Head and Neck

Cervical presentation of peripheral T-cell lymphoma not otherwise specified

December 19, 2014     Alexander S. Misono, MD; Harrison W. Lin, MD; Linda N. Lee, MD; Judith A. Ferry, MD; James W. Rocco, MD, PhD
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Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is an uncommon type of lymphoma with a clinically aggressive course and a relatively poor prognosis. Many affected patients present with nodal involvement, and there is also potential for extranodal involvement of the liver, gastrointestinal tract, bone marrow, and/or skin. We describe the case of a 68-year-old woman who presented with a 6-week history of an intermittently tender left-sided neck mass. Findings on imaging and fine-needle aspiration biopsy were inconclusive. Pathologic studies of excisional biopsy specimens ultimately revealed the diagnosis of PTCL-NOS. Of the lymphomas, neither PTCL nor the PTCL-NOS subtype is frequently discussed or studied in prospective trials. However, these cases should be identified because of their substantial clinical management implications.

Temporal bone chondrosarcoma: Presentation of 4 cases and review of the literature

December 19, 2014     Duoduo Tao, MD; Matthew R. Hoffman, MD; Bing Chen, MD, PhD
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We describe 4 cases of chondrosarcoma of the temporal bone, which occurred in a 66-year-old man and in 3 women aged 34, 37, and 47 years. One of these patients was originally diagnosed with an epithelial cyst and another with a middle ear neoplasm. Three patients underwent surgical removal of their tumor, while the other patient declined (a craniotomy for biopsy was performed in this case). An accurate diagnosis in all 4 cases was not made until histopathologic examination was performed. None of the patients received postoperative radiotherapy for various reasons. However, the male patient experienced a tumor recurrence, which necessitated a second surgery, and he did receive radiotherapy after the second operation. All 3 operated patients were doing well at the most recent follow-up, and the other patient was soon lost to follow-up. Because of its rarity and potential for severe complications, temporal bone chondrosarcoma remains a difficult disease to diagnose and manage.

A persistent left superior vena cava, with the accessory nerve passing through a duplicate segment of the left internal jugular vein: A unique presentation

October 17, 2014     Omar Ayoub, MSc, FRCSEd(ORL-HNS); Jamie Benton, MRCS; Shaun Jackson, FRCSEd
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Abstract

The internal jugular vein and the spinal accessory nerve are important landmarks during neck dissection; unexpected variations in their positions can result in inadvertent iatrogenic damage to adjacent structures. We report the case of a 79-year-old man who was found during neck dissection to have a duplicate segment of his left internal jugular vein (IJV), a persistent left superior vena cava, and an absent right superior vena cava. The spinal accessory nerve passed through the duplicate section of the IJV. A MEDLINE search found no previously reported case of these anomalies occurring together. We also review 10 previously reported cases of IJV duplication. Finally, we discuss the embryologic and anatomic background of these malformations so that otolaryngologists may be aware that identification of such anomalies may help to prevent postoperative morbidity.

Transoral approach to a deep-lobe parotid tumor

October 17, 2014     Lyndon Gonzalez, BS; Alex Fernandez, MS; Belinda Mantle, MD
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Because of their location in this potential space, parapharyngeal tumors tend to be asymptomatic and remain undetected for a long time.

Complete second branchial cleft anomaly presenting as a fistula and a tonsillar cyst: An interesting congenital anomaly

October 17, 2014     Prasad John Thottam, DO; Samba S. Bathula, MD; Janet M. Poulik, MD; David N. Madgy, DO
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Abstract

Branchial cleft anomalies make up 30% of all pediatric neck masses, but complete second branchial cleft anomalies are extremely rare. We report an unusual case of a complete second branchial cleft anomaly that presented as a draining neck fistula and a tonsillar cyst in an otherwise healthy 3-month-old girl. At the age of 7 months, the patient had been experiencing feeding difficulties, and there was increasing concern about the risk of persistent infections. At that point, the anomaly was excised in its entirety. Our suspicion that the patient had a complete second branchial cleft anomaly was confirmed by imaging, surgical excision, and histopathologic analysis.

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS
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Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

Submental nodular fasciitis: Report of an unusual case

October 17, 2014     Jiun Fong Thong, MRCS(Eng); Tiong Yong Tan, FRCR(UK); Shi Wang, FRCPA(UK); Paul Mok, FRCS(Glasg); David Loke, FRCS(Edin)
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Abstract

A 30-year-old woman presented for evaluation of a hard, enlarging, submental mass that was fixed to the underlying mandible. Fine-needle aspiration cytology initially led to a diagnosis of pleomorphic adenoma, which was unusual given the superficial location of the lesion on computed tomography. The lesion was a well-defined rim-enhancing mass, and it had displaced adjacent structures medially. Intraoperatively, the mass was found to abut against and erode the mandibular cortex. A diagnosis of nodular fasciitis was established by histologic analysis. Such a location for this tumor is unusual. The prognosis for patients with this benign condition is excellent following complete surgical excision. We discuss the clinical presentation and the cytologic, histologic, and radiologic features of this uncommon entity.

Medullary thyroid carcinoma presenting as a supraglottic mass

October 17, 2014     Jeremy White, MD; Ahmed Mohyeldin, MD, PhD; Arnold Schwartz, MD, PhD; Steven Bielamowicz, MD
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Abstract

We report a rare case of medullary thyroid carcinoma that presented as a metastasis to the supraglottic larynx. A 92-year-old man with a 3-month history of voice change and airway obstruction was diagnosed with medullary thyroid carcinoma metastatic to the supraglottis. Excision of the mass, total thyroidectomy, and elective neck dissection were recommended, but the patient declined because of his advanced age. Medullary carcinoma of the thyroid gland is a rare neuroendocrine tumor with a poor prognosis when associated with a distant metastasis. To the best of our knowledge, this is the first case of a medullary carcinoma of the thyroid presenting as a supraglottic mass. Total thyroidectomy, neck dissection, and surgical excision of the entire tumor comprise the treatment of choice.

Castleman disease of the parotid gland in a pediatric patient: A case report

October 17, 2014     Sudesh Kumar, MS, DNB; Rashid Al Abri, MD, FRCS; Nasreen Abdul Kadir, MD; Dilani Lokuhetty, MD
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Abstract

Castleman disease, also called angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Affected patients usually present with mediastinal lymphadenopathy; sometimes other groups of lymph nodes are involved, with or without associated systemic manifestations. We report a case of Castleman disease involving the intraparotid lymph node in a 15-year-old boy who presented with a 3-month history of a painless swelling of the right parotid gland. Fine-needle aspiration cytology of the mass revealed only reactive hyperplasia. The diagnosis of Castleman disease was established on histopathologic examination of the resected mass. We discuss the clinical course, histopathologic features, radiologic characteristics, and management of Castleman disease of the parotid gland in a pediatric patient.

Mesenchymal chondrosarcoma of the mandible: A rare malignant tumor

September 17, 2014     Rakesh Kumar Singh, MS; Saurabh Varshney, MS; Sampan Singh Bist, MS; Meena Harsh, MD; Nitin Gupta, MD
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Abstract

Mesenchymal chondrosarcoma (MCHS) is a highly aggressive, malignant, cartilaginous tumor that represents about 1% of all chondrosarcomas. Only about 50 cases of MCHS of the jaw have been reported in the English-language literature; maxillary tumors are much more common than mandibular tumors. We present a new case of MCHS of the mandible that arose in a 22-year-old woman whose initial two biopsies did not reveal the features of the tumor. The diagnosis was made only after an incisional biopsy.

A rare case of ameloblastic carcinoma

September 17, 2014     Michael Yunaev, MBBS; Muzib Abdul-Razak, FRCS(Edin); Hedley Coleman, FFOP(RCPA); Yaroslav Mayorchak, MBBS; Ian Kalnins, FRACS
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Abstract

Ameloblastic carcinoma is a rare type of ameloblastoma that has received little mention in the literature. While a number of cases have been published over many years, no institution has been able to produce a substantial case series. Ameloblastic carcinoma originates in the embryonic tooth components. It is believed to be an aggressive tumor that can metastasize; once metastasis occurs, the prognosis tends to be poor. Ameloblastic carcinoma is primarily a surgical condition that is best treated with resection; there has been little indication that other modalities are helpful. We present the case of a 40-year-old woman who was found to have a mandibular lesion by a dentist. After surgical resection, the tumor was found to be an ameloblastic carcinoma. The patient recovered without complication, and she was recurrence-free 18 months postoperatively. We also briefly review the available literature on the natural history of and management options for this rare tumor.

Waldeyer ring lymphoma: A case series

September 17, 2014     Carren S.L. Teh, MBBS, MS(ORL-HNS); Pailoor Jayalakshmi, FRCPath; Sheldon Y.C. Chong, MBBS, MS(ORL-HNS)
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Abstract

We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.

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