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

July 20, 2015     Kenneth D. Royal, PhD, MSEd; Thomas R. Guskey, PhD
article

Primary melanoma of the petrous temporal bone

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

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
article

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
article

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
article

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
article

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)
article

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...

Use of fluoroscopic guidance to remove a migrating esophageal foreign body

June 4, 2015     Ramanuj Sinha, MS; Utpal Jana, MS; Soumya Ghatak, MS; Gautam Biswas, MS; Jayanta Saha, MS; Indranil Sen, MS
article

Abstract

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.

Dehiscent high jugular bulb attached to the tympanic membrane

June 4, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD
article

The differential diagnosis of high jugular bulb includes cholesterol granuloma, aberrant carotid artery, and tumors such as paraganglioma or schwannoma.

[Editor's note: A partial version of this article was published in the March 2015 issue of ENT Journal as the result of a computer error.]

Nonossifying fibroma (metaphyseal fibrous defect) of the mandible in a 15-year-old boy

June 4, 2015     Abul Ala Syed Rifat Mannan, MD; N. Gopendro Singh, MD; Salah Al-Waheeb, MBBCh, FRCPC, FRCPath; Taher N.M. Taher, MBBCh, BDS, MOMS; Emad El Din A.M. Mohammed, BDS, MSc, PhD
article

Abstract

We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma. Three months later, radiography detected a fracture of the implantation plate. The area was re-explored with curettage of the soft tissue, which on microscopy demonstrated findings similar to the initial curettage findings. Follow-up radiology revealed satisfactory healing of the jaw, and no further recurrence was seen 2 years after the initial surgery. We present this case to highlight the importance of recognizing nonossifying fibroma in the mandible, which can be easily confused with more common mandibular lesions.

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