Anthracosis: An unusual cause of vocal fold paralysis

July 20, 2015     Sedat Aydin, MD; Ozlem Celebi, MD; Merve Kiroglu, MD; Mehmet Gökhan Demir, MD
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Abstract

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Introduction Anthracosis, a form of pneumoconiosis, is most commonly seen in coal miners, and it is also caused by environmental factors such as air pollution, biomass smoke, and cigarette smoke.1,2 Intrapulmonary lymph-adenopathy (LAP) often occurs in anthracosis, while mediastinal or axillary LAP is rare.3 Dark anthracotic pigmentation in the...

Cervical lipoblastoma: An uncommon presentation

July 20, 2015     Rohaizam Jaafar, MD; Tang Ing Ping, MS(ORL-HNS); Doris Evelyn Jong Yah Hui, MS(ORL-HNS); Mohammad Zulkarnaen Ahmad Narihan, MPath
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Abstract

Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.

Introduction Lipoblastomas are rare, benign, adipose tumors primarily seen in infants and children younger than 3 years old. They are frequently seen in the trunk and extremities. Lipoblastoma has an immature cellular composition and closely resembles low-grade liposarcoma. Symptoms of the lesions in the head and neck vary from painless neck...

Maxillary sinus angiomyolipoma: A case report and overview

July 20, 2015     Steven M. Weindling, MD; David M. Menke, MD; William E. Bolger, MD, FACS
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Abstract

Otolaryngologists are called upon to evaluate and treat sinonasal masses discovered incidentally on imaging studies. Although common conditions such as sinonasal polyps and mucus retention cysts predominate, it is prudent practice to formulate a differential diagnosis to identify unusual conditions. We present a case of a maxillary sinus mass in a 78-year-old man that was discovered incidentally on brain imaging and subsequently identified on biopsy as an angiomyolipoma (AML). AMLs are benign hamartomatous tumors that rarely occur in extrarenal locations. Only a few cases have been reported in the nasal cavity. We believe our case represents the first reported instance of AML arising within a maxillary sinus. Identification of intratumoral fat within the mass on imaging studies may suggest the diagnosis of AML preoperatively. Close interdisciplinary collaboration among the otorhinolaryngology, radiology, and pathology services is beneficial for patient management. We report this case to raise awareness that AML can arise in this previously unreported location. Moreover, we wish to emphasize that AML should be considered in the differential diagnosis when imaging studies demonstrate a well-defined, heterogeneous, fat-containing solitary mass in the nasal cavity or maxillary sinus.

On the appropriateness of norm- and criterion-referenced assessments in medical education

July 20, 2015     Kenneth D. Royal, PhD, MSEd; Thomas R. Guskey, PhD
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Primary melanoma of the petrous temporal bone

July 20, 2015     Jonathan L. McJunkin, MD; Richard J. Wiet, MD, FACS
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Abstract

Melanoma is a malignant tumor of melanocytes that is predominantly found in the skin. In rare cases, it arises from mucosal melanocytes. We describe a case of a solitary melanoma of the petrous apex of the temporal bone in a 67-year-old woman who presented with sudden hearing loss, aural fullness, and headaches, all on the right side. Magnetic resonance imaging identified a mass located at the right petrous apex; the lesion was hyperintense on T1-weighted imaging and isointense on T2 weighting, and it enhanced brightly with gadolinium contrast. The patient underwent removal of the lesion via a transcochlear approach with facial nerve translocation. Intra- and postoperative pathology identified a poorly differentiated malignancy consistent with a melanoma. Further investigations found no evidence of metastasis. Given a concern for residual disease, the patient was treated with radiation to the primary site. To the best of our knowledge, only 1 other case of primary melanoma of the petrous apex has been described in the literature.

Sweet syndrome: A case report and review of the literature

July 20, 2015     Robert B. Contrucci, DO; Donna Bilu Martin, MD
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Abstract

Sweet syndrome (acute febrile neutrophilic dermatosis) is a disorder of unknown etiology. It has been associated with autoimmune processes, malignancies, infections, drug reactions, and gastrointestinal disorders such as inflammatory bowel disease. We describe the case of a 51-year-old man who presented with severe pain in his tongue and throat and referred pain in his right ear, along with odynophagia, fever, and hoarseness of 48 hours'duration. An oral and oropharyngeal examination revealed the presence of aphthous ulcerations, as well as a 3 x 3-cm raised inflammatory lesion on the right anterior lateral tongue and a 5 x 5-mm bulla on the hard palate in the midline. In addition, erythematous papules and macules were noted on his face, neck, and extremities. Cultures, a biopsy, and laboratory tests yielded a diagnosis of Sweet syndrome. The patient was prescribed oral prednisone, and his signs and symptoms resolved within 2 months. Although Sweet syndrome is uncommon, even in dermatology practice, its head and neck and oral manifestations and its association with paraneoplastic disease warrant the need for otolaryngologists to be aware of the condition.

Introduction Sweet syndrome (acute febrile neutrophilic dermatosis) is a severe dermatologic disease. Affected patients pre-sent with an abrupt onset of tender plaques or nodules and accompanying fever, arthralgias, ophthalmologic manifestations, headaches and, in rare cases, oral or genital lesions.

Fetal rhabdomyoma of the tongue in a newborn

July 20, 2015     Nicole L. Aaronson, MD; Julia C.D. Toman, MD; Michael Z. Lerner, MD; Eric D. Baum, MD
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Most extra-cardiac rhabdomyomas in the oral cavity arise in the floor of mouth,

Radiographic findings of a well-differentiated sinonasal neuroendocrine neoplasm: Case report and review of the literature

July 20, 2015     Cui Ping Mao, PhD; Ming Zhang, MD; Chen Niu, PhD; Min Li, MD; Yuan Wang, MD
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Abstract

Typical carcinoid is a rare tumor among other neuroendocrine neoplasms that occur in the nasal cavity. Only a few cases of typical carcinoids in the nasal cavity have been reported. We report a case of typical carcinoid of the nasal cavity in a 61-year-old man who had a history of persistent nasal obstruction and epistaxis for approximately 17 years. Computed tomography revealed a huge, lobulated mass in the nasal cavity with extension into the posterior sphenoid sinus. Extensive bone destruction could be seen in the neighboring sphenoid sinus. MR imaging suggested that the tumor was close to the dura. The final histologic evaluation of the excised biopsy specimen yielded a diagnosis of a well-differentiated neuroendocrine neoplasm (typical carcinoid). In this article, the relevant reports in the literature are reviewed, and the role of radiographic findings on tumor diagnosis and on the establishment of a surgery plan is emphasized.

A rare case of malignant fibrous histiocytoma (pleomorphic undifferentiated sarcoma NOS) of the vocal fold

July 20, 2015     Jin Pyeong Kim, MD; Jin Yong Kim, MD; Gyung Hyuck Ko, MD; Seung Hoon Woo, MD
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Abstract

Malignant fibrous histiocytoma, also known as pleomorphic undifferentiated sarcoma not otherwise specified, arises in numerous organs. The first-line treatment is complete excision of the mass, but in some cases postoperative chemo- and/or radiotherapy is recommended. Only a few cases of malignant fibrous histiocytoma of the vocal fold have been previously reported in the literature. We report a new case, which originated in the true vocal fold of a 65-year-old man. The mass was removed via CO2 laser excision with preservation of the vocal fold and without the need for further treatment. At 3 years of follow-up, the patient remained recurrence-free.

Introduction Malignant fibrous histiocytoma (MFH), also known as pleomorphic undifferentiated sarcoma not otherwise specified (NOS), originates in the interstitial cells that differentiate fibroblasts and histiocytes.1 These tumors are the most common of all the soft-tissue sarcomas seen in adults. Their incidence is highest in the trunk and the...

Duplication of the right internal jugular vein: A case report

June 4, 2015     Srinivasalu Bathala, FRCS(ORL-HNS); Zvoru G. Makura, FRCS(ORL-HNS)
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Abstract

We present a case of duplication of the right internal jugular vein (IJV) in a patient who underwent neck dissection as part of the management of carcinoma of the larynx. The patient was a 63-year-old man who presented to the otolaryngology department with a 7-month history of hoarseness and a 3-week history of noisy breathing. Flexible endoscopy detected a transglottic tumor that had extended beyond the vocal folds. The patient underwent a total laryngectomy and bilateral selective neck dissection at levels II-VI. Intraoperatively, the right IJV was noted to be duplicated. The duplicate segment was approximately 10 cm in length, and it rejoined the normal vein before the normal vein joined the subclavian vein.

Introduction Duplication of the internal jugular vein (IJV) is very rare. Its incidence is only 4 per 1,000 unilateral neck dissections,1 and only a handful of cases have been previously reported in the literature.1-10 We describe a case of duplication of about 10 cm of the IJV, which we believe is the largest such duplication to be reported thus...
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