Nasopharynx

Solitary nasal schwannoma clinically presenting as an angiofibroma of the nasopharynx

June 30, 2010     S.C. Gupta, MS, Jain Sachin, MS, Saxena Savyasachi, MS, Jaiswal Ritesh, MBBS, Garg Neha, MBBS, and Himanshu P. Singh, MBBS
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Abstract

Benign schwannomas of the nasal cavity are rare. When they do occur, their clinical presentation is variable, and some are fairly vascular. We report the case of a 17-year-old boy who presented with epistaxis associated with a unilateral nasal mass that extended into the nasopharynx. The tumor was removed via a transpalatal approach. In most such cases, a clinical diagnosis of angiofibroma is made. In this case, however, histopathologic examination identified the lesion as a schwannoma.

Combined endoscopic and transoral resection of a primary nasopharyngeal paraganglioma

April 30, 2010     Eugene A. Chu, MD, William H. Westra, MD, Nafi Aygun, MD, and Nasir I. Bhatti, MD
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Abstract

We present what to the best of our knowledge is only the fourth case of a primary nasopharyngeal paraganglioma to be reported in the literature, and we describe a novel surgical approach to its removal. The patient was a 53-year-old woman who presented with a nasopharyngeal mass. A subtotal resection and biopsy of the mass identified it as a paraganglioma. The remainder of the tumor was completely excised via a combined transnasal endoscopic and transoral approach that allowed us to spare the palate. The total operating time was less than 90 minutes. Blood loss was estimated at 300 ml, and there were no intraoperative or postoperative complications. At follow-up 12 months later, endoscopic examination and imaging found no residual or recurrent tumor.

Dermoid of the nasopharynx: An unusual finding in an older child

March 31, 2010     Eyal Russo, MD, Hananya Vaknine, MD, and Yehudah Roth, MD
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Radiologic findings after successful chemoradiation for nasopharyngeal cancer with skull base erosion

January 1, 2010     Federico Ampil, MD, Guillermo Sangster, MD, Glenn Mills, MD, Cherie Ann Nathan, MD, Timothy Lian, MD, and Andrew Hall, BS
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Abstract

Nonoperative management is generally accepted as a treatment strategy for nasopharyngeal cancer characterized by destruction of the skull base. Chemoradiotherapy is considered the standard of care in these cases. We report a case in which imaging studies documented the successful treatment of the patient's locally extensive nasopharyngeal carcinoma with this nonsurgical approach.

Synchronous presentation of extramedullary plasmacytoma in the nasopharynx and the larynx

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.

A case of nasogastric tube perforation of the nasopharynx causing a fatal mediastinal complication

August 31, 2009     Ohad Ronen, MD and Nechama Uri, MD
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Abstract

Iatrogenic nasopharyngeal perforations secondary to improper nasogastric tube insertion probably occur more frequently than has been reported. Our review of the literature found very few cases. We report the case of a 79-year-old woman who died of mediastinal complications following the improper insertion of a nasogastric tube that resulted in a nasopharyngeal perforation. We also review the proper technique for inserting these tubes.

Nasopharyngeal angiofibroma: Rare presentations

December 1, 2008     Ramanuj Sinha, MS (ENT), DNB (ENT), Saumik Das, MS (ENT), DNB (ENT), Sanjay Ray, MBBS, Pranabashish Banerjee, MBBS, and Partha Sadhu, MS (ENT)
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Abstract

Nasopharyngeal angiofibromas are benign tumors of the nasopharynx that occur in adolescent boys. The extensive extensions and various clinical presentations of the tumor have been well documented in the literature. Very rarely, these tumors may extend outside the nasal cavity as a large polypoid mass. Two interesting cases of angiofibroma with atypical presentations, showing extensive spread in multiple directions, are reported here. In one case, the angiofibroma exited the right nostril as a large polypoidal mass and also presented as an intraoral tumor in the right upper gingivo-alveolar region. In the other case, in addition to polypoidal presentation through the anterior nares, the tumor produced severe respiratory obstruction resulting from extensive bulging of the soft palate.

Nasopharyngeal neuroendocrine carcinoma: A case report

December 1, 2008     Ali Reza Mohebbi, MD, Ahmad Daneshi, MD, and Ali Reza Emami, MD
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Abstract

Neuroendocrine carcinoma is a type of neuroendocrine system neoplasm that occurs in organisms in which amine precursor uptake and decarboxylation (APUD) cells are uncommon. In the human body, the most common sites of neuroendocrine carcinoma are the gastrointestinal tract and the lungs. From a histologic standpoint, these tumors are identified by their positive reaction to silver stains and specific markers for neuroendocrine tissues, such as chromogranin A, synaptophysin, and neuron-specific enolase. In addition to local symptoms, these tumors may cause flushing, wheezing, and episodic diarrhea secondary to the release of vasoactive substances. Our medline search encompassing the 20-year period prior to 2003 found few cases of this type of tumor in the paranasal sinuses and nasal cavities and only 1 case of an isolated neuroendocrine carcinoma in the nasopharynx. We describe another case of an isolated nasopharyngeal neuroendocrine carcinoma, which we observed in a 74-year-old woman. We review the clinical presentation and the surgical and systemic treatment.

Small-cell neuroendocrine carcinoma originating from the lateral nasopharyngeal wall

October 31, 2008     Shetty Deviprasad, MS (ENT), DLO, Aroor Rajeshwari, MS (ENT), Mohammed Tahir, MS (ENT), T.V. Adarsha, DLO, DNB (ENT), and Somayaji Gangadhara, MS (ENT)
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Abstract

A 40-year-old man presented with right-sided nasal blockage and epistaxis of 18 months' duration. Examination revealed a pinkish mass in the right nasal cavity and nasopharynx. Initial biopsy was suggestive of angiofibroma. Complete excision through a lateral rhinotomy approach was performed. The postoperative histopathologic report was suggestive of sinonasal neuroendocrine carcinoma, which was confirmed by immunohistochemistry. To the best of our knowledge, this is the first reported case of sinonasal neuroendocrine carcinoma arising from the lateral wall of the nasopharynx in the English literature. We describe its clinical presentation and management and provide a brief review of the literature.

Juvenile nasopharyngeal angiofibroma: Spontaneous resolution

August 31, 2008     Patrick M. Spielmann, MRCSEd, Richard Adamson, FRCS, Kenneth Cheng, MRCS, and Robert J. Sanderson, FRCS†
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Abstract

Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Common practice is to excise the tumor with open or endoscopic surgery. We report the case of a 17-year-old male who presented in 1995 with a mass filling the left posterior nasal cavity. A diagnosis of juvenile nasopharyngeal angiofibroma was obtained with computed tomography and magnetic resonance imaging. The patient elected to have no treatment. On annual scans, the lesion changed little until 1998, when it began to gradually decrease in size. Although it is not well proven, the natural history of these tumors seems to be regression over time. This case supports the argument that a policy of watchful waiting with regular imaging studies may postpone or eliminate the need for surgery and its attendant risks.

Ectopic nasopharyngeal pituitary adenoma resected with endoscopic technique

June 30, 2008     Alan A.Z. Alexander, MD, Nikta Niktash, MD, David E. Kardon, MD, and Nader Sadeghi, MD
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Abstract

We describe the case of an 80-year-old man with diabetes who presented with nonspecific dizziness. He was found on magnetic resonance imaging to have a 3.2-cm mass within the posterior and central aspect of the nasopharynx. Nasal endoscopy showed that the mass, which arose from the posterior edge of the nasal septum and was attached to the superior nasopharynx, was narrowing the patient's airway. Although initially the mass was suspected to be a minor salivary gland tumor, histopathologic analysis led to a diagnosis of pituitary adenoma. The ectopic tumor was removed via transnasal en bloc resection with partial adjacent septal resection. Final pathology confirmed the diagnosis. The patient had an uneventful recovery and no sequellae at 2-year follow-up.

Nasopharyngeal angiofibroma

April 30, 2008     Ryan Kau, BS, Mala Tanna, BA, Sasmita Misra, MD, and Alejandro Luina Contreras, MD
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