Tumor

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.

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.

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.

Juvenile xanthogranuloma of the nasal vestibule

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

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.

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