Tumor

Tracheal carcinoid presenting as refractory cervicalgia in a postpartum patient: Correlation versus epiphenomenon

September 7, 2012     Arturo Loaiza-Bonilla, MD; Flavia Rossi, MD; Bassel Alkhalil, MD
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Abstract

Primary tracheal carcinoid tumor is an extremely rare disorder that has been reported only occasionally in the medical literature. We report a case of a 36-year-old African American woman who presented to the emergency department complaining of persistent neck pain for the preceding week. She was 2 weeks postpartum and had no significant medical history. Laboratory workup was unremarkable. Computed tomography and magnetic resonance imaging showed a polypoid mass in the trachea. After bronchoscopy and laser ablation of the mass were performed, the final diagnosis of carcinoid tumor was made. To our knowledge this is the first reported case of this tumor in a postpartum patient. Further studies regarding the interactions between the natural history of carcinoid tumors and pregnancy are warranted. Their infrequency, clinical features, and pathophysiology make tracheal carcinoid tumors a formidable and interesting diagnostic challenge.

Adult extracardiac rhabdomyoma of the parapharyngeal space

September 7, 2012     Aayesha M. Khan, MD; Paula J. Chor, MD; John F. Eisenbeis, MD
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Abstract

Adult extracardiac rhabdomyoma (ER) is a rare, slowly growing, benign tumor of skeletal-muscle origin that has a strong predilection for the head and neck. Complete surgical resection has been proposed as the treatment of choice. We describe a case of adult ER that manifested as a nasopharyngeal mass. The diagnosis was made by transnasal endoscopic biopsy, and the patient was managed conservatively. We discuss the current knowledge regarding the clinical presentation, diagnosis, and treatment of adult ER of the parapharyngeal space, and we propose a new concept for treating this tumor nonsurgically in appropriately selected patients.

Paraganglioma of the palatine tonsil

August 10, 2012     Joshua I. Warrick, MD; David S. Brink, MD; Ronald B. Mitchell, MD
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Abstract

Paragangliomas of the head and neck are rare. We describe the case of an 11-year-old girl who presented with an enlarged right palatine tonsil (grade 4). After a bilateral tonsillectomy, microscopic examination of the right tonsillar tissue revealed well-formed nests of polygonal epithelial cells separated by a collagenous stroma. The tumor cell nuclei were centrally placed and featured finely clumped chromatin and moderate anisonucleosis. Occasional mitotic figures were present. No necrosis was seen. An immunohistochemical staining panel showed no label for keratin, epithelial membrane antigen, HMB-45, or Melan-A; there was a strong label of tumor cells with chromogranin A, synaptophysin, and neuron-specific enolase. The S-100 protein label was strongly positive in the surrounding stromal cells and weakly positive in the polygonal tumor cells. Given the classic histology and the immunohistochemical staining profile, the diagnosis of paraganglioma was made. At 7 months postoperatively, the patient exhibited no evidence of recurrence or metastasis. To the best of our knowledge, no case of a paraganglioma of the palatine tonsil has been previously described in the literature.

Extramedullary plasmacytoma of the true vocal fold

August 10, 2012     Nilantha De Zoysa, MRCS, DOHNS, BS; Belinda Sandler, MRCP, BSc; Kwame Amonoo-Kuofi, MRCS; Rajiv Swamy, FRCPath; Prasad Kothari, MDS, FDSRCS, FRCS(ORL–HNS); George Mochloulis, MD, CCST(ORL–HNS)
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Abstract

We report a rare case of extramedullary plasmacytoma (EMP) of the true vocal fold. Our patient, a 62-year-old woman, presented with dysphonia. On workup, fiberoptic laryngoscopy detected a lesion arising from the anterior half of her left true vocal fold. No evidence of other pathology was noted. The patient underwent radical radiotherapy, and the lesion resolved. Follow-up revealed no sign of recurrence. A type of myeloma, EMP is rare, especially in the larynx. To the best of our knowledge, our patient represents the sixth case of glottic EMP to be reported in the literature.

Management of head and neck paragangliomas: A series of 9 cases and review of the literature

August 10, 2012     Domenico Destito, MD; Sebastiano Bucolo, MD; Alessandra Florio, MD; Carmelo Quattrocchi, MD
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Abstract

We conducted a retrospective study of the long-term functional results of surgery for head and neck paragangliomas. Our study population was made up of 9 patients—4 men and 5 women, aged 22 to 59 years (mean: 46.6; median: 51)—who had undergone surgical excision of a head and neck paraganglioma from January 2002 through December 2006 in the ENT Department at Pugliese-Ciaccio Hospital in Catanzaro, Italy. Of the 9 paragangliomas, 4 were carotid body tumors, 2 were glomus tympanicum tumors, and 3 were glomus vagale tumors. None of the cases was bilateral or hereditary. Complete tumor resection was achieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerve paraganglioma had to be left in situ. The internal carotid artery was preserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid body tumor. Follow-up ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatment of head and neck paragangliomas provided excellent tumor control with low postoperative morbidity, even in patients with large tumors. A wait-and-scan policy may be more appropriate for patients at an advanced age or who are otherwise at high surgical risk, as well as for those whose tumors have recurred following radiotherapy.

Primary solitary extramedullary plasmacytoma of the tongue

July 5, 2012     Cem Onal, MD; Ezgi Oymak, MD; Aysun Uguz, MD; Melek Ergin, MD
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Abstract

Extramedullary plasmacytomas are rare malignancies. Most cases (80%) are seen in the head and neck region, where they represent 1% of all head and neck malignancies. We report a case of an extramedullary plasmacytoma of the tongue that was treated successfully with three-dimensional conformal radiotherapy. The patient was a 50-year-old woman who was admitted to our hospital with bilateral pain and ulceration on the sides of her tongue. Findings on magnetic resonance imaging and positron-emission tomography did not demonstrate any mass within the tongue or any lymphatic or distant metastasis. A tissue biopsy identified a plasma cell neoplasm. The patient was treated with a total dose of 50 Gy delivered in 2-Gy daily fractions. After 54 months of post-treatment follow-up, she exhibited no sign of systemic myeloma or local recurrence. This case is presented not only for the rarity of the tumor type, but also for its unusual location.

Skull base plasmacytoma with conductive hearing loss and an external auditory canal mass

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.

A case of paraganglioma of the recurrent laryngeal nerve

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.

Inflammatory myofibroblastic tumor of the nose and paranasal sinuses masquerading as a malignancy

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.

Mycobacterial tuberculosis superimposed on a Warthin tumor

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.

Germ cell tumor metastatic to the oral cavity

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.

The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity

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.

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