Mass

Extraorbital pseudotumor of the petrous apex: Biopsy via a transnasal endoscopic approach

March 31, 2012     Jeffrey J. Nelson, MD and Parul Goyal, MD
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Abstract

Extraorbital idiopathic pseudotumors of the skull base are very uncommon. We report the case of a 50-year-old woman who presented with left ophthalmoplegia and vision loss. Imaging studies revealed an enhancing lesion involving the left petrous apex and cavernous sinus. A transnasal endoscopic approach was used to obtain a biopsy of the left petrous apex. Pathology identified the lesion as an idiopathic pseudotumor. The patient was treated with high-dose steroids and steroid-sparing immunomodulators, and she experienced a significant improvement. To the best of our knowledge, this is the first reported case of a transnasal endoscopic approach to a biopsy of a pseudotumor involving the petrous apex. We discuss the features of this case, and we review the literature on this condition.

Topical measles-mumps-rubella vaccine in the treatment of recurrent respiratory papillomatosis: Results of a preliminary randomized, controlled trial

March 31, 2012     Jin Lei, MD, Wang Yu, MD, Lin Yuexin, MD, Chen Qi, MD, Sun Xiumin, MD, and Zhang Tianyu, PhD
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Abstract

We conducted a study to test the hypothesis that the measles-mumps-rubella (MMR) vaccine can either prevent further recurrences of recurrent respiratory papillomatosis (RRP) or prolong its remission. Our study population was made up of 26 children with RRP. All patients underwent surgical excision of their lesions. After the lesions were removed, half of these patients were prospectively randomized to receive a topical coating of the MMR vaccine on the site of their excised lesion (intervention group); the other half were treated with excision alone (control group). The patients in the intervention group experienced a longer period of recurrence-free remission than did those in the control group (median: 160 and 133 days, respectively), but the difference was not statistically significant. Therefore, it appears that topical MMR vaccine as an adjunct to routine surgical management may not be beneficial in preventing or slowing the return of RRP. However, we believe that further studies with larger patient populations are warranted.

Acquired toxoplasmosis of the buccal area with extranodular involvement: Report of an unusual case

December 1, 2009     Serap Köybasi, MD, Ahmet Emre Süslü,w, MD, Beyhan Yigit, MD, and Cetin Boran, MD
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Abstract

Acquired toxoplasmosis is a common parasitic infection in humans. It can be caused by ingestion of infected meat or other food that has been contaminated by the feces of infected cats. Approximately 90% of immunocompetent patients with acquired toxoplasmosis are asymptomatic and undiagnosed; in the other 10%, toxoplasmosis manifests as a nonspecific, self-limited illness that usually does not require treatment. In symptomatic cases, cervical lymphadenopathy is one of the most common clinical findings. We report the case of a 33-year-old woman who experienced unilateral facial swelling secondary to toxoplasmosis. In addition to the atypical location of her disease (i.e., the buccal area), the atypical histopathologic findings in this case (e.g., extranodular involvement) constituted a very unusual presentation of toxoplasmosis.

Synovial chondromatosis of the middle ear: A case report

June 30, 2009     Domenico Saggese, MD, Ignacio Javier Fernandez, MD, Nunzio C.M. Salfi, MD, and Alberto Rinaldi Ceroni, MD
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Abstract

Synovial chondromatosis is a rare pathology of unknown etiology characterized by multinodular cartilaginous proliferation in the synovium. When it does occur, it usually develops in the large synovial joints (e.g., the knee, hip, elbow, and shoulder). Only rarely does it occur in the head and neck (most often in the temporomandibular joint). We report a case of synovial chondromatosis of the middle ear (i.e., the incudomalleolar joint) in a 64-year-old woman, and we describe the clinical, radiologic, and intraoperative findings in this case. To the best of our knowledge, this is the first reported case of synovial chondromatosis in the middle ear.

Cervical unicentric Castleman disease presenting as a neck mass: Case report and review of the literature

April 30, 2009     Jonathan Liang, MD, Jason G. Newman, MD, Dale M. Frank, MD, and Ara A. Chalian, MD
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Abstract

Castleman disease is an uncommon lymphoproliferative disorder that usually presents asymptomatically at a single site, most commonly the mediastinum; it is rare in the head and neck. Although Castleman disease may be mistaken for a malignant process such as lymphoma, it is a benign condition that is curable with complete surgical resection. We report the case of a 43-year-old man with the hyaline vascular type of unicentric Castleman disease who presented with an isolated neck mass.

Rosai-Dorfman disease in an Asian Indian woman with classic generalized lymphadenopathy and nasal obstruction: A case report

March 1, 2009     Neetu Singh, PhD, Ramesh Sharma, PhD, Umesh P. Verma, DPharm, MDS, Sanjay K. Singh, MS, Jaya Dixit, MDS, and Anil K. Balapure, PhD
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Abstract

Rosai-Dorfman disease is rare. When it does occur, it usually affects children, and it has a propensity for whites and blacks as opposed to members of other races. We report the case of a 45-year-old Asian Indian woman who presented with painful masses in the area of the axillary, cervical, and inguinal lymph nodes. She had a decade-long history of tonic-clonic seizures and a recent history of digestive complaints and progressive nasal stuffiness. Endoscopic examination of the left nasal cavity revealed the presence of submucosal bulges along the septum and the lateral wall; hypertrophy of the adenoids was also noted. Histologic analysis of lymph node specimens revealed dilated parenchymal sinuses, germinal activity with infiltration of numerous histiocytes (emperipolesis), and chronic inflammatory cells. The patient was diagnosed with Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) with atypical extranodal involvement (the nasal area). An aggressive course of polychemotherapy thrice daily was initiated, but it had no lasting effect, and the patient died 8 months later of an undetermined cause. Our patient's age at the onset of her disease, her race, and the extranodal involvement make this case of Rosai-Dorfman disease unusual and perhaps unique.

Chondroid metaplasia mimicking recurrent squamous cell carcinoma of the head and neck

January 1, 2009     Shane K. Kohl, MD, Roger J. Simpson, MD, and James Wisecarver, MD, PhD
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Abstract

A 65-year-old woman presented with a “sore bump” on her tongue. She had a history of squamous cell carcinoma of the head and neck that had been treated with surgery and radiotherapy 11 years earlier. The tongue lesion was excised, and pathologic examination identified a submucosal focus of benign-appearing cartilage. No evidence of dysplasia or malignancy was seen. She was diagnosed with chondroid metaplasia. Chondroid metaplasia involving the head and neck is rare. When it has occurred, it has been seen in both reactive and neoplastic settings. To our knowledge, this is the first reported case of a chondroid metaplasia of the tongue.

Venous malformation of the neck with giant phleboliths

December 1, 2008     Tabassum Ahmed, MD, Gul Moonis, MD, Laurie Loevner, MD, and Gregory Weinstein, MD
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Abstract

We present a case involving a 76-year-old man with a massive right-sided vascular neck mass that had been present since birth. The mass had been stable throughout the patient's life, but recently a portion of it had become hard. Physical examination revealed a firm, palpable focus within the vascular lesion in the right side of the neck. Computed tomography revealed the presence of numerous hyperdense foci, many more than 2 cm in size, which were confirmed by fine-needle aspiration to be phleboliths. The patient was followed for 6 months to ensure that the vascular mass and phleboliths remained stable.

White mass in the middle ear

October 31, 2008     Maroun T. Semaan, MD and Jose N. Fayad, MD
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Otolaryngologists and orbital pseudotumor: A case report

September 25, 2008     Vikas Mehta, MD, Behrooz A. Torkian, MD, Steven M. Daines, MD, and Timothy F. Kelly, MD
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Abstract

Orbital pseudotumor (idiopathic orbital inflammation) is the third most common orbital disease, accounting for 5 to 6% of orbital disorders. It often presents in a manner very similar to inflammatory or neoplastic sinus disease. In addition, sinus disease is often a cause of orbital pseudotumor, although the etiology of this entity has yet to be defined. Treatment with steroids is usually successful early on, but long-term treatment-failure and recurrence rates are high. Despite otolaryngologists' intimate knowledge of sinus pathology, we have generally not been heavily involved in researching the causes and treatment of orbital pseudotumors. In this article, we report the case of an affected patient who presented with an orbital mass on radiography. The mass was likely the result of sinus disease in the setting of an untreated orbital floor fracture. We describe the clinical, radiographic, and operative features of this case, and we discuss the otolaryngologist's role in the management of orbital pseudotumors.

Giant esophageal lymphangioma

August 31, 2008     Melanie W. Seybt, MD and Gregory N. Postma, MD
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Focal inflammatory myositis of the paraspinal neck muscles

July 31, 2008     Jaiganesh Manickavasagam, MRCS (Edin), Sam Majumdar, FRCS (ORL–HNS), and Abir K. Bhattacharyya, FRCS (ORL)
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