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.

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.

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.

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.

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.

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.

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.

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.

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.

Sinonasal tract mucosal melanoma

October 17, 2014     Lester D.R. Thompson, MD

Patients with obstructive symptoms, multiple sites of involvement, tumors of 3 cm or larger, an undifferentiated tumor on histology, a high mitotic count, and an elevated stage are more likely to have a poor prognosis.

Mucormycosis (Mucor fungus ball) of the maxillary sinus

October 17, 2014     Hang Sun Cho, MD; Hoon Shik Yang, MD, PhD; Kyung Soo Kim, MD, PhD


A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the “Mucor fungus ball.” To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.

Transoral approach to a deep-lobe parotid tumor

October 17, 2014     Lyndon Gonzalez, BS; Alex Fernandez, MS; Belinda Mantle, MD

Because of their location in this potential space, parapharyngeal tumors tend to be asymptomatic and remain undetected for a long time.

Complete second branchial cleft anomaly presenting as a fistula and a tonsillar cyst: An interesting congenital anomaly

October 17, 2014     Prasad John Thottam, DO; Samba S. Bathula, MD; Janet M. Poulik, MD; David N. Madgy, DO


Branchial cleft anomalies make up 30% of all pediatric neck masses, but complete second branchial cleft anomalies are extremely rare. We report an unusual case of a complete second branchial cleft anomaly that presented as a draining neck fistula and a tonsillar cyst in an otherwise healthy 3-month-old girl. At the age of 7 months, the patient had been experiencing feeding difficulties, and there was increasing concern about the risk of persistent infections. At that point, the anomaly was excised in its entirety. Our suspicion that the patient had a complete second branchial cleft anomaly was confirmed by imaging, surgical excision, and histopathologic analysis.

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS

Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

A rare occurrence of a fungus ball in the sphenoethmoid recess

October 17, 2014     Jae-Hoon Lee, MD; Ha-Min Jeong, MD

A fungus ball usually appears as a calcification within the sinus, suggesting the presence of a foreign body.

Lingual hamartoma associated with a cleft palate in a newborn

October 17, 2014     Opeyemi O. Daramola, MD; Mariko Suchi, MD, PhD; Robert H. Chun, MD


A hamartoma is a benign malformation of native tissue that may occur in any area of the body. Hamartoma of the tongue is a rare developmental lesion. We describe the case of a pendulant lingual hamartoma in a 2-day-old girl that had not been identified on prenatal ultrasonography. We also review the utility of prenatal imaging options, the role of preoperative imaging, the mechanical relationship between lingual hamartoma and cleft palate, the histopathology of this tumor, surgical treatment, and emergency airway management.

Management of soft palate agenesis in Nager syndrome with an elongated, superiorly based pharyngeal flap

October 17, 2014     Oneida A. Arosarena, MD; Troy Hemme, DO


Nager syndrome, or preaxial acrofacial dysostosis, is associated with aberrant development of the first and second branchial arch structures, as well as abnormal development of the limb buds. It is a rare disorder, and its clinical manifestations have not been completely defined. Absence of the soft palate has been reported in patients with Nager syndrome. In this report we describe the use of an elongated, superiorly based pharyngeal flap for the treatment of severe velopharyngeal insufficiency in a patient with Nager syndrome and absence of the soft palate. We also describe the dysmorphisms associated with Nager syndrome and present a differential diagnosis for the condition.

Can we be as good as our mentors?

October 17, 2014     Jennifer R. Cracchiolo, MD

Primary laryngeal tuberculosis: An unusual cause of hoarseness

October 17, 2014     Peter Fsadni, MD, MRCP(UK); Claudia Fsadni, MD, MRCP(UK), MSc(Lond); Brendan Caruana Montaldo, MD, FACP


Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.

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