Tumor

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.

Solitary extramedullary plasmacytoma of the nasal tract: An unusual cause of epistaxis

June 11, 2013     Kushaljit Singh Sodhi, MD, MAMS, FICR; Niranjan Khandelwal, MD, DipNB, FICR; Vivek Virmani, MD, DipNB, FRCR; Ashim Das, MD; and Naresh Panda, MS
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Abstract

Solitary extramedullary plasmacytoma is a rare hematologic malignancy with nonspecific clinical symptoms and imaging findings. We present a case of this entity that arose in the nasal tract of a 50-year-old man. The tumor was removed surgically, and the patient showed no evidence of recurrence on follow-up. We review the clinical features, imaging and histopathologic findings, and treatment of this rare disease. It is essential for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision and radiation therapy for plasmacytomas can be curative in patients who have no underlying overt plasma cell dyscrasias.

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.

A case of glomangiopericytoma involving the orbital wall

April 17, 2013     Eun Sun Jung, MD, PhD; Suk-Woo Yang, MD, PhD; Ji-Hong Kim, MD; Soo Whan Kim, MD, PhD
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Abstract

Sinonasal type hemangiopericytomas are very rare tumors, and are often called glomangiopericytoma. They are believed to be derived from perivascular modified smooth muscle cells. Their origin is similar to glomus tumors but some distinct differences exist. Glomangiopericytomas are indolent tumors and overall survival rates are higher after complete surgical excision. Recurrence rates are as high as 30%. We present a case of glomangiopericytoma which involves the orbital wall, noteworthy because such bone-dissolving glomangiopericytomas are extremely rare.

Giant jugular foramen tumor

April 17, 2013     Wen-Sen Lai, MD; Jih-Chin Lee, MD; Chih-Hung Wang, MD, PhD; Yueng-Hsiang Chu, MD, PhD
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Jugular foramen syndrome is characterized by unilateral paralysis of the glossopharyngeal, vagus, and accessory nerves, which emerge in a line from the medulla oblongata and then run at the lateral part of the jugular foramen, where they leave the posterior cranial fossa.

Huge hibernoma of the neck with extension into the mediastinum

April 17, 2013     Ramanuj Sinha, MS, DNB; Saumik Das, MS, DNB; Pranabashish Banerjee, MS, MRCS; Atish Halder, DLO, MS; Mainak Dutta, MS
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Abstract

Hibernomas are benign tumors made up of brown fat. They are rarely encountered in otolaryngologic clinical practice, as they are usually located in the interscapular area, axilla, thigh, mediastinum, and retroperitoneum. We report an extremely rare case of a very large hibernoma in a 45-year-old man who presented with a 4-year history of neck swelling. Radioimaging was suggestive of a mass in both parapharyngeal spaces; the lesion was more prominent on the left side. The mass extended from C2 into the retropharyngeal space and superior mediastinum. Fine-needle aspiration cytology failed to yield a diagnosis. On surgical exploration, a tumor measuring 17 x 16 x 5 cm was removed and sent for histopathologic examination. Light microscopy was suggestive of a hibernoma. Staining with oil red O confirmed the diagnosis. To the best of our knowledge, a large hibernoma with such massive extension has not been previously reported in the literature.

Endolymphatic sac tumor

April 17, 2013     Lester D.R. Thompson, MD
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Giant osteoma of the middle turbinate: A case report

April 17, 2013     Samar Pal Singh Yadav, MS(ORL); Joginder Singh Gulia, MS(ORL); Anita Hooda, MDS(Prosthodontics); Ajoy Kumar Khaowas, MS
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Abstract

Osteoma of the nose is a slowly developing benign tumor with a reported incidence of 0.6% of all the osteomas of the nose and paranasal sinuses. It is asymptomatic in initial stages and is usually diagnosed when it causes nasal obstruction. Osteoma arising from the middle turbinate is very rare and only two cases have been previously reported. We report a giant middle turbinate measuring 36 x 35 x 20 mm which, to the best of our knowledge, is the largest reported osteoma arising from the middle turbinate.

Glomangioma of the nasal septum: A case report and review

April 17, 2013     Magdalena Chirila, MD, PhD; Liliana Rogojan, MD
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Abstract

Glomangioma is a painful, blue-red tumor that appears as a solitary encapsulated nodular mass, almost always on the skin. The first case of nasal glomangioma was reported in 1965. Since then, only 31 other cases have been reported in the literature. We present a new case of glomangioma of the nasal septum in a 61-year-old woman. The tumor was removed via an intranasal endoscopic excision. No recurrence was found at 3 years of follow-up. Our challenge was to distinguish the glomangioma from a true hemangiopericytoma and a paraganglioma.

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.

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.

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