Primary diffuse large B-cell lymphoma of the ethmoid sinus: A case report

August 27, 2014     Jing-pu Yang, MD; Lian-ji Wen, MD; Chun-shun Jin, MD; Yan Liu, MD
article

Abstract

B-cell lymphoma of the paranasal sinuses is rare. We present the case of a 42-year-old woman who presented with proptosis, diplopia, and vision disturbances in the right eye. She was diagnosed with diffuse large B-cell lymphoma of the ethmoid sinus. We describe the general clinical presentation, diagnosis, and differential diagnosis of this entity, and we review the pathology of diffuse large B-cell lymphoma.

Tympanic membrane perforation with squamous epithelial ingrowth

August 27, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
article

The squamous epithelium of the tympanic membrane and external auditory canal exhibits an inherent migration pattern to facilitate the exfoliation of keratinizing squamous cells as part of a natural cleansing mechanism.

A 67-year-old man presented with right-sided tinnitus and hearing loss. He had first noticed the tinnitus 7 months earlier and described it as an “oohing” sound. It was constant but improved when he was busy or with masking. He denied tinnitus in the left ear. He reported slight right-sided hearing loss but felt his hearing was normal...

Transnasal endoscopic resection of a calcifying cystic odontogenic tumor

August 27, 2014     Daniel Schuster, MD; Joel Cure, MD; Bradford A. Woodworth, MD
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Abstract

Calcifying cystic odontogenic tumor (CCOT) is a rare histologic subtype of odontogenic tumor. Treatment requires complete enucleation. We report what we believe is the first case of CCOT to be removed via a transnasal endoscopic approach. A 16-year-old boy was referred to our department by his dentist for evaluation of an expansile mass of the left maxillary sinus. The dentist had noted an area of hyperlucency of the left palate during a routine examination. Computed tomography confirmed the presence of a large tumor. Complete resection of the tumor was achieved via a transnasal endoscopic surgical approach. Resection of odontogenic tumors is necessary because of their tendency to expand and produce a mass effect on surrounding structures. We believe resection via an entirely transnasal endoscopic approach is a valuable and important technique in the treatment of odontogenic tumors that leaves the patient with a more cosmetically acceptable postoperative appearance.

Acoustic neuroma: An investigation of associations between tumor size and diagnostic delays, facial

August 27, 2014     Marc Olshan, MD, MBA; Visish M. Srinivasan, MD; Tre Landrum, DO; Robert T. Sataloff, MD, DMA, FACS
article

Abstract

We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients-41 men and 55 women, aged 17 to 84 years (mean: 54)-who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.

Non-otogenic lateral sinus thrombosis: A complication of acute sphenoid sinusitis

August 27, 2014     Jessica M. Somerville, MD; Erik Lyman, MD; Jerome W. Thompson, MD, MBA; Rosemary Stocks, MD, PharmD
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Abstract

The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.

Survival characteristics of injected human cartilage slurry in a nude mouse model: A preliminary study

July 13, 2014     Bounmany Kyle Keojampa, MD; Jacob Pieter Noordzij, MD; Bohdana Burke, MD; Joseph Alroy, DVM; Vartan Mardirossian, MD; Alphi Elackttu, MD; Zhi Wang, MD
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Abstract

We conducted a study to examine the viability, host response, and volume retention characteristics of drilled human septal cartilage slurry when injected into an athymic nude mouse model. We injected 0.2 ml of the slurry into the hind limbs of 6 mice. The mice were sequentially sacrificed over a period of 180 days. Histologic reviews of the hind limbs were performed to determine the viability of injected chondrocytes, host response, and volume retention. Specimens were obtained and histomorphologic analysis was performed at 1, 30, 90, and 180 days after injection. We identified viable cartilage throughout the study. Cartilage injection was well tolerated, and minimal inflammatory reaction occurred without significant adverse effects. The injected bolus of cartilage was found to have progressively dispersed throughout the muscle over time. Our findings warrant further investigation with a larger cohort of nude mice or possibly human subjects.

Introduction Unilateral vocal fold paralysis is a significant cause of morbidity. Nerve injury can occur in a variety of ways: as an iatrogenic recurrent laryngeal nerve injury during surgery, as a complication of endotracheal intubation, and as the result of blunt chest/neck trauma, a viral infection, or a tumor of the skull, neck and chest;...

Angiolipoleiomyoma located in the earlobe

July 13, 2014     Sirin Yasar, MD; Zehra Asiran Serdar, MD; Fatih Goktay, MD; Burcu Barutcugil, MD; Selvinaz Ozkara, MD; Pelin Demirturk, MD
article

Abstract

Angiolipoleiomyoma (ALLM) is a solid tumor that is mostly derived from muscle tissue. It is often located in the kidneys of patients with tuberous sclerosis; ALLMs located outside the kidneys are very rare. Among the rare presentations are cutaneous ALLMs, which manifest as 1- to 4-cm asymptomatic, acquired, solitary, subcutaneous nodules that have a strong predilection for males. To the best of our knowledge, only 22 cases of ALLM of the skin have been previously reported in the literature; in 5 of these cases, the tumor was located on the ear. Histologically, tumoral proliferation is observed with smooth muscle, fat tissue, and vascular channels surrounded by a fibrous capsule; cellular atypia is not observed. We report the case of a 67-year-old man who presented for evaluation of a purplish nodular lesion that had been present on his right earlobe for 10 years. Analysis of an excisional biopsy specimen revealed a nodular formation that consisted mostly of thick-walled veins within a fibromyxoid stroma; smooth-muscle tissue and fat globules were observed in places. The lesion was diagnosed as a cutaneous ALLM.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
article

It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Acute vocal fold hemorrhage after phonosurgery

July 13, 2014     Joel E. Portnoy, MD; Catherine Capo, BS; Robert T. Sataloff, MD, DMA, FACS
article

In this case, the KTP laser was used to vaporize the bilateral vocal fold varicosities.

A 48-year-old truck driver presented with hoarseness, vocal fatigue, volume disturbance, and a loss of range following an upper respiratory infection 6 months earlier. Five years previously, he had undergone removal of vocal fold “polyps” elsewhere; he had received no postoperative voice therapy.

Parathyroid adenoma

July 13, 2014     Lester D.R. Thompson, MD
article

Most of these lesions are identified in glands within their usual anatomic location instead of in an ectopic or supernumerary site.

A parathyroid adenoma is a benign neoplasm of parathyroid parenchymal cells. There is an association with the HRPT2 gene (1q25-q31), which is associated with hyperparathyroidism-jaw tumor syndrome (an autosomal dominant disorder). Parathyroid adenoma is the single most common cause of hyperparathyroidism. It is usually seen in patients in the...
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