic and functional disability while providing good surgical access to the tumor.

Introduction Parapharyngeal-space tumors comprise less than 1% of all tumors of the head and neck; of these, 70 to 80% are benign.1-5 Tumors of the parapharyngeal space are subclassified as poststyloid and prestyloid. Common tumors existing posterior to the styloid space include neurogenic tumors, such as schwannomas, paragangliomas, and...

Fish bone impaction in the supraglottis

October 17, 2014     Willis S.S. Tsang, FRCSEd(ORL); John K.S. Woo, FRCS(ORL); C. Andrew van Hasselt, M Med (Otol)

The most common sites of fish bone impaction are the tonsils, tonsillar pillars, tongue base, valleculae, and piriform fossa. Impaction in the supraglottic area is extremely uncommon.

A 60-year-old man with a recent history of radiotherapy for tongue carcinoma presented with dry mouth, throat discomfort, swallowing difficulties, and diminished pharyngeal sensation. These signs are the predisposing factors for foreign-body impaction in the upper aerodigestive tract. Examination revealed the presence of a fish bone impacted in...

Endoscopic view of an ostium in a concha bullosa of the superior turbinate

October 17, 2014     Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS

A specific outflow tract or ostium of the superior turbinate, as was seen in this case, has been infrequently described or imaged.

A 38-year-old woman came to us with recurring bouts of sinusitis that had persisted despite numerous antibiotics and other treatments. Computed tomography (CT) of the sinuses revealed a pneumatized superior turbinate (figure, A) and an ostium that opened toward the superior meatus (figure, B). The patient elected to undergo endoscopic sinus...

Synchronous double cancers of the hypopharynx: Malignant fibrous histiocytoma and squamous cell carcinoma

October 17, 2014     Shao-Cheng Liu, MD; Wan-Fu Su, MD


We report a unique case of synchronous double hypopharyngeal tumors in a 39-year-old man. The patient presented with a 1-year history of a muffled voice and mild odynophagia. Laryngoscopy detected two grossly different tumors in the hypopharynx: a malignant fibrous histiocytoma (MFH) in the postcricoid area and a squamous cell carcinoma (SCC) in the posterior pharyngeal wall. Chemoradiotherapy was administered, and the patient was free of disease at 23 months of follow-up. Synchronous double cancers of the hypopharynx that feature different oncotypes are very rare, especially those that include an MFH. In fact, to the best of our knowledge, no case of synchronous MFH and SCC of the hypopharynx has been previously reported in the literature. Because the number of reported cases of MFH in the hypopharynx is so small, no consensus exists with respect to the preferred option among the various treatment choices.

Introduction Malignant fibrous histiocytoma (MFH) is an aggressive neoplasm composed of fibroblasts and histiocytes.1 It is the most common type of bony and soft-tissue high-grade sarcoma of late adult life. MFH usually involves the extremities and retroperitoneum. With the exception of radiation-induced tumors, MFH is less common in the head and...

A persistent left superior vena cava, with the accessory nerve passing through a duplicate segment of the left internal jugular vein: A unique presentation

October 17, 2014     Omar Ayoub, MSc, FRCSEd(ORL-HNS); Jamie Benton, MRCS; Shaun Jackson, FRCSEd


The internal jugular vein and the spinal accessory nerve are important landmarks during neck dissection; unexpected variations in their positions can result in inadvertent iatrogenic damage to adjacent structures. We report the case of a 79-year-old man who was found during neck dissection to have a duplicate segment of his left internal jugular vein (IJV), a persistent left superior vena cava, and an absent right superior vena cava. The spinal accessory nerve passed through the duplicate section of the IJV. A MEDLINE search found no previously reported case of these anomalies occurring together. We also review 10 previously reported cases of IJV duplication. Finally, we discuss the embryologic and anatomic background of these malformations so that otolaryngologists may be aware that identification of such anomalies may help to prevent postoperative morbidity.

Introduction The two most important structures encountered during neck dissection are the internal jugular vein (IJV) and the spinal accessory nerve (cranial nerve [CN] XI), which are clear intraoperative landmarks that allow for precise and accurate surgery. Injury to either of these structures, especially CN XI, can result in considerable...

Primary malignant melanoma of the external auditory canal extending into the preauricular area and scalp

October 17, 2014     Mainak Dutta, MS; Soumya Ghatak, MS; Ramanuj Sinha, MS, DNB


Malignant melanomas in the head and neck region are uncommon. When they do occur, they usually represent a metastasis. To the best of our knowledge, only 11 cases of primary malignant melanoma of the external auditory canal have been previously reported in the English-language literature since 1954. We describe a new case, which occurred in a 72-year-old woman who presented with a large, lobulated, pigmented mass with ulcerated bleeding on its surface. The patient was scheduled for surgery, but during preoperative preparations she developed signs of rapid dissemination and metastases to the liver and lungs, and she died of multiple organ failure within 3 weeks of presentation. Apart from the rarity of malignant melanoma of the external auditory canal, this case included other extraordinary features that make it noteworthy. Our experience with this case underscores the importance of early diagnosis and prompt initiation of treatment for patients with this potentially fatal malignancy.

Introduction Pigmented lesions of the head and neck region are usually noticed at an early stage, and thus diagnosis and treatment can be undertaken before the disease has progressed very far. We present a case of primary malignant melanoma of the external auditory canal (EAC) in a patient who presented at a very advanced stage in the course of...

Congenital airway anomaly of double aortic arch in a 2-day-old infant

October 17, 2014     Seo Moon, MD; Jessica Mayor, MD; Ramzi Younis, MD

Double aortic vascular ring is a complete vascular ring that is formed when the distal portion of the right dorsal aorta fails to regress and the ascending aorta bifurcates to surround and compress both trachea and esophagus and rejoins to form the descending aorta.

Vascular rings are vascular anomalies of the aortic arch, pulmonary artery, and brachiocephalic vessels. We report the case of a 2-day-old full-term baby girl with a double aortic arch who presented with stridor since birth and a heart murmur. In her history there were no episodes of desaturation or cyanosis, and there was no exacerbation of...