Mass

Angiofollicular lymphoid hyperplasia (Castleman disease) presenting as an isolated neck mass

August 10, 2012     Benjamin D. Liess, MD; Alan A.Z. Alexander, MD; Matthew E. Dahl, MD; Robert P. Zitsch III, MD; Jason Scott Lawrence Holly, MD
article

Abstract

Castleman disease is a relatively uncommon lymphoproliferative disorder. A presentation as an isolated lesion in the neck is extremely rare. We report the case of a 26-year-old man who presented with a 4-month history of an enlarging right neck mass that was identified as Castleman disease on excisional biopsy. The biopsy was curative. In localized forms of Castleman disease, excisional biopsy is both diagnostic and curative. However, in multicentric forms, additional treatment is required.

Paranasal sinus mucocele

July 5, 2012     Lester D.R. Thompson, MD
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Radiographic findings are essential to the diagnosis of paranasal sinus mucocele. Usually opacification of the sinus with thinning, erosion, or destruction of the sinus wall are seen.

Laryngeal lipoma

June 4, 2012     Rima A. DeFatta, MD; Tre Landrum, DO; Joseph Whitten, MD; Robert T. Sataloff, MD, DMA, FACS
article

Osteoid osteoma of the ethmoid sinus: A rare diagnosis

April 30, 2012     E. Bradley Strong, MD; James R. Tate, MD; Dariusz Borys, MD
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Abstract

Osteoid osteomas are benign osseous lesions. They have seldom been described in the otolaryngology literature, and they are extremely rare in the ethmoid sinuses. We report a new case of osteoid osteoma of the ethmoid sinus in a 15-year-old girl. The workup consisted of computed tomography. Treatment involved local excision via an external ethmoidectomy approach. The diagnosis was based on histopathologic examination.

Primary acquired cholesteatoma

April 30, 2012     Joseph A. Ursick, MD; Jose N. Fayad, MD
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Cholesteatomas are believed to form as the result of poor eustachian tube function with resultant tympanic membrane retraction and a lack of normal epithelial migration.

Third branchial anomaly: Endoscopic management revisited

March 31, 2012     Mala Tanna, MD, Monica R. Sharma, DDS, and Bijal Patel, MD
article

Third and fourth branchial apparatus anomalies may be misidentified as a recurrent deep neck abscess that does not respond to appropriate medical or surgical therapy or as recurrent acute suppurative thyroiditis, respiratory distress, or retropharyngeal abscess.

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

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

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
article

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
article

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
article

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.

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