March 31, 2008 Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
March 31, 2008 Ryan Dempewolf, MD and John H. Lee, MD
article
Abstract
Most of the recent evidence suggests that extramedullary plasmacytoma should be treated initially with radiation, as response rates have exceeded 90% in many studies. Surgery is not considered a primary treatment modality for such tumors. We report the case of a chronically immunosuppressed 43-year-old man with bilateral extramedullary plasmacytomas of the nasal cavities. The right-sided mass was surgically excised, while the left-sided mass was initially treated with radiation. However, the left mass proved to be radioresistant, and it was subsequently excised surgically. The patient showed no evidence of recurrence of either mass at 42 months of follow-up. We believe that the particulars of this case, combined with the results of some recent studies, provide good evidence that surgery should be considered in the treatment of certain cases of extramedullary plasmacytoma.
March 1, 2008 Geoffrey S. Getnick, MD, Samuel J. Lin, MD, Joseph R. Raviv, MD, William E. Walsh, MD, and Kenneth W. Altman, MD, PhD
article
Abstract
Lingual hematoma is a rare but potentially fatal cause of upper airway obstruction. Patients receiving anticoagulants such as heparin can suffer from significant complications of these medications. Not only does heparin exert effects directly on the coagulation cascade, but it has the potential to cause thrombocytopenia by stimulating formation of antibodies against platelets. We present the case of a patient being treated with heparin for a deep-vein thrombosis, who subsequently developed heparin-induced thrombocytopenia and lingual hematoma, necessitating tracheotomy.
March 1, 2008 Ertap Akoğlu, MD, Ergün Seyfeli, MD, Sebahat Akoğlu, MD, Sinem Karazincir, MD, Şemsettin Okuyucu, MD, and Ali Şafak Dağli, MD
article
Abstract
Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach—intubation, tracheotomy, or conservative therapy—is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.
February 1, 2008 Sofia Avitia, MD, Jason S. Hamilton, MD, and Ryan F. Osborne, MD, FACS
February 1, 2008 Jennings R. Boyette, MD, John W. Seibert, MD, Chun-Yang Fan, MD, PhD, and Brendan C. Stack Jr., MD, FACS, FACE
article
Abstract
Chordomas are rare tumors of notochordal origin that arise along the vertebral axis. These slowly growing yet highly destructive tumors are associated with an alarming rate of recurrence, although surgical resection followed by proton, proton/photon, or conventional radiotherapy has been somewhat successful in terms of recurrence-free survival. Still, recurrent disease as a result of metastasis or surgical pathway seeding does occur. We retrospectively reviewed the case of a 64-year-old woman who presented with a left neck mass at level II. She had a history of recurrent chordomas involving the occipital portion of the clivus that had been treated with multiple resections and proton-beam irradiations over a period of several years. The new mass was found to have infiltrated the superior end of the sternocleidomastoid muscle. Neck dissection was performed. Pathology revealed no lymphoid tissue in the main specimen and no evidence of chordoma in any of the lymph nodes. We believe that this latest clival chordoma might have occurred as a result of surgical pathway seeding during a previous operation anterior to the sternocleidomastoid muscle, although metastasis cannot be ruled out. We also review the literature on clival and skull base chordomas as it relates to recurrence, metastasis, and seeding.
December 1, 2007 Jacob D. Steiger, MD and Alexander G. Chiu, MD
article
Abstract
Sinonasal papillomas are classically categorized by their histology. Inverted, cylindrical, and fungiform are the three subtypes used to describe these lesions, and their medical and surgical management is often based on the specific subtype. We describe a case of a sinonasal papilloma with all three subtypes represented within the same surgical specimen. To our knowledge, this represents the first such case in the literature and has implications for the management of all sinonasal papillomas.
December 1, 2007 Scott L. Lee, MD, Ching Y. Lee, MD, PhD, Rami K. Batniji, MD, and Steven Silver, MD
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Abstract
We report a case of unilateral tonsillar lymphoepithelioma with extension into the ipsilateral parapharyngeal space, and we review the clinical, histologic, and radiographic findings of the case. The patient presented with a tonsillar mass that was confirmed on biopsy to be lymphoepithelioma. Computed tomography demonstrated ipsilateral parapharyngeal space involvement. Association with Epstein-Barr virus was not assessed since it does not affect the treatment modality. We also review the literature and discuss the diagnosis and current treatment options.
December 1, 2007 Eiji Yanagisawa, MD, FACS, Joseph P. Mirante, MD, FACS, and Dewey A. Christmas, MD
October 31, 2007 Sofia Avitia, MD, Jason Hamilton, MD, and Ryan F. Osborne, MD, FACS
September 30, 2007
article
Lisa Lee, MD;
Christine M. Glastonbury, MBBS;
Doris Lin, MD
Abstract
Rosai-Dorfman disease is a rare, benign granulomatous disease that typically presents with massive cervical lymphadenopathy. In less than 50% of cases, other soft-tissue manifestations may also be found in the head and neck. Rosai-Dorfman disease can be difficult to diagnose because of its rarity and its ability to mimic, both clinically and radiologically, more common diseases such as lymphoma. The histopathologic diagnosis can also be difficult to make, particularly when the disease exhibits extranodal manifestations. We present a case of isolated extranodal Rosai-Dorfman disease involving the carotid sheath, without the typical massive adenopathy.
July 31, 2007 James Lin, MD; Jose N. Fayad, MD
