Tumor

Oncocytoma of the nasal cavity: A case report

March 24, 2013     Mark E. Fons, DO; David Poetker, MD; Paul E. Wakely Jr., MD
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Abstract

Oncocytomas arising in the nasal cavity are quite rare. These entities more commonly occur in the major salivary glands, minor salivary glands, respiratory seromucinous glands, and endocrine organs. Very few cases of oncocytoma in the nasal cavity have been reported, with only 5 diagnosed as malignant. This article describes a case involving an 81-year-old man with a nasal oncocytoma that was completely resected with an endoscopic medial maxillectomy. The diagnostic rationale is discussed, along with a review of the literature.

Mastoid osteoma: A case report and review of the literature

March 24, 2013     Jeffrey Cheng, MD; Roberto Garcia, MD; Eric Smouha, MD
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Abstract

We describe the case of a 22-year-old woman who presented with a slowly growing osseous lesion of the mastoid cortex. On computed tomography, the lesion was found to involve the mastoid cortex, with which it demonstrated similar attenuation. The indications for treatment in this case were the patient's sensation of a mass effect, the encroachment of the mass onto the external auditory meatus, and a cosmetic deformity. The tumor was removed in its entirety via a postauricular approach. Findings on histopathologic examination were consistent with a compact osteoma. Mastoid osteomas are rare, benign tumors. If their growth significantly occludes the meatus, they may cause cosmetic deformities, conductive hearing loss, and recurrent external ear infections. Several other osseous lesions of the temporal bone should be considered in the differential diagnosis. The etiology of mastoid osteomas is poorly understood. Surgical management can be undertaken with minimal postoperative morbidity.

Malignant paraganglioma of the thyroid gland with synchronous bilateral carotid body tumors

February 25, 2013     Nadia Mohyuddin, MD; Karen Ferrer, MD; Urjeet Patel, MD, FACS
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Abstract

We describe a case of primary malignant paraganglioma of the thyroid gland that was found in a 55-year-old woman who had undergone surgery for bilateral carotid body tumors. The paraganglioma was treated with a total thyroidectomy followed by radiation therapy, and the patient was disease-free after more than 2 years of follow-up. Malignant paragangliomas of the thyroid gland are extremely rare. The diagnosis of malignancy is based on histopathologic findings, tumor behavior, and metastasis. These tumors can be misdiagnosed as other types of thyroid malignancies, thus resulting in less than optimal treatment. A genetic etiology was suspected in our patient.

Recurrent Pindborg tumor of the maxilla: A case report and review of the literature

February 25, 2013     Gangadhara Somayaji, MS(ENT); Aroor Rajeshwary, MS(ENT); Sullia Ramesh, MDS; Sullia Dinesh, MDS
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Abstract

We report a case of recurrent Pindborg tumor (calcifying epithelial odontogenic tumor) of the maxilla. The patient was a 34-year-old woman who had been previously diagnosed with Pindborg tumor and treated with curettage. She was subsequently referred to us for evaluation of nasal obstruction. Examination revealed the presence of a mass lesion in the right nasal cavity and right maxilla, which was identified as a recurrence of her earlier Pindborg tumor. The patient was treated with maxillectomy with orbital preservation. Pindborg tumor is a rare odontogenic tumor; when it does occur, it is more often seen in the mandible than in the maxilla. While this tumor is often treated with curettage alone, the aggressive nature of the recurrence in our patient necessitated radical surgery. We report this case to highlight the need to be suitably aggressive in treating these types of tumors in order to avoid recurrence.

Pott puffy tumor in a 5-year-old girl with frontal sinusitis

February 25, 2013     Tanya Rogo, MD, FIDSA; Richard H. Schwartz, MD, FAAP
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Abstract

We describe the case of a 5-year-old girl with a Pott puffy tumor on her forehead. Computed tomography confirmed frontal sinusitis and an epidural abscess. This case is unusual in that the patient's age at presentation was younger than the age when the frontal sinuses are believed to develop.

Intramuscular lipoma of the tongue masquerading as angioedema

January 24, 2013     Ali Amirzadeh, MD; William Klaustermeyer, MD
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Abstract

In most cases, the diagnostic evaluation of angioedema is challenging, as there are many possible etiologies. We report a case of an infiltrating lipoma of the tongue that masqueraded as angioedema. The patient, a 68-year-old man, presented with tongue swelling that had followed a waxing and waning course over a 6-month period. Physical examination showed a diffusely enlarged tongue with no discrete mass. A laboratory evaluation for angioedema was unremarkable. After the patient's condition did not respond to treatment with antihistamines and oral prednisone, a further workup was initiated. Magnetic resonance imaging of the neck and computed tomography of the oral cavity revealed only diffuse enlargement of the tongue. The patient underwent a tongue biopsy, which identified the cause of the swelling to be an infiltrating lipoma of the tongue. Clinicians should be aware that other causes of tongue swelling may mimic angioedema.

Renal cell carcinoma metastatic to the sinonasal region: Three case reports with a review of the literature

October 31, 2012     Pradipta Kumar Parida, MS, DNB, MNAMS
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Abstract

The paranasal sinuses are a rare location for metastases. The most frequent infraclavicular primary tumor to metastasize to the nose and paranasal sinuses is renal cell carcinoma. Three cases of bilateral renal cell carcinoma with metastases to the paranasal sinuses and with destruction of the skull base are reported. These patients had a primary renal cell carcinoma on the left side for which they had undergone a left nephrectomy many years previously. Right-sided renal cell carcinoma was diagnosed only after the patients had developed symptoms secondary to their metastases. These patients presented with the unusual manifestations of frontal swelling, proptosis, and epistaxis. They were offered palliative treatment in the form of radiotherapy and interferon therapy.

Hypoglossal nerve tumor: A rare primary extracranial meningioma of the neck

October 31, 2012     Abu Bakar Zulkiflee, MS; Narayanan Prepageran, FRCS; Omar Rahmat, MS; Pailoor Jayalaskhmi, MPath, FRCPath; Tengku Sharizal, MS
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Abstract

We report a case of primary extracranial meningioma arising from the hypoglossal nerve in a 54-year-old man who presented with a 9-month history of hoarseness and progressive dysphagia. He had also noticed that his tongue was deviated to the left and, as a result, he was having difficulty pronouncing words. Examination revealed fasciculation and muscle wasting on the left side of the tongue. Other cranial nerve functions were normal. Contrast-enhanced computed tomography detected a heterogeneous mass that had arisen above the bifurcation of the left common carotid artery and had extended to near the skull base. Transcervical excision of the tumor was performed, and histopathology identified it as a meningioma of the hypoglossal nerve. The patient recovered uneventfully, and he was without recurrence at more than 2 years of follow-up. A primary extracranial meningioma is extremely rare, and its presentation may be subtle. A thorough investigation is necessary to avoid fatal compressive symptoms.

Juvenile xanthogranuloma of the nasal vestibule

October 8, 2012     Wan-Ling Ho, MD; Kai-Chieh Chan, MD
article

The histopathologic hallmark of juvenile xanthogranuloma is the Touton giant cell, a multinucleated giant histiocyte whose rings of nuclei separate a central homogeneous core from a foamy periphery.

Malignant ossifying fibromyxoid tumor of the parapharyngeal space

October 4, 2012     Neil Tanna, MD, MBA; Nisha Chadha, MD; Raman R. Sharma, BS; Joseph F. Goodman, MD; Nader Sadeghi, MD
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Abstract

Ossifying fibromyxoid tumor (OFMT) is a rare, recently described entity. As such, there is a paucity of information in the literature regarding this neoplasm. According to most reports, the tumor usually develops subcutaneously in the soft tissues of the extremities. Malignant forms of the tumor are far more rare than their benign counterparts. We present a new case of a malignant OFMT of the parapharyngeal space in a 33-year-old Pakistani man. The tumor was excised, and the patient did well with no complications. This case represents a rare occurrence of OFMT of the parapharyngeal space.

Primary meningioma of the middle turbinate: A case report

October 4, 2012     Pradipta K. Parida, MS, DNB; Ramandeep Singh Virk, MS;
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Abstract

Meningioma of the sinonasal tract is a rare entity. Meningioma of the nose and paranasal sinuses may occur in one of two ways: (1) by secondary extension of a primary tumor in the cranial cavity or orbit or (2) primarily in the nose and paranasal sinuses de novo from the ectopic meningocytes derived from pluripotent mesenchymal cells. Primary sinonasal meningiomas are often difficult to diagnose because of their infrequent occurrence. The final diagnosis rests on the histologic examination. We report what is to our knowledge the first case of primary meningioma of the middle turbinate.

Puffed-cheek computed tomography: A dynamic maneuver for imaging oral cavity tumors

September 7, 2012     Nezahat Erdogan, MD; Erdogan Bulbul, MD; Murat Songu, MD; Engin Uluc, MD; Kazim Onal, MD; Melda Apaydin, MD; Huseyin Katilmis, MD
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Abstract

We conducted a prospective study to compare the effectiveness of conventional computed tomography (CT) and puffed-cheek CT in detecting the presence and extension of oral cavity malignant tumors. We enrolled 11 patients—5 men and 6 women, aged 32 to 85 years—who had a primary squamous cell carcinoma of the oral cavity. These tumors were located in the floor of the mouth in 4 patients, in the buccal mucosa in 4, in both the buccal mucosa and retromolar trigone in 2, and in the retromolar trigone only in 1. First, conventional contrast-enhanced axial CT was obtained through the oral cavity and neck in each patient. Next, axial imaging was obtained through the oral cavity while patients inflated their cheeks, pursed their lips, and held their breath. We found that the puffed-cheek CTs provided more information regarding the size and extent of the squamous cell carcinomas than did the conventional CTs. For example, in 8 patients, conventional CT could not differentiate the tumor from the normal mucosal surface, but puffed-cheek images clearly showed the surface of the tumor as distinct from the normal mucosa. More disconcerting was the fact that in the other 3 patients, conventional CTs were evaluated as normal, even though puffed-cheek imaging clearly showed the mass in each case. We conclude that puffed-cheek CT is superior to conventional CT for evaluating the mucosal surfaces of the oral cavity. It provides a clearer and more detailed picture with no downside.

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