July 5, 2012 Andrew I. Ahn, MD; Mary K. Wren, MD; Ted A. Meyer, MD, PhD
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Abstract
Skull base plasmacytomas are rare and difficult to differentiate clinically and radiologically from other tumors of the head and neck. Because of the risk of progression to multiple myeloma, early diagnosis is essential. We report the case of a 65-year-old woman who presented with left-sided conductive hearing loss and an external auditory canal mass. The tumor was removed along with much of the tympanic membrane, and it was found to be a plasmacytoma. The patient was subsequently diagnosed with multiple myeloma and treated with chemoradiation before being lost to follow-up.
June 4, 2012 Samuel J.C. Fishpool, MRCS, MEd; Philip Wilson, MRCPath; Peter A. Williamson, FRCS
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Abstract
Paragangliomas are rare neuroendocrine tumors that derive from the extra-adrenal paraganglia. In the head and neck region, these neoplasms most commonly arise from the carotid body, the vagus nerve, and the jugulotympanic area. We describe the case of an 87-year-old woman with an incidental finding of a clinically, radiologically, and cytologically presumed retrosternal goiter. During a left thyroid lobectomy, she was found to have a mass that originated in the left recurrent laryngeal nerve. The mass was resected, and subsequent histopathologic examination found it to be a paraganglioma. Follow-up evaluation confirmed the expected finding of a left-sided vocal fold palsy. To the best of our knowledge, this is the first reported case of a paraganglioma arising from a recurrent laryngeal nerve.
April 30, 2012 Mohamed Amin, MD, FRCSI; Rohana Ali, AFRCS; Susan Kennedy, MD; Conrad Timon, MD, FRCSI
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Abstract
Inflammatory myofibroblastic tumor (IMT) of the nose and paranasal sinuses is a rare entity that exhibits a diverse histologic pattern that can mimic malignant tumors clinically and radiologically. We present a case of IMT in an 88-year-old man who presented with an aggressive tumor-like lesion in the nose and paranasal sinuses that had a malignant appearance on radiology. We discuss this tumor's clinicoradiologic resemblance to a malignancy, and we review the treatment options following careful histologic and immunohistochemical analysis.
April 30, 2012 Kang-Chao Wu, MD; Bo-Nien Chen, MD
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Abstract
The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.
March 31, 2012 Luis Lee, MD, Randy Oppenheimer, MD, and Lakshmi Jayaram, MD
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Abstract
Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.
March 1, 2012 Mehmet Haksever, MD, Hasan Mete İnançlı, MD, Ümit Tunçel, MD, Şefik Sinan Kürkçüoğlu, MD, Melek Uyar, MD, Ömer Genç, MD, and Çiğdem Irkkan, MD
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Abstract
Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.
March 1, 2012 Demet Etit, MD, Nese Ekinci, MD, Ayca Tan, MD, Deniz Altinel, MD, and Filiz Dag, MD
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Abstract.
The epidemiology of salivary gland tumors worldwide is not very well defined. Although many studies on this subject have been undertaken, the data are generally focused on specific topics such as parotid gland neoplasms or tumors of the major salivary glands. We conducted a study to establish the prevalence and distribution of benign and malignant neoplasms of both the major and minor salivary glands at a single institution. We reviewed 244,204 cases that had come through our pathology department from January 1994 through December 2005 and found 235 cases of a salivary gland neoplasm (0.09%). The female-to-male ratio was 1.04:1, and the mean age of the patients was 47 years. Of the 235 neoplasms, 159 (67.66%) were located in the parotid gland, 34 (14.47%) in the submandibular gland, and 42 (17.87%) in the minor salivary glands. A total of 146 tumors (62.13%) were benign and 89 (37.87%) were malignant. Pleomorphic adenoma was the most common neoplasm, occurring in 98 cases (41.70%). The most common malignancy was mucoepidermoid carcinoma, with 27 cases (11.49%). Our data demonstrate that the characteristics of salivary gland tumors in a Turkish population at a single institution are similar to those reported in the literature worldwide.
March 1, 2012 Andrew J. Ebelhar, BS and Arun K. Gadre, MD, FACS
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Single osteomas can be removed surgically via one of two routes, depending on their location. Those arising lateral to the isthmus of the external auditory canal can be removed under local anesthesia using a transmeatal approach; those arising medial to the isthmus should be removed under general anesthesia using a postauricular approach.
January 1, 2010 Lakshmi Vaid, MBBS, MS, Manish Gupta, MBBS, MS, Neelima Gupta, MBBS, MS, and P.P. Singh, MBBS, MS
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Abstract
Cervical lymphangioma in adults is a rare, benign tumor. Traditionally, the most accepted treatment has been surgical excision. However, when lymphangioma infiltrates vital neurovascular structures, excision is difficult and recurrence rates are high. The most common alternate treatment is intralesional injection of sclerosing agents, which has resulted in good outcomes in children. However, until now, no report of such treatment in adults has been published. We describe the case of a 60-year-old woman who presented with two lymphangiomas in the cervical area-one in the upper cervical area just below the angle of the mandible and the other in the submental area. She was treated with an intralesional injection of 1 mg/kg of bleomycin at both sites. Fifteen days later, the submental swelling had remitted completely and the other swelling had been reduced by 50%; 2 weeks later, a second injection was administered to the remaining swelling. At 6 months of follow-up, both lymphangiomas were in complete remission.
January 1, 2010 Sohit P. Kanotra, MS, Sonika Kanotra, MS, J. Paul, MS, and Padam S. Jamwal, MS
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Abstract
Chondrosarcoma is the most frequently encountered nonepithelial tumor of the larynx. Still, laryngeal chondrosarcoma is a rare disease, accounting for less than 1% of all laryngeal neoplasms; only about 600 cases have been reported in the world literature. The two most common sites of origin are the cricoid cartilage (69% of cases) and the thyroid cartilage (9%); arytenoid cartilage origin has been seen in less than 3% of cases. The diagnosis of laryngeal chondrosarcoma is easy to miss because of its infrequent occurrence, its indolent pattern of growth, and the difficulty in differentiating it histopathologically from chondroma. However, suspicion of arytenoid chondrosarcoma may be raised by a finding of its characteristic appearance as a smooth, hard, mucosa-covered supraglottic mass that is fairly recognizable on indirect laryngoscopy. We report a new case of chondrosarcoma of the arytenoid cartilage in a 47-year-old man, and we discuss the clinical features, diagnosis, and management of this uncommon tumor.
December 1, 2009 Olivier Choussy, MD, Emmanuel Babin, MD, PhD, Angélique De Barros, MD, Nicolas Bon-Mardion, MD, Jean-Paul Marie, PhD, and Daniàle Dehesdin, MD
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Abstract
Vagal paragangliomas are rare in the head and neck. Complementary use of computed tomography and magnetic resonance imaging can facilitate the diagnosis and help determine the best management approach. Most paragangliomas should be treated with surgery. We report a case of vagal paraganglioma of the neck in a 50-year-old man. The patient was treated with superficial parotidectomy via a transcervical approach. No postoperative morbidity was noted, and at 3 years of follow-up, he was free of disease.
October 31, 2009 Mete Iseri, MD, Murat Ozturk, MD, and S. Arif Ulubil, MD
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Abstract
Simultaneous extramedullary plasmacytoma of the nasopharynx and larynx is exceedingly rare; to the best of our knowledge, only 1 other case has been previously reported. We report a new case, which occurred in a 46-year-old woman. She was treated with a combination of surgery, radiotherapy, and chemotherapy. At 2 years of follow-up, no evidence of recurrence or progression to multiple myeloma was noted. We discuss the clinical features and treatment of plasma cell neoplasms in general and their three variants in particular.
