Rhinology

Solitary extramedullary plasmacytoma of the nasal tract: An unusual cause of epistaxis

June 11, 2013     Kushaljit Singh Sodhi, MD, MAMS, FICR; Niranjan Khandelwal, MD, DipNB, FICR; Vivek Virmani, MD, DipNB, FRCR; Ashim Das, MD; and Naresh Panda, MS
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Abstract

Solitary extramedullary plasmacytoma is a rare hematologic malignancy with nonspecific clinical symptoms and imaging findings. We present a case of this entity that arose in the nasal tract of a 50-year-old man. The tumor was removed surgically, and the patient showed no evidence of recurrence on follow-up. We review the clinical features, imaging and histopathologic findings, and treatment of this rare disease. It is essential for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision and radiation therapy for plasmacytomas can be curative in patients who have no underlying overt plasma cell dyscrasias.

Aneurysmal bone cyst in the middle turbinate: A case report

June 11, 2013     Gokce Simsek, MD; Cem Saka, MD; Didem N. Sonbay, MD; Istemihan Akin, MD; and Fulya Koybasioglu, MD
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Abstract

Aneurysmal bone cyst is a benign and locally destructive bone lesion usually seen in the younger population. Its etiology is unknown. Its yearly incidence rate has been reported to be 0.14/100,000, comprising 1% of all bone tumors. It may develop primarily or arise from primary bone tumors. Hemorrhagic fluid content with a septated appearance is the characteristic feature of aneurysmal bone cyst. It is most commonly seen in the metaphysis of the long bones. In rare cases, the cyst is located in the skull. Primary treatment is surgical excision, and the recurrence rate after treatment is 10 to 30%. Based on a review of the current literature, there have been no previous reports of aneurysmal bone cyst located in the middle turbinate. We report a case of aneurysmal bone cyst with an atypical location and discuss the treatment of the patient with endoscopic surgery in light of relevant literature.

Primary pleural malignant mesothelioma with delayed metastasis to the piriform sinus: Report of a case

June 11, 2013     Umit Taskin, MD; Ozgur Yigit, MD; Mithat Aricigil, MD; and Gulben Huq, MD
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Abstract

Piriform sinus tumors are uncommon and silent lesions. Their prognosis is poor because these tumors are usually not detected until they have reached an advanced stage. Almost all piriform sinus cancers are primary squamous cell carcinomas; other primary and metastatic tumors of the hypopharynx are exceedingly rare. One of the rare tumors in the laryngopharyngeal area is sarcomatoid carcinoma, which is an unusual type of squamous cell carcinoma. Another uncommon malignant tumor that is histologically similar to sarcomatoid carcinoma is malignant mesothelioma, which is a rare form of lung carcinoma. The macroscopic appearance and histologic characteristics of sarcomatoid carcinoma and malignant mesothelioma are so similar that differentiation is usually achieved by immunohistochemical examination. To the best of our knowledge, no case of primary or metastatic laryngohypopharyngeal malignant mesothelioma has been previously reported in the literature. In this article, we describe a case of isolated malignant mesothelioma of the piriform sinus that resembled a sarcomatoid carcinoma in a 50-year-old man with a history of lung mesothelioma.

Previous presentation: The information in this article has been updated from its original presentation as a poster at the 5th International Consensus Conference on Nasal Polyposis; May 28-31, 2009; Antalya, Turkey.

Management of pterygoid venous plexus hemorrhage during resection of a large juvenile nasopharyngeal angiofibroma: A review of 27 cases

April 17, 2013     Lin Chang, MD; Yi Zixiang, MD; Fang Zheming, MD; Lin Gongbiao, MD; Li Zhichun, MD; Zhang Rong, MD; Zhou Aidong, MD; Lan Shuzhan, MD
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Abstract

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

Giant osteoma of the middle turbinate: A case report

April 17, 2013     Samar Pal Singh Yadav, MS(ORL); Joginder Singh Gulia, MS(ORL); Anita Hooda, MDS(Prosthodontics); Ajoy Kumar Khaowas, MS
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Abstract

Osteoma of the nose is a slowly developing benign tumor with a reported incidence of 0.6% of all the osteomas of the nose and paranasal sinuses. It is asymptomatic in initial stages and is usually diagnosed when it causes nasal obstruction. Osteoma arising from the middle turbinate is very rare and only two cases have been previously reported. We report a giant middle turbinate measuring 36 x 35 x 20 mm which, to the best of our knowledge, is the largest reported osteoma arising from the middle turbinate.

Endoscopic view of the posterior septal branch of the sphenopalatine artery

April 17, 2013     Jae Hoon Lee, MD
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Moderate posterior epistaxis can be avoided if the posterior septal branch of the sphenopalatine artery is accounted for when extending the natural ostium inferiorly to a distance greater than approximately 5 mm.

Glomangioma of the nasal septum: A case report and review

April 17, 2013     Magdalena Chirila, MD, PhD; Liliana Rogojan, MD
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Abstract

Glomangioma is a painful, blue-red tumor that appears as a solitary encapsulated nodular mass, almost always on the skin. The first case of nasal glomangioma was reported in 1965. Since then, only 31 other cases have been reported in the literature. We present a new case of glomangioma of the nasal septum in a 61-year-old woman. The tumor was removed via an intranasal endoscopic excision. No recurrence was found at 3 years of follow-up. Our challenge was to distinguish the glomangioma from a true hemangiopericytoma and a paraganglioma.

A case of glomangiopericytoma involving the orbital wall

April 17, 2013     Eun Sun Jung, MD, PhD; Suk-Woo Yang, MD, PhD; Ji-Hong Kim, MD; Soo Whan Kim, MD, PhD
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Abstract

Sinonasal type hemangiopericytomas are very rare tumors, and are often called glomangiopericytoma. They are believed to be derived from perivascular modified smooth muscle cells. Their origin is similar to glomus tumors but some distinct differences exist. Glomangiopericytomas are indolent tumors and overall survival rates are higher after complete surgical excision. Recurrence rates are as high as 30%. We present a case of glomangiopericytoma which involves the orbital wall, noteworthy because such bone-dissolving glomangiopericytomas are extremely rare.

Endoscopic view of a septochoanal polyp

April 17, 2013     Jae Hoon Lee, MD
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Most nasal cavity polyps develop from the mucosa of the anterior ethmoid sinus, the contact areas of the uncinate process, and the middle turbinates.

Intranasal tooth and associated rhinolith in a patient with cleft lip and palate

March 24, 2013     Gisele da Silva Dalben, DDS, MSc; Vivian Patricia S. Vargas, DDS; Bruno A. Barbosa, MSc; Marcia R. Gomide, PhD; Alberto Consolaro, PhD
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Abstract

We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.

Oncocytoma of the nasal cavity: A case report

March 24, 2013     Mark E. Fons, DO; David Poetker, MD; Paul E. Wakely Jr., MD
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Abstract

Oncocytomas arising in the nasal cavity are quite rare. These entities more commonly occur in the major salivary glands, minor salivary glands, respiratory seromucinous glands, and endocrine organs. Very few cases of oncocytoma in the nasal cavity have been reported, with only 5 diagnosed as malignant. This article describes a case involving an 81-year-old man with a nasal oncocytoma that was completely resected with an endoscopic medial maxillectomy. The diagnostic rationale is discussed, along with a review of the literature.

Case report: Metastatic breast cancer presenting as a hypopharyngeal mass

March 24, 2013     Rodrigo Bayon, MD; Sandra K. Banas, MD; Barry L. Wenig, MD, MPH
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Abstract

Although carcinoma of the breast has a propensity toward distant metastasis, metastasis to the head and neck is uncommon. Most patients with metastasis to the head and neck region present with cervical lymphadenopathy; however, spread to the upper aerodigestive tract has been described previously. We present a case of a patient found to have a pedunculated mass in her right piriform sinus. When she swallowed, the mass would completely prolapse into the esophagus and cause symptoms. Subsequent workup revealed widespread metastatic disease, for which the patient was treated with chemoradiotherapy. Microlaryngoscopy with excision of the mass was performed for palliation of her dysphagia, and a diagnosis of metastatic breast carcinoma was obtained. The patient healed well from the excision and went on to be treated for the metastatic breast cancer. To our knowledge, our report represents the first case of metastatic breast carcinoma presenting as severe dysphagia.

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