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Primary NK/T-cell lymphoma of the larynx: Report of 2 cases and review of the English-, Japanese-, and Chinese-language literature

April 30, 2016     Su-Yu Zhu, MD; Yuan Yuan, MD; Ke Liu, MD, MSc; Liang Zeng, MD, PhD; Ju-Mei Zhou, MD, PhD; Qiong-Hui Lu, MD; Zai-Jie Huang, MD


Natural killer/T (NK/T) -cell lymphoma in the larynx is extremely rare, as only 29 cases have been previously reported in the English-language, Japanese-language, and Chinese-language literature. Its characteristics have never been systematically illustrated. We report 2 new cases of laryngeal NK/T-cell lymphoma, and we discuss the process of the diagnosis of this disease, the choice of treatment, and treatment outcomes. We also summarize all 31 cases reported thus far. Symptoms of laryngeal NK/T-cell lymphoma are difficult to differentiate from those of other laryngeal diseases. The most common laryngeal subsite in the reported cases was the supraglottis, and roughly one-third of these cases involved the cervical lymph nodes. Because of our limited experience with this disease and the difficulties encountered in interpreting the pathologic findings, most patients required multiple biopsies over a few months before their diagnosis was confirmed. The outcome of treatment was generally poor. Radiotherapy, alone or combined with chemotherapy, was superior to chemotherapy alone in treating this disease in its early stages. In view of the frequency of local lymph node metastasis, irradiation fields should cover the entire cervical area. We believe that prompt diagnosis and treatment with radiotherapy are both critical to improving survival for patients with laryngeal NK/T-cell lymphoma.

Synchronous bilateral tonsillar squamous cell carcinoma related to human papillomavirus: Two case reports and a brief review of the literature

April 30, 2016     Allison Rasband-Lindquist, MD; Yelizaveta Shnayder, MD; Maura O'Neil, MD


Human papillomavirus (HPV) was recently identified as a risk factor for oropharyngeal squamous cell carcinoma (SCC) independent of tobacco and alcohol use. The prognosis of patients with HPV-related oropharyngeal carcinomas is better than that for patients with non-HPV-related cancers. Researchers and clinicians can test for HPV infection in cancer by (1) testing directly for HPV DNA and (2) testing for overexpression of the downstream p16 protein; there is currently no consensus regarding which is the better test. The chances of developing a reliable oropharyngeal HPV screening test for high-risk populations are promising. Such a test would allow for secondary prevention by identifying individuals with precursor or early-stage cancerous lesions that are more amenable to treatment. HPV testing has particular significance in SCC of an unknown primary site in head and neck cancer. Successful HPV testing of nodal metastasis can localize cancer specifically to the oropharynx. The optimal evaluation for SCC of an unknown primary in the head and neck has yet to be determined. Some studies have shown that the tonsillar fossa is the most probable primary site, followed closely by the base of the tongue. Biopsies often miss tonsillar carcinoma in the deep crypts of the lymph tissue, as well as in those rare cases in which the primary tumor is located contralateral to the metastatic lymph node. Recently, there has been an increase in the number of reports of diagnosed synchronous bilateral HPV-related tonsillar carcinomas. This increase has profound implications for the surgical approach of SCC of an unknown primary site in the head and neck and in tonsillar carcinoma, and it supports the need for bilateral tonsillectomy. We present 2 cases of incidentally discovered synchronous bilateral tonsillar carcinoma, and we review the literature.

Intramuscular hemangiomas of the head and neck: Three case reports

April 30, 2016     Omer Aydin, MD; Gurkan Keskin, MD; Mete Iseri, MD; Arif Ulubil, MD; Fatma Demir Kuru, MD; Abdulkadir Oran, MD; Serhan Derin, MD


Hemangiomas are tumors of vascular origin that frequently occur on the skin and mucosal surfaces in the pediatric age group. Hemangiomas located in skeletal muscles are called intramuscular hemangiomas. Intramuscular hemangiomas mostly occur in the extremities and the trunk. In this article, 3 cases of surgically treated intramuscular hemangiomas that could not be diagnosed by routine preoperative investigations are presented in light of recent literature.

Ear and temporal bone meningioma

April 30, 2016     Lester D. Thompson, MD

Because of anatomic restrictions, most tumors are smaller than 1.5 cm, removed in multiple, gritty tissue fragments.

A large vestibular schwannoma after recent negative MRI: A case report

April 30, 2016     Thomas J. Muelleman, MD; James Lin, MD


Vestibular schwannomas are, on average, slowly growing tumors that may remain quiescent for some time before manifesting themselves symptomatically or being found incidentally on imaging. We describe a case of a vestibular schwannoma that grew rapidly and to a large size in a patient who had undergone negative imaging 5 years earlier for unrelated issues. This case highlights the importance of repeat imaging in patients with symptoms concerning for vestibular schwannoma who might have previously undergone negative scans.

Metastatic pilomatrix carcinoma: Not so rare after all? A case report and review of the literature

March 16, 2016     Daniel M. Walker, MBBS; Samuel Dowthwaite, MBBS, FRACS; Drew Cronin, MBBS; Tristan Molden-Hauer, MBBS; Brent McMonagle, MBBS, FRACS


Pilomatrixoma is a slowly growing benign tumor of the dermal hair cells. Metastatic disease is exceptionally rare. Pilomatrixoma can occur at any age, but most patients are older than 40 years at presentation. Approximately 60% of these lesions occur in the head and neck region. Their size is usually about 4 cm at the time of presentation. Surgical excision with adequate margins is still the preferred treatment. We report a case of an aggressive malignant metastatic pilomatrixoma in a 43-year-old woman who underwent multiple extensive local resections. However, she died within 4 months of presentation.

Papillary carcinoma in thyroglossal duct cyst: Two case reports and review of the literature

March 16, 2016     Neil S. Patel, MD; Kianoush Sheykholeslami, MD, PhD


The thyroglossal duct cyst is one of the more common congenital anterior neck masses. In rare cases, carcinoma has been detected within one of these cysts on histopathologic analysis of resected tissue. Since the incidence of thyroglossal duct cyst carcinoma is low, the appropriate management of the thyroid gland proper is not algorithmic. We present 2 cases of papillary thyroid carcinoma that were discovered in a thyroglossal duct cyst, and we describe the diagnostic and therapeutic measures taken in each case. Particular attention is paid to two points: (1) fine-needle aspiration biopsy may not be sufficient to rule out carcinoma and (2) removal of the thyroid gland may be advisable in selected situations.

Endolymphatic sac tumor in association with von Hippel-Lindau syndrome

March 16, 2016     Kevin Shaigany, BS; Alejandro Vazquez, MD; Kelvin M. Kwong, MD; James K. Liu, MD; Robert W. Jyung, MD

Patients with ELST present most commonly with sensorineural hearing loss, tinnitus, and vertigo, in a pattern reminiscent of Ménière disease.

Bilateral intubation granulomas

March 16, 2016     Wen-Sen Lai, MD; Yuan-Yung Lin, MD; Yueng-Hsiang Chu, MD, PhD; Jih-Chin Lee, MD

Granulomas typically appear as pale, pedunculated masses, usually found on the posterior one-third of the vocal folds overlying the vocal process of the arytenoid cartilage.


March 16, 2016     Lester D. Thompson, MD

Surgical treatment is the mainstay of therapy for rhinosporidiosis, but there is a 10% recurrence rate.

Ectopic thyroid tissue simulating metastasis

March 16, 2016     Juan S. Gomez, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold R. Neitzschman, MD, FACR

Simultaneous occurrence of maxillary and sphenoid sinus fungus ball

March 16, 2016     Jae-Hoon Lee, MD; Ha-Min Jeong, MD

The maxillary sinus is the site most commonly affected by the fungus ball, followed by the ethmoid and sphenoid sinuses.

The effects of round window membrane injury and the use of a model electrode application on hearing in rats

March 16, 2016     Murat Koc, MD; Abdullah Dalgic, MD; Mehmet Ziya Ozuer, MD


We conducted an animal experiment to investigate the effects of mechanical trauma to the round window with the placement of a model electrode inserted into the scala tympani on the cochlear reserve, and to determine the efficacy of topical steroids in preventing hearing loss in such a situation. Our subjects included 21 male Wistar albino rats that were assigned into three groups of 7 each. In all three groups, an initial mechanical injury to the round window was created. At that point, group 1 received no further treatment, group 2 received a dexamethasone injection into the cochlea, and group 3 underwent implantation of a multichannel cochlear implant guide followed by dexamethasone administration. After a few minutes, the round window opening was obliterated with muscle, and the incision was sutured with 4-0 Vicryl Rapide polyglactin in all 3 groups. Distortion-product otoacoustic emissions were obtained before and immediately after the surgical injury, and again on postoperative day 7. Mean signal/noise ratios (S/Ns) obtained at 2, 3, and 4 kHz were calculated, and datasets were compared with nonparametric statistical tests. We found that the early postoperative mean S/N values were significantly lower than the preoperative values in groups 1 and 2, but there was no difference between the mean preoperative values and those obtained on postoperative day 7 in those two groups. In group 3, there were statistically significant differences among the mean preoperative, early postoperative, and postoperative day 7 S/N values. We observed that an electrode insertion into the cochlea via the round window subsequent to mechanical trauma seemed to cause a progressive hearing loss. Therefore, we conclude that special care must be taken to avoid injury to the round window membrane during placement of a cochlear implant electrode, as well as during surgery for chronic otitis media.

Respiratory epithelial adenomatoid hamartoma of the olfactory groove: A report of 4 cases and a review of the literature

March 16, 2016     William G. Albergotti, MD; Alkis J. Psaltis, MBBS (Hons), PhD; Rodney J. Schlosser, MD


Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion that affects the nasal cavity and paranasal sinuses. We present 4 cases of REAH that involved the olfactory clefts; 1 case was bilateral. Each of the cases was treated surgically, and no recurrence was observed. Most reports have indicated that REAH occurs in the presence of sinonasal inflammation, particularly nasal polyposis, yet all 4 of our cases occurred in the absence of concurrent rhinosinusitis. This suggests that the etiology of REAH is multifactorial. In addition, we review the literature on REAH, and we discuss its presentation, differential diagnosis, radiology, histopathology, and underlying treatment principles.

Myxoinflammatory fibroblastic sarcoma of the nose: First reported case at an unusual location (nasal dorsum), with a review of the literature

March 16, 2016     Jura Numminen, PhD; Argyro Bizaki, MD; Jarno Kujansivu, MD; Sanna Huovinen, MD; Markus Rautiainen, MD, PhD


Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, low-grade, malignant, soft-tissue tumor that typically affects the distal extremities of middle-aged patients. In most cases, it presents as a painless, slowly growing mass within the subcutaneous tissue. It is associated with a low rate of metastasis but a high rate of local recurrence. In addition to the distal extremities, MIFS has been reported in the thigh, arm, forearm, groin, upper back, neck, and temporal area. As far as we know, no case has been previously reported in the nasal area. We report for the first time a case of MIFS presenting on the dorsum of the nose. The painless, 3.0-cm tumor was initially mistaken for reticular erythematous mucinosis, a benign skin condition that occurs when fibroblasts produce abnormally large amounts of mucopolysaccharides. The tumor was surgically removed in its entirety with surgical margins of 3 to 5 mm. During 4 years of follow-up, no clinical or radiologic evidence of a recurrence or metastasis was seen. We discuss the imaging and histologic features of MIFS, as well as its clinical management and follow-up, and we review related reports in the literature.

Medial orbital wall reconstruction with a porous polyethylene titan barrier implant

March 16, 2016     Alexander Ovchinsky, MD; Jeffrey P. Cranford, MD

When selecting an alloplastic implant for orbital reconstruction, it is important to consider the material properties of the implant.

Is the emergency department management of ENT foreign bodies successful? A tertiary care hospital experience in Australia

March 16, 2016     Ritesh Gupta, MBBS, MS(ENT); Rugare Percy Nyakunu, MBBS, BMedSci; Jorian Russell Kippax, MBChB, FACEM


We evaluated the role of the emergency department (ED) in the management of ear, nose, and throat foreign bodies in an Australian tertiary care hospital. We retrospectively reviewed all cases of ENT foreign-body presentations in the ED over a 2-year period. We identified 168 such cases, a large proportion of which involved pediatric patients. In addition to demographic factors, we also collected data on the nature of the foreign bodies, the specific sites involved, the rate of successful treatment by the ED staff, the seniority/rank of the treating clinician, and complications. Foreign bodies in the ear accounted for 49% of all cases, the nose for 43%, and the throat for 8%. The ED staff attempted to remove the foreign body in 89% of cases, while the rest were referred to the ENT team. The rate of successful removal of all foreign bodies attempted by the ED team was fairly high-78%; success rates were 86% for nasal foreign bodies, 72% for aural objects, and 67% for those lodged in the throat. No major complications occurred; minor bleeding episodes after removal occurred in 8% of cases. Most ENT foreign-body presentations were managed safely and entirely by the ED team; most of the ENT referrals were to outpatient clinics.

Stapediovestibular ankylosis in an HIV/HCV-copositive patient

March 16, 2016     Stephan Radoslavov Lolov, MD, PhD, DSc


To the best of the author's knowledge, no case of a patient with stapediovestibular ankylosis who was also coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been previously described in the literature. This report describes the case of a 36-year-old woman who was diagnosed with all three conditions. The clinical diagnosis of stapes fixation was based on otoscopic, audiometric, tympanometric, and surgical findings. Stapedectomy was performed, and perilymph and serum samples were obtained and tested for anti-HIV and anti-HCV antibodies. While the titers of anti-HCV antibodies in the serum and perilymph were of similar magnitude, there were almost 16 times more anti-HIV antibodies in the serum than in the perilymph. This case offered a unique opportunity to study the titers of anti-HIV/HCV antibodies in both the blood serum and perilymph. Data relating to these titers may provide new insights into the mechanisms of stapediovestibular ankylosis and inner ear immunology.

Helicobacter pylori in lacrimal secretions

March 16, 2016     Aysegul Batioglu-Karaaltin, MD; Ozlem Saatci, MD; Meltem Akpinar, MD; Melih Ozgur Celik, PhD; Omer Develioglu, MD; Ozgur Yigit, MD; Mehmet Kulekci, MD; Alper Tunga Akarsubasi, PhD


The aim of this study was to investigate the presence of Helicobacter pylori in human lacrimal and nasal secretions. Eighty patients with complaints of dyspepsia who had undergone endoscopies and gastric antrum biopsies were included in the study. A total of five specimens, including 2 lacrimal secretion samples, 2 nasal mucosal swab samples, and 1 gastric antrum biopsy, were collected from each patient and investigated with polymerase chain reaction (PCR) methods consisting of the urease enzyme coding gene GlmM (UreC) and the H pylori-specific 16S rRNA coding gene. The Reflux Symptom Index and ophthalmologic complaints of the patients were recorded. The detected positivity rates of the H pylori 16S rRNA coding gene in gastric biopsies and nasal mucous and lacrimal secretions were 55, 11.2, and 20%, respectively. The patients were grouped as gastric-antrum-biopsy-negative (Group I [n = 36]) and -positive (Group II [n = 44). In Group II, H pylori positivity in the lacrimal and nasal mucous secretions was 36.3 and 18%, respectively. A comparison between the groups in terms of H pylori presence in nasal mucous and lacrimal secretions yielded statistically significant differences (p = 0.0001, p = 0.003). The simultaneous presence of H pylori in nasal mucous and lacrimal secretions was 13.6% in Group II. H pylori positivity in nasal mucous and lacrimal secretions had a positive moderate correlation (r = 0.40; p = 0.0003). The present study is the first report on the presence of H pylori in lacrimal secretions through nested PCR, which suggested the presence of a number of mechanisms for H pylori transmission to lacrimal secretions.

World Voice Day 2016

March 16, 2016     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief