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.
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.
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.
September 30, 2009 Amy L. Rutt, DO, Xiaoli Chen, MD, and Robert T. Sataloff, MD, DMA, FACS
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Abstract
Primary jugular fossa meningiomas are among the rarest subtypes of meningioma. They are intimately related to the lower cranial nerves, the jugular bulb and vein, and the temporal bone, and they have a tendency to extend both intra- and extracranially. The most common morbidity associated with jugular fossa lesions is lower cranial nerve deficits. In these cases, the differential diagnosis and preoperative radiographic diagnosis are very important because preoperative management and operative planning for the jugular fossa subtype differ considerably from those of other types of meningioma. Because of the rarity of this condition, our understanding of its treatment, long-term follow-up, and recurrence is limited. As experience with radiosurgical treatment of all meningiomas is accumulating, we may find that radiosurgery of jugular fossa meningiomas is appropriate. In the meantime, cure is still possible with complete surgical resection, and surgical morbidity can be minimized through meticulous planning and surgical technique. We describe a case of primary jugular fossa meningioma in a 45-year-old man who presented with complaints of chronic left aural fullness, hearing loss, and difficulty understanding voices. Imaging revealed the presence of a destructive jugular fossa mass. The patient underwent surgical resection without complication, and he was free of recurrence at 1 year of follow-up.
June 30, 2009 Farzad Izadi, MD, Mohammad Reza Azizi, MD, Hadi Ghanbari, MD, Maryam Kadivar, MD, and Behzad Pousti, MD
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Abstract
Laryngeal spindle cell neoplasms are uncommon tumors, frequently misdiagnosed as reactive lesions or mesenchymal malignancies. One of the rare mesenchymal tumors of the larynx is myxoid spindle cell tumor (angiomyxoma), a benign proliferative lesion. It is considered the laryngeal counterpart of the aggressive angiomyxoma of the pelvis and perineum. Although benign, angiomyxomas have a propensity for local recurrence due to their tendency to infiltrate surrounding tissues. They commonly appear encapsulated, but simple enucleation does not provide adequate treatment; excision should include a margin of normal tissue around the tumor. We describe a case of laryngeal angiomyxoma in a 40-year-old man that, to the best of our knowledge, is only the second such case reported in the literature. The tumor in our case showed no histologic evidence of aggressive behavior, but because of the potential for local recurrence, close follow-up was warranted.
June 30, 2009 Lester D.R. Thompson, MD
June 30, 2009 Banu Dogan Gun, MD, Sukru Oguz Ozdamar, MD, Burak Bahadir, MD, and Lokman Uzun, MD
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Abstract
Salivary gland tumors that display myoepithelial differentiation exclusively or predominantly are relatively uncommon, and the assessment of malignancy in a myoepithelial tumor can be difficult. We report a case of parotid gland myoepithelioma composed predominantly of spindle cells with focal capsular invasion. The patient was a 65-year-old woman who presented with a painless mass in the right preauricular region. Histologically, the tumor had a solid and multinodular growth pattern and was predominantly made up of spindle cells with a minor component of epithelioid cells with moderate cellular atypia. Focal regions of tumor cells infiltrated the capsule with tongue-like processes, but tumor infiltration into the adjacent parotid tissue was absent. The tumor cells showed strong cytoplasmic immunoexpression of vimentin, pankeratin, S-100 protein, and smooth-muscle actin. Immunostains with glial fibrillary acidic protein, melanoma marker, epithelial membrane antigen, and carcinoembryonic antigen were negative. Expression of p53 was observed focally in the nuclei of the tumor cells. A final diagnosis of salivary gland myoepithelioma with focal capsular invasion was made, and the case was regarded as a myoepithelial tumor of uncertain malignant potential. In this report, we discuss the histologic criteria required to diagnose malignancy in salivary gland myoepithelial tumors.
May 31, 2009 Jeffrey Tseng, MD, Michelle A. Michel, MD, and Todd A. Loehrl, MD
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Abstract
Esthesioneuroblastoma is a rare malignancy that arises in the olfactory epithelium. We report an interesting case of esthesioneuroblastoma in an 82-year-old man that included an unusual but characteristic imaging feature of this tumor: cysts at the tumor-brain interface. The patient declined primary surgical resection and elected to undergo primary radiation therapy. At 2 years of follow-up, he remained disease-free. The rarity of this tumor and its unique natural history can lead to a complicated assessment of the clinical picture. We review the diagnostic and treatment alternatives.
April 30, 2009 Deba P. Sarma, MD and Eric E. Santos, MD
March 31, 2009 S.K. Kaluskar, MS, FRCS, Rahul Mehta, MS, MRCS, Turlough B. Farnan, MRCS, and S.I. Basha, MS, FRCS
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Abstract
Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Our series included 9 patients with inverted papilloma of the nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mo). Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years of follow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses can be attributed to excellent visualization with the endoscope and to the bloodless dissection achieved with the KTP-532 laser. We emphasize the need for frequent and long-term follow-up of these patients; a thorough endoscopic examination at every visit is extremely important.
March 1, 2009 Anthony Sparano, MD, Portia Kreiger, MD, and Ken Kazahaya, MD
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Abstract
Malignant rhabdoid tumor has been a somewhat controversial entity since it was first described in 1978 as a possible sarcomatous variant of Wilms tumor. Eventually, however, it was found to be a distinct neoplastic tumor with histologic characteristics similar to those of rhabdomyosarcoma. Malignant rhabdoid tumors affect children. Clinically, they occur primarily in the kidney, and they behave aggressively. Associated mortality is significant, even with combined-modality treatment regimens. We describe the case of a large extrarenal malignant rhabdoid tumor of the parapharyngeal space with extension to the infratemporal fossa and skull base in a previously healthy 2-year-old girl who had presented with a cervical mass and ipsilateral Horner syndrome. The patient underwent complete surgical extirpation of the lesion and received adjunctive cisplatin chemotherapy and radiation therapy, and she remained disease-free at 9 months of follow-up. Given the age group of the patients that these neoplasms most commonly affect and given the neoplasms' resemblance to rhabdomyosarcoma and other small round-cell tumors of the head and neck, discussion of the associated clinical pathology, imaging characteristics, histopathologic features, and mode of management are of particular importance, especially so in view of the uncommon location of the tumor in this specific case. Such a discussion may help lead to minimization of misdiagnosis and maximization of therapeutic benefit.
