February 25, 2013 Lorraine Williams-Smith, MD, FACS; Reena Gupta, MD, FACS; and Ryan F. Osborne, MD, FACS
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It is important to remember that parotid lymphomas do occur and should be considered in the differential diagnosis for parotid masses.
February 25, 2013 Mia E. Miller, MD; Andrew A. McCall, MD; Guy F. Juillard, MD; Celina M. Nadelman, MD; Marilene B. Wang, MD; Vishad Nabili, MD
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Abstract
We describe the case of a 55-year-old man with known multifocal hepatocellular carcinoma (HCC) who presented with a painful mandibular mass. Fine-needle aspiration cytology of the mass revealed the presence of bile canaliculi and bile formation, an extremely rare finding. Findings on immunoperoxidase staining of the aspirate were consistent with an HCC. Since the patient was known to have multiorgan metastatic disease, he was administered palliative radiation therapy to the mandibular metastasis for pain control, which was achieved. One year after presentation, the patient died as a result of disease progression. HCC rarely metastasizes to the mandible, as only about 70 such cases have been reported in the literature. We discuss the histopathologic appearance of HCC metastatic to the mandible, the radiologic findings, and the established treatment modalities.
February 25, 2013 Parvathidevi K. Gollahalli, SSAHE; Panduranga Chikkannaiah, MD, SSAHE; Vamseedhar Annam, MD, SSAHE
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Abstract
We report a case of papillary carcinoma of the thyroid that arose in a branchial cyst. The patient, a 45-year-old woman, presented with a left lateral neck mass of 3 months' duration. The cyst was removed intact. Because we could not rule out the possibility that a small primary malignancy was present within the gland, we performed a total thyroidectomy; however, no occult primary tumor of the thyroid was found. The patient was placed on thyroid hormone replacement therapy, and she was well at 2 years of follow-up. We briefly review the literature regarding the possible embryologic origin of such a phenomenon and the role of fine-needle aspiration cytology in differentiating a branchial cyst from a metastatic lymph node. To the best of our knowledge, this is only the 11th reported case of a thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst, and the second such report from India.
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.
January 24, 2013 Luiz O.M. Coelho, MD; Sergio E. Ono, MD; Arnolfo de Carvalho Neto, PhD; Christiane S. Kawasaki, MD; Luciano V. Sabóia, MD; Maria F. Soares, MD
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Abstract
We report a case of histology-proven pleomorphic adenoma of the parapharyngeal space in a 20-year-old man. This case was unusual in that a massive amount of dystrophic calcification was scattered throughout the tumor. The patient underwent successful surgical resection, and he exhibited no signs of recurrence during follow-up. Literature about such an unusual presentation is scarce.
January 24, 2013 Lorena Garza Garcia, MD; Enrique Palacios, MD, FACR; Alexander Quiroz-Casian, MD; Harold Neitzschman, MD, FACR
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Patients with the hyaline vascular variant of Castleman disease tend to be asymptomatic, although some have complained of symptoms caused by compression of adjacent structures, and others have reported a palpable mass.
January 24, 2013 Brandon E. Fornwalt, BS; Jerald S. Altman, MD
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Abstract
Parry-Romberg syndrome is an uncommon degenerative disorder characterized by a slow and progressive atrophy of the subcutaneous tissue on one side of the face. Its etiology is unknown, and there is no cure. It is usually seen in children. Surgical reconstruction is often the best treatment option, and a wide variety of techniques have been employed. It is often difficult to diagnose Parry-Romberg syndrome because its signs and symptoms overlap with those of several other disorders. We describe a case of Parry-Romberg syndrome in a 42-year-old woman, whose age at onset was the unusual feature of this case.
January 24, 2013 Ashu Bhalla Seith, MD, MAMS; Ankur Gadodia, MD, DNB, MNAMS, FRCR; Raju Sharma, MD, MNAMS; Rajinder Parshad, MS
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Abstract
Congenital agenesis of the parotid gland is rare, and its association with accessory parotid tissue is even rarer. We report an unusual case of unilateral agenesis of the left parotid gland associated with pleomorphic adenoma of the left accessory parotid gland. To best of our knowledge, this is only the second such published case in the literature.
January 24, 2013 Christopher V. Lisi, MD; Tré Landrum, DO; Robert T. Sataloff, MD, DMA, FACS
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Facial nerve injury with resulting facial paralysis is perhaps the most feared complication of middle ear and mastoid surgery.
January 24, 2013 Abby R. Nolder, MD; Amit Agarwal, MD; Emily Howard, MD, PhD; Gresham T. Richter, MD
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Abstract
Cervical ectopic thymus is a rare cause of solid neck masses in children. Most children are asymptomatic, but some may present with a palpable neck mass, with or without compressive symptoms. Cervical ectopic thymus is often discovered incidentally and mistaken for an infection or neoplasm. We present the case of an infant with retropharyngeal ectopic thymus and describe our intraoral surgical approach.
December 31, 2012 Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
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Encephaloceles arise when brain contents from the temporal lobe herniate through the middle cranial fossa and into the lateral sphenoid sinus.
December 31, 2012 Daniel T. Ganc, MD; Charles Prestigiacomo, MD; Soly Baredes, MD
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Abstract
We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.
