Tumor

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

Patients classically present with pulsatile tinnitus and a red mass medial to the tympanic membrane. Some patients may have findings of a red mass that blanches with pneumatic otoscopy, called Brown's sign.

The role of contact endoscopy in screening for premalignant laryngeal lesions: A study of 141 patients

May 7, 2014     Marisa Klancnik, MD; Ivo Gluncic, MD, PhD; Drasko Cikojevic, MD, PhD
article

Abstract

At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients-51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified.

Chondroid syringoma of the ear lobule: A unique case

May 7, 2014     Yasser Al Omran, BSc (Hons); Rawia Mohamed, MBBS, FRCPA; Mohammed-Kamal Al-Omran, MBBS, FRCS Ed, FRCS (Glasg)
article

Because of the inconspicuous clinical presentation of chondroid syringomas, they are often disregarded; other, more common, differential diagnoses are usually considered.

Endoscopic transnasal transsphenoidal approach for craniopharyngioma: Report of 6 cases

May 7, 2014     Chan-Soon Park, MD; Byung-Guk Kim, MD; Ji-Hyeon Shin, MD; Jin-Hee Cho, MD
article

Abstract

We conducted a retrospective study to evaluate outcomes in patients with a craniopharyngioma who were managed via a transnasal transsphenoidal approach. Craniopharyngiomas exhibit histologically benign but “clinically malignant” features. Our study group was made up of 5 patients who underwent a total of 6 operations. The study population included 1 female and 5 males, aged 14 to 50 years (mean: 29.2). The overall rate of near-total tumor removal was 67%, but all patients eventually experienced a recurrence. Revision surgery to correct any severe postoperative complications was not required in any case. We found that the endoscopic transnasal transsphenoidal approach could be a safe and less invasive surgical option for the removal of craniopharyngiomas, although we were unable to remove all tumor or prevent recurrences.

Endoscopic modified Lothrop approach for the excision of bilateral frontal sinus tumors

March 18, 2014     Jiun Fong Thong, MRCS; Deyali Chatterjee, MD; Siew Yoong Hwang, FRCS
article

Abstract

We describe the use of an endoscopic modified Lothrop approach for clearance of an extensive sinonasal-type hemangiopericytoma of the nasal cavity and paranasal sinuses with bilateral frontal sinus involvement in a 44-year-old woman. The modified Lothrop approach is conventionally used to treat sinusitis, but with some slight modifications to the technique, it can also be used for tumor excision.

Aggressive inflammatory pseudotumor of the maxillary sinus and orbit

March 18, 2014     Sheldon Chong, MBBS, MS(ORL-HNS); Carren S.L. Teh, MBBS, MS(ORL-HNS); Shashinder Singh, MBBS, FRACS; Mun Kein Seong, MBBS, MPath; Subrayan Viswaraja, MBBS, FRCS(Edin), FRCOphth(UK)
article

Abstract

Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. It is uncommon in the head and neck region, particularly in the paranasal sinuses. We present an unusual case of IPT of the maxillary sinus and orbit in a 27-year-old woman who presented with cheek swelling, right orbital swelling, double vision, and associated fever and trismus. Computed tomography identified a mass with radiologic features suggestive of a malignancy of the maxillary sinus and orbit; the mass extended into the infratemporal fossa, parapharyngeal space, anterior antral wall, and surrounding soft tissue. A diagnosis of IPT was established on the basis of histologic and immunohistochemical analysis, which identified a proliferation of bland spindle cells and a mixed inflammatory cell infiltrate. Despite its aggressive appearance, IPT is associated with a good prognosis. Our patient was treated successfully with a combination of surgery, steroid therapy, and methotrexate. Chemotherapeutic agents are generally reserved for recalcitrant cases.

Two cases of granular cell tumors of the head and neck at different sites

March 18, 2014     Mustafa Paksoy, MD; Mehmet Eken, MD; Emin Ayduran, MD; Gokhan Altin, MD
article

Abstract

Granular cell tumor (GCT) is an uncommon, primarily benign lesion. We describe 2 cases of GCT. Patient 1 was a 38-year-old man who presented with a reddish, vegetative lesion that involved the posterior third of the left true vocal fold. Patient 2 was an 18-year-old girl who presented with a firm, slightly extruded submucosal mass in the posterior lateral third of the tongue. Both lesions were identified as GCTs on biopsy. Both tumors were removed surgically, and both patients exhibited no signs of recurrence during follow-up. It is important that otolaryngologists be familiar with GCT and its management. Although the length of follow-up has varied substantially in the literature, we recommend long-term surveillance, including regular clinical examinations and periodic imaging with contrast-enhanced magnetic resonance imaging, at least until additional studies have clarified the natural history and recurrence patterns of GCT with greater certainty.

Cervical sympathetic chain paraganglioma: A report of 2 cases and a literature review

March 18, 2014     Rahul Seth, MD; Manzoor Ahmed, MD; Aaron P. Hoschar, MD; Benjamin G. Wood, MD; Joseph Scharpf, MD
article

Abstract

We review 2 cases of surgically and pathologically confirmed paraganglioma of the cervical sympathetic chain. Both patients-a 46-year-old man and a 33-year-old woman-were treated surgically. Intraoperatively, both tumors were found to be hypervascular and arising from the cervical sympathetic chain. Histopathologic analysis confirmed both as paragangliomas. Paragangliomas arising from the cervical sympathetic chain are exceptionally rare, but they must be considered in the differential diagnosis of parapharyngeal masses. They often present with ipsilateral Horner syndrome and oropharyngeal fullness, and they may be associated with a higher rate of catecholamine secretion. Typical imaging characteristics include anterolateral or lateral displacement of both the carotid and jugular vessels.

Osteochondroma of the nasal dorsum presenting as a nasal hump

February 12, 2014     Hakan Tutar, MD; Aykut Erdem Dinc, MD; Omer Uluoglu, MD; and Metin Yilmaz, MD
article

Abstract

We describe the case of a 24-year-old man who underwent open septorhinoplasty for the treatment of progressive nasal disfigurement caused by a nasal hump. Postoperative histopathology of the resected hump revealed that it was an osteochondroma. The patient showed no evidence of recurrence during 2 years of follow-up. To the best of our knowledge, this is the first case of an osteochondroma involving the nasal dorsum to be reported in the English-language literature.

Organized hematoma of the maxillary sinus: A clinicopathologic study of 5 cases

February 12, 2014     Hidenori Yokoi, MD, PhD; Atsushi Arakawa, MD, PhD; Fumihiko Matsumoto, MD, PhD; Naoko Yokoi, MD, PhD; Katsuhisa Ikeda, MD, PhD; and Naoyuki Kohno, MD, PhD
article

Abstract

Organized hematoma of the maxillary sinus is rare. Its pathogenesis is still not clear, and it appears to have multiple causes. We report the clinical, clinicopathologic, and immunohistochemical findings in 5 patients-3 men and 2 women, aged 19 to 68 years (mean: 40.2)-with pathologically proven organized hematoma of the maxillary sinus. In all 5 cases, we were able to successfully perform curative treatment via endoscopic sinus surgery. Our findings suggest that most organized hematomas are angiomatous. Immunohistochemical analysis identified the presence of proliferative activity.

A case of bilateral internal auditory canal osteomas

January 21, 2014     Maria K. Brake, MD; David P. Morris, MD, FRCS(C); Jonathan Trites, MD, FRCS(C); S. Mark Taylor, MD, FRCS(C); Rene G. Van Wijhe, PhD; Robert D. Hart, MD, FRCS(C)
article

Abstract

Osteomas of the skull base are rare, benign, slowly progressing growths of dense cortical bone. Osteomas occurring in the internal auditory canal are extremely rare. These lesions have sometimes been linked with dizziness, sensorineural hearing loss, and/or tinnitus. Although there have been documented cases in which surgical excision has improved these symptoms, symptomatic relief is not always achieved with surgical management. Here we pre-sent, to the best of our knowledge, only the third reported case of bilateral osteomas of the internal auditory canal. An 82-year-old woman presented with an acute onset of vertigo without a history of trauma or ear infection. She reported two similar episodes occurring a few years earlier, with symptoms persisting for only a few days. Audiometry showed presbycusis. Computed tomography and magnetic resonance imaging identified bilateral internal auditory canal osteomas. The patient was treated conservatively, monitored, and had complete resolution of her symptoms.

Transglottic laryngeal paraganglioma: A rare location for this tumor

December 20, 2013     Secil Arslanoglu, MD; M. Zafer Uguz, MD; Demet Etit, MD; Murat Ermete, MD
article

Abstract

Laryngeal paragangliomas are rare neoplasms that originate in the neural crest cells of the laryngeal paraganglia. Although the vast majority of these tumors are benign, they exhibit different types of biologic behavior that require different treatment modalities. Therefore, differentiation among these tumors is extremely important. We report a rare case of laryngeal paraganglioma that presented as a transglottic lesion in a 68-year-old man. The atypical location of the tumor led to difficulties in diagnosis and management. To the best of our knowledge, this is only the third such case to be reported in the English-language literature.

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