Adenoma

Cavernous sinus syndrome secondary to pituitary adenoma: A case report

February 1, 2010     Michael J. Barry, LCDR MC(FS) USN and Ashley A. Schroeder, CDR MC USN
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Abstract

In this case report we demonstrate the intimate association between the sella turcica and the cavernous sinus and review the neuroanatomy involved. The otolaryngologist should be aware of this association when collaborating with a neurosurgeon in pituitary surgery.

Preoperative localization of parathyroid adenomas

March 31, 2009     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
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Neuroendocrine adenoma of the middle ear (NAME)

March 31, 2009     Karen Leong, MD, Marian M. Haber, MD, Venu Divi, MD, and Robert T. Sataloff, MD, DMA, FACS
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Abstract

Neuroendocrine adenoma of the middle ear (NAME) is a rare tumor. We report a case of NAME, the clinical and pathologic findings of which illustrate the biologic behavior of adenomatous tumors of the middle ear and their relationship with rare carcinoid tumors of the middle ear. A 29-year-old man presented with a history of recurrent otitis media, right conductive hearing loss, and aural fullness. The tumor was removed in its entirety. Otolaryngologists should be familiar with this unusual but important entity.

Giant intrathyroid parathyroid adenoma: A preoperative and intraoperative diagnostic challenge

March 1, 2009     Wanli Cheng, MD, Greg T. MacLennan, MD, Pierre Lavertu, MD, and Jay K. Wasman, MD
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Abstract

We describe the case of an unusually large (giant) cystic intrathyroid parathyroid adenoma in a 73-year-old woman who had a 1-year history of hypercalcemia and a 5-year history of an asymptomatic enlargement of the left lobe of the thyroid. This unique case highlights the potential difficulties that can arise in the evaluation of thyroid nodules in patients with hyperparathyroidism. These difficulties were accentuated in this case by the large size of the mass, its intrathyroid location, and cytologic features that were compatible with a lesion of thyroid origin. In some cases, including this one, even a thorough preoperative evaluation that includes fine-needle aspiration biopsy and radiographic and nuclear medicine studies may not allow for a definitive preoperative diagnosis. The histologic overlap between thyroid and parathyroid lesions can also be problematic at the time of intraoperative frozen-section evaluation. Intraoperative parathyroid hormone monitoring may be helpful in these difficult cases.

Ectopic nasopharyngeal pituitary adenoma resected with endoscopic technique

June 30, 2008     Alan A.Z. Alexander, MD, Nikta Niktash, MD, David E. Kardon, MD, and Nader Sadeghi, MD
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Abstract

We describe the case of an 80-year-old man with diabetes who presented with nonspecific dizziness. He was found on magnetic resonance imaging to have a 3.2-cm mass within the posterior and central aspect of the nasopharynx. Nasal endoscopy showed that the mass, which arose from the posterior edge of the nasal septum and was attached to the superior nasopharynx, was narrowing the patient's airway. Although initially the mass was suspected to be a minor salivary gland tumor, histopathologic analysis led to a diagnosis of pituitary adenoma. The ectopic tumor was removed via transnasal en bloc resection with partial adjacent septal resection. Final pathology confirmed the diagnosis. The patient had an uneventful recovery and no sequellae at 2-year follow-up.

Pleomorphic adenoma of the trachea

April 30, 2008     Michael J. Rodriguez, MD, Giovana R. Thomas, MD, and Uzma Farooq, MD
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Abstract

Primary pleomorphic adenoma of the trachea is rare, as only 33 cases have been previously reported worldwide since 1922. We describe a new case of primary tracheal pleomorphic adenoma that was discovered incidentally in a 78-year-old man. The tumor was excised, and the patient recovered without complication. Salivary gland tumors of the trachea should be considered in the differential diagnosis of tracheal lesions; the diagnosis is confirmed by pathologic evaluation. Patients are adequately treated with sleeve resection and primary anastomosis whenever possible.

An unusual site of a CSF leak following resection of a retrosigmoid acoustic neuroma

March 1, 2006     Michael P. Ondik, MD; Aaron G. Benson, MD; Hamid Djalilian, MD
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Abstract
Cerebrospinal fluid (CSF) leaks may occur after acoustic neuroma resection. These leaks are usually the result of an iatrogenic injury during removal. The retrosigmoid approach is commonly associated with leaks that occur through the lateral end of the internal auditory canal, through the perilabyrinthine cells extending to the region of the internal auditory canal, or through the retrosigmoid air cells. We describe a case of an infracochlear CSF leak that developed following the retrosigmoid resection of an acoustic neuroma. To the best of our knowledge, this leak was unique for both its location and etiology.

Pituitary adenoma

March 1, 2006     Lester D.R. Thompson, MD, FASCP
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Parathyroid adenoma mimicking cervical recurrence on CT/PET fusion scan

February 1, 2006     Sofia Avitia, MD; Ryan F. Osborne, MD, FACS
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Bilateral pleomorphic adenoma of the anterior tongue: A case report

December 1, 2005     Ramandeep S. Virk, MS; Harbir Hundal, MS
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Abstract
We report a case of bilateral pleomorphic adenoma of the anterior two-thirds of the tongue in a 38-year-old man. Both tumors were excised via a transoral route. To the best of our knowledge, this is the first reported case of a bilateral pleomorphic adenoma of the anterior tongue.

Neuroendocrine adenoma of the middle ear

August 31, 2005     Lester D.R. Thompson, MD
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Minimally invasive surgery for parotid pleomorphic adenoma

April 30, 2005     Robert L. Witt, MD
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Abstract
Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve''defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve''is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients''15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.
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