While metastases to the paranasal sinuses are unusual, metastases to the sphenoid sinus are exceedingly rare, especially metastases of a cutaneous melanoma to the mucosa. We report the case of a 38-year-old man who presented with a solitary sphenoid sinus metastasis that had spread from a cutaneous malignant melanoma. The metastasis was removed via a wide, endoscopically assisted sphenoidotomy. The patient was further treated with external radiotherapy, and at 8 months of follow-up he was free of disease. However, he experienced a recurrence at 3 years that proved to be fatal. We review the pathogenesis and histopathology of sinus metastases, and we discuss the imaging features that characterize melanoma metastatic to the upper respiratory tract. While complete cure of patients with a sphenoid sinus metastasis has not been reported, significant palliation with radiation therapy is possible in many patients. Therefore, patients with sphenoid sinus symptoms suggestive of a sphenoid sinus malignancy should be vigorously evaluated for the possibility of a primary malignancy as well as a metastasis to the sinus.
Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is an uncommon type of lymphoma with a clinically aggressive course and a relatively poor prognosis. Many affected patients present with nodal involvement, and there is also potential for extranodal involvement of the liver, gastrointestinal tract, bone marrow, and/or skin. We describe the case of a 68-year-old woman who presented with a 6-week history of an intermittently tender left-sided neck mass. Findings on imaging and fine-needle aspiration biopsy were inconclusive. Pathologic studies of excisional biopsy specimens ultimately revealed the diagnosis of PTCL-NOS. Of the lymphomas, neither PTCL nor the PTCL-NOS subtype is frequently discussed or studied in prospective trials. However, these cases should be identified because of their substantial clinical management implications.
Lymphoma is the second most common extracranial primary head and neck malignancy, representing 3 to 5% of cancers in this region.1 Patients with head and neck lymphoma classically present with enlarged, nontender lymph nodes without necrosis on imaging.2 The head and neck is second only to the gastrointestinal tract as the most...
Occasionally, patients who have amyotrophic lateral sclerosis initially present with vocal and respiratory signs and symptoms.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that involves both the upper and lower motor neurons. Most commonly, patients present with weakness, muscle atrophy, and fasciculation.
Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.
Cervical esophageal perforation is a rare and complex condition. Potential etiologies include penetrating trauma, foreign body ingestion, iatrogenic processes, intubation, and erosion of bulky hardware, including spinal fusion hardware. Prompt diagnosis and treatment are critical to prevent multiple comorbidities and life-threatening...
Presenting signs and symptoms of acute calcific tendinitis of the longus colli musclegenerally include severe, often debilitating, neck pain and odynophagia without any recent associated trauma.
Acute calcific tendinitis of the longus colli muscle (CTLC) is a rare and self-limiting inflammatory disorder of the tendon insertions. It is characterized by an acute onset of severe neck pain and odynophagia that mimic signs and symptoms of retropharyngeal infections. Familiarity with the clinical presentation and characteristic findings on...