Granuloma

Multiple plasma cell granulomas of the larynx in a young man

March 18, 2014     Courtney Shires, MD; Sandeep Samant, MD, FACS
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Abstract

Plasma cell granuloma of the larynx is a rare benign lesion of unknown etiology, with only 21 cases reported previously. We report an additional case of plasma cell granuloma in which a 26-year-old man experienced a 1.5 x 3.4-cm, completely obstructing subglottic lesion. Because of the patient's young age, history of hemoptysis, bleeding from his tracheostomy, and the rarity of plasma cell granulomas, the patient was assumed to have hemangioma until proven otherwise. He presented with a partially obstructing glottic lesion 4 months later. Both the subglottic and glottic lesions were excised endoscopically. Multiple modalities have been used to treat plasma cell granulomas, including radiation, endoscopic CO2 laser ablation, high-dose prednisone, and open excision. In our case, steroids were given in the interim between the 2 excisions. This is the first report of a patient with two laryngeal plasma cell granulomas and the 22nd reported case of laryngeal plasma cell granuloma.

How to approach a bilobed petrous apex granuloma: A case report

January 21, 2014     Aaron G. Benson, MD
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Abstract

Cholesterol granulomas are the most common lesions involving the petrous apex. However, they are still an uncommon finding overall, and they often remain undiagnosed until they have become extremely large and symptomatic. Many surgical approaches to the petrous apex exist. Factors that often influence the surgical approach include the surgeon's experience, the patient's anatomy, and the patient's hearing status. The purpose of this case report--which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left-sided pulsatile tinnitus--is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.

Recurrent pyogenic granuloma in a noncompliant patient

January 21, 2014     David Galos, MD; Farhad R. Chowdhury, DO; Reena Gupta, MD; Yolanda D. Heman-Ackah, MD; and Robert T. Sataloff, MD, DMA, FACS
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Patients occasionally develop multiple recurrent granulomas even after excellent reflux control (including fundoplication), voice therapy, surgical removal (including steroid injection into the base of the granuloma), angiolytic laser therapy, and other treatments.

Chronic facial pain and Meckel cave masses as the initial presentation of neurosarcoidosis: A case report

December 20, 2013     Graham M. Strub, PhD; Jaime E. Moore, MD; Andrew T. Huang, MD; Aaron W. Stevenson, MD; Evan R. Reiter, MD, FACS
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Abstract

Sarcoidosis is a systemic inflammatory disease that can affect virtually every organ system, leading to a wide variety of clinical manifestations. Central nervous system involvement producing neurologic symptoms can occur in patients with sarcoidosis, yet rarely are these symptoms the initial manifestations of the disease. Here we present the case of a 38-year-old man who presented with a history of chronic facial pain, blurred vision, increased lacrimation, and periodontal abscesses. Physical examination revealed no evidence of infection or neoplasm. Magnetic resonance imaging revealed space-occupying lesions in Meckel cave bilaterally, with soft-tissue density extending into the left sphenoid and posterior ethmoid sinuses. Endoscopic biopsy of sinus mucosa demonstrated the presence of noncaseating granulomas and the absence of organisms, findings suggestive of neurosarcoidosis. The diagnosis was further supported by chest radiography, which demonstrated bilateral hilar adenopathy. The patient was treated with corticosteroids, and his facial pain improved markedly. In this article we discuss neurosarcoidosis and its manifestations, diagnosis, and clinical course.

Hemorrhagic vocal process granuloma

April 17, 2013     Farhad R. Chowdhury, DO; Kevin Hsu, DO; Robert T. Sataloff, MD, DMA, FACS
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Most small vocal process granulomas will resolve spontaneously if the primary insult is removed, but these lesions have a very high tendency to recur.

A false-positive FDG uptake in Teflon granuloma: A case report

April 17, 2013     Munir Demir Bajin, MD; Ali Sefik Hosal, MD
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Abstract

Positron emmision tomography (PET) is successfully used to monitor malignancies. Unfortunately it is not tumor specific. We present a case with history of rectum cancer and lentigo maligna who underwent PET-CT which revealed an increased uptake in the larynx. What was first considered as a third pirmary turned out to be a Teflon granuloma.

Central giant cell reparative granuloma of the ethmoids with bilateral proptosis and intracranial extension

February 25, 2013     Subhash C. Gupta, MS; Sachin Jain, MS; Ravi Mehrotra, MD; Himanshu P. Singh, MBBS
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Abstract

Central giant cell reparative granuloma is an infrequent, benign, proliferating lesion affecting the maxilla, mandible and, rarely, cranial bones. A 16-year-old girl presented with a 6-month history of recurrent nasal bleeding, a mass in the nose, difficulty in nasal breathing, a change in voice, and bilateral proptosis. Radiologically, an extensive ethmoidal mass was seen. Histologic examination revealed a central giant cell reparative granuloma. After endoscopic removal, the patient was symptom-free at the 12-month follow-up. The clinical picture of central giant cell reparative granuloma of the ethmoids is discussed, along with the differential diagnosis, histologic evaluation, appearance on computed tomography, and endoscopic management of this lesion.

Wegener granulomatosis

January 24, 2013     Lester D.R. Thompson, MD
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Wegener granulomatosis presents clinically as ulcerative and crusted lesions with tissue destruction.

Cholesterol granuloma

October 8, 2012     Joseph A. Ursick, MD; Derald E. Brackmann, MD
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 Cholesterol granulomas can cause bony expansion and typically become symptomatic when they encroach upon adjacent cranial nerves.

Intracranial sarcoid granuloma as an extension of severe sinonasal sarcoidosis

March 31, 2012     Stephen M. Wold, MD and John T. Sinacori, MD
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Abstract

Sarcoidosis is a chronic, multisystem, granulomatous disease of unknown etiology. It manifests with a wide range of symptoms and clinical findings, including some that occur in the head and neck. Sinonasal sarcoidosis, in particular, frequently demonstrates a rather recalcitrant course and a potential for severe complications if left untreated. We present the case of a 46-year-old woman with extensive sinonasal sarcoidosis that progressed to involve the skull base and olfactory tract and ultimately led to the formation of a granuloma within the frontal lobe that required craniotomy and excision. Although surgery is not considered the primary treatment modality for sarcoidosis, it may have a role in managing this highly variable disease in certain patients.

Oral traumatic ulcer

November 22, 2011     Lester D.R. Thompson, MD
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Petrous apex cholesterol granuloma involving the sphenoid sinus

November 22, 2011     Dirk Korbmacher, MD, Martin Lehmann, MS, Hans-Björn Gehl, MD, Jörg Ebmeyer, MD, and Holger Sudhoff, MD, PhD
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Abstract

Petrous apex cholesterol granulomas are slowly expanding lesions that clinically present with a variety of cranial nerve deficits. We present a case of a 40-year-old man with a right-sided, sudden-onset hearing loss. Apart from a 60-dB high-frequency sensorineural hearing loss in the right ear, all other neurotologic examinations were normal. Computed tomography revealed partial destruction of the right carotid canal, petrous apex, and clivus. Surgical treatment was performed via an endoscopic transnasal, trans-sphenoid approach using an image-guidance system. Postoperative magnetic resonance imaging showed a significant reduction in the size of the cholesterol granuloma and a stable hearing threshold.

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