Tumor

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
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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.

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)
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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.

The endoscopic transnasal paraseptal approach to a sphenoid sinus osteoma: Case report and literature review

December 20, 2013     Frank Rikki Canevari, MD; Georgios Giourgos, MD; Andrea Pistochini, MD
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Abstract

Osteomas are the most common benign tumors of the nose and paranasal sinuses. Their symptoms, which are nonspecific, occur as the result of a blocked nasal airflow or, in some rare cases, the involvement of nearby structures. Isolated sphenoid sinus osteomas are very rare, as only 20 cases have been previously reported in the literature. Most authors advise surgical treatment for symptomatic lesions. Surgical access to the sphenoid sinus has traditionally been a challenge for surgeons. We describe an endoscopic transnasal paraseptal resection of a sphenoid osteoma in a 35-year-old man. We also discuss surgical access and review the evolution of the surgical approaches to the sphenoid sinus.

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
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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.

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.

A case and a series of published cases of esthesioneuroblastoma (ENB) in which long-standing paraneoplastic SIADH had preceded ENB diagnosis

October 23, 2013     Uri Gabbay, MD, MPH; Leonor Leider-Trejo, MD; Gideon Marshak, MD; Merav Gabbay, MD; and Dan M. Fliss, MD
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Abstract

Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.

Nasopharyngeal yolk sac tumors: A rare pediatric occurrence

August 21, 2013     Belinda Mantle, MD and Ryan F. Osborne, MD, FACS
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Symptoms of yolk sac tumors depend on the site affected. The characteristic finding is rapid growth over a few weeks.

Mummified leiomyoma of the midline anterior neck: Case report and literature review

August 21, 2013     Jacob Minor, MD; Mona Rizeq, MD; and Todd Wine, MD
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Abstract

Leiomyomas are benign smooth-muscle tumors that have only rarely been reported in the head and neck. Extensive calcification (mummification) is occasionally seen in deep somatic soft-tissue leiomyomas, which represent a rare subtype. We describe a case of mummified leiomyoma of the soft tissues of the midline anterior neck in a 31-year-old man. His tumor was successfully managed with surgical excision. To the best of our knowledge, this case represents the only description of a mummified leiomyoma at this particular site and the first reported case of any leiomyoma at this site in more than 50 years. We also review the literature concerning leiomyomas of the head and neck, their subtypes, diagnostic and management considerations, and outcomes.

Peripheral osteoma of the hard palate

August 21, 2013     Borlingegowda Viswanatha, MS, DLO, PhD
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Abstract

Peripheral osteomas of the hard palate are relatively rare. Two cases of osteoma of the hard palate are reported, along with a review of the literature.

Spindle cell lipoma of the larynx

June 11, 2013     Antonio D'Antonio, MD, PhD; Giampiero Mottola, MD; Alessia Caleo, MD; Maria Addesso, MD; and Amedeo Boscaino, MD
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Abstract

Among the primary mesenchymal tumors of the hypopharynx and larynx, lipomas are rare. Macroscopically, they often resemble a retention cyst or laryngeal nodule. Spindle cell lipomas (SCLs) are an uncommon variant of lipoma. SCLs are extremely rare in the larynx; as far as we know, only 4 cases have been previously described in the literature. We present a new case of laryngeal SCL in a 65-year-old man who presented with a 1-year history of hoarseness, choking spells, stridor, and dyspnea. Examination revealed the presence of a large polyp on the left true vocal fold that had caused stenosis of the posterior glottis. The polyp was removed endoscopically, and the patient's stridor and dyspnea resolved. Histologically, the tumor was composed of bland, CD34-positive spindle cells with an abundant fibrous and myxoid stroma interspersed with mature fatty tissue. The patient was free of local recurrence at 2 years of follow-up.

Giant cell tumor of the larynx: A case of malignant sarcomatous transformation

June 11, 2013     Richard J. Vivero, MD; Sandeep P. Dave, MD; Carmen R. Gomez, MD; and Donald T. Weed, MD
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Abstract

We report what is to the best of our knowledge the first case of malignant transformation of a giant cell tumor of the larynx. The patient, a 34-year-old man, presented to our tertiary care university teaching hospital where he underwent hemilaryngopharyngectomy with radial forearm free flap reconstruction and 11 of 15 cycles of chemotherapy. He remained disease-free at approximately 6 years and 4 months of follow-up. The patient is decannulated and continues to have a good voice with excellent quality of life to this day. We discuss the patient's clinical course and subsequent treatment within the context of a review of the current literature regarding this disease entity. Our experience demonstrates that giant cell tumor of the larynx may present as a malignant neoplasm without adversely affecting the patient's prognosis when treated aggressively with surgical resection and adjunct chemotherapy.

Previous presentation: The information in this article has been updated from its original presentation as a poster at The Triologic Society's Combined Southern and Middle Sections Meeting; January 8-11, 2009; Bonita Springs, Fla.

Primary pleural malignant mesothelioma with delayed metastasis to the piriform sinus: Report of a case

June 11, 2013     Umit Taskin, MD; Ozgur Yigit, MD; Mithat Aricigil, MD; and Gulben Huq, MD
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Abstract

Piriform sinus tumors are uncommon and silent lesions. Their prognosis is poor because these tumors are usually not detected until they have reached an advanced stage. Almost all piriform sinus cancers are primary squamous cell carcinomas; other primary and metastatic tumors of the hypopharynx are exceedingly rare. One of the rare tumors in the laryngopharyngeal area is sarcomatoid carcinoma, which is an unusual type of squamous cell carcinoma. Another uncommon malignant tumor that is histologically similar to sarcomatoid carcinoma is malignant mesothelioma, which is a rare form of lung carcinoma. The macroscopic appearance and histologic characteristics of sarcomatoid carcinoma and malignant mesothelioma are so similar that differentiation is usually achieved by immunohistochemical examination. To the best of our knowledge, no case of primary or metastatic laryngohypopharyngeal malignant mesothelioma has been previously reported in the literature. In this article, we describe a case of isolated malignant mesothelioma of the piriform sinus that resembled a sarcomatoid carcinoma in a 50-year-old man with a history of lung mesothelioma.

Previous presentation: The information in this article has been updated from its original presentation as a poster at the 5th International Consensus Conference on Nasal Polyposis; May 28-31, 2009; Antalya, Turkey.

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