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A large vestibular schwannoma after recent negative MRI: A case report

April 30, 2016  |  Thomas J. Muelleman, MD; James Lin, MD

Abstract

Vestibular schwannomas are, on average, slowly growing tumors that may remain quiescent for some time before manifesting themselves symptomatically or being found incidentally on imaging. We describe a case of a vestibular schwannoma that grew rapidly and to a large size in a patient who had undergone negative imaging 5 years earlier for unrelated issues. This case highlights the importance of repeat imaging in patients with symptoms concerning for vestibular schwannoma who might have previously undergone negative scans.

Metastatic pilomatrix carcinoma: Not so rare after all? A case report and review of the literature

March 16, 2016  |  Daniel M. Walker, MBBS; Samuel Dowthwaite, MBBS, FRACS; Drew Cronin, MBBS; Tristan Molden-Hauer, MBBS; Brent McMonagle, MBBS, FRACS

Abstract

Pilomatrixoma is a slowly growing benign tumor of the dermal hair cells. Metastatic disease is exceptionally rare. Pilomatrixoma can occur at any age, but most patients are older than 40 years at presentation. Approximately 60% of these lesions occur in the head and neck region. Their size is usually about 4 cm at the time of presentation. Surgical excision with adequate margins is still the preferred treatment. We report a case of an aggressive malignant metastatic pilomatrixoma in a 43-year-old woman who underwent multiple extensive local resections. However, she died within 4 months of presentation.

Papillary carcinoma in thyroglossal duct cyst: Two case reports and review of the literature

March 16, 2016  |  Neil S. Patel, MD; Kianoush Sheykholeslami, MD, PhD

Abstract

The thyroglossal duct cyst is one of the more common congenital anterior neck masses. In rare cases, carcinoma has been detected within one of these cysts on histopathologic analysis of resected tissue. Since the incidence of thyroglossal duct cyst carcinoma is low, the appropriate management of the thyroid gland proper is not algorithmic. We present 2 cases of papillary thyroid carcinoma that were discovered in a thyroglossal duct cyst, and we describe the diagnostic and therapeutic measures taken in each case. Particular attention is paid to two points: (1) fine-needle aspiration biopsy may not be sufficient to rule out carcinoma and (2) removal of the thyroid gland may be advisable in selected situations.

Endolymphatic sac tumor in association with von Hippel-Lindau syndrome

March 16, 2016  |  Kevin Shaigany, BS; Alejandro Vazquez, MD; Kelvin M. Kwong, MD; James K. Liu, MD; Robert W. Jyung, MD

Patients with ELST present most commonly with sensorineural hearing loss, tinnitus, and vertigo, in a pattern reminiscent of Ménière disease.

Bilateral intubation granulomas

March 16, 2016  |  Wen-Sen Lai, MD; Yuan-Yung Lin, MD; Yueng-Hsiang Chu, MD, PhD; Jih-Chin Lee, MD

Granulomas typically appear as pale, pedunculated masses, usually found on the posterior one-third of the vocal folds overlying the vocal process of the arytenoid cartilage.

Rhinosporidiosis

March 16, 2016  |  Lester D. Thompson, MD

Surgical treatment is the mainstay of therapy for rhinosporidiosis, but there is a 10% recurrence rate.

Ectopic thyroid tissue simulating metastasis

March 16, 2016  |  Juan S. Gomez, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold R. Neitzschman, MD, FACR

Simultaneous occurrence of maxillary and sphenoid sinus fungus ball

March 16, 2016  |  Jae-Hoon Lee, MD; Ha-Min Jeong, MD

The maxillary sinus is the site most commonly affected by the fungus ball, followed by the ethmoid and sphenoid sinuses.

The effects of round window membrane injury and the use of a model electrode application on hearing in rats

March 16, 2016  |  Murat Koc, MD; Abdullah Dalgic, MD; Mehmet Ziya Ozuer, MD

Abstract

We conducted an animal experiment to investigate the effects of mechanical trauma to the round window with the placement of a model electrode inserted into the scala tympani on the cochlear reserve, and to determine the efficacy of topical steroids in preventing hearing loss in such a situation. Our subjects included 21 male Wistar albino rats that were assigned into three groups of 7 each. In all three groups, an initial mechanical injury to the round window was created. At that point, group 1 received no further treatment, group 2 received a dexamethasone injection into the cochlea, and group 3 underwent implantation of a multichannel cochlear implant guide followed by dexamethasone administration. After a few minutes, the round window opening was obliterated with muscle, and the incision was sutured with 4-0 Vicryl Rapide polyglactin in all 3 groups. Distortion-product otoacoustic emissions were obtained before and immediately after the surgical injury, and again on postoperative day 7. Mean signal/noise ratios (S/Ns) obtained at 2, 3, and 4 kHz were calculated, and datasets were compared with nonparametric statistical tests. We found that the early postoperative mean S/N values were significantly lower than the preoperative values in groups 1 and 2, but there was no difference between the mean preoperative values and those obtained on postoperative day 7 in those two groups. In group 3, there were statistically significant differences among the mean preoperative, early postoperative, and postoperative day 7 S/N values. We observed that an electrode insertion into the cochlea via the round window subsequent to mechanical trauma seemed to cause a progressive hearing loss. Therefore, we conclude that special care must be taken to avoid injury to the round window membrane during placement of a cochlear implant electrode, as well as during surgery for chronic otitis media.

Respiratory epithelial adenomatoid hamartoma of the olfactory groove: A report of 4 cases and a review of the literature

March 16, 2016  |  William G. Albergotti, MD; Alkis J. Psaltis, MBBS (Hons), PhD; Rodney J. Schlosser, MD

Abstract

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion that affects the nasal cavity and paranasal sinuses. We present 4 cases of REAH that involved the olfactory clefts; 1 case was bilateral. Each of the cases was treated surgically, and no recurrence was observed. Most reports have indicated that REAH occurs in the presence of sinonasal inflammation, particularly nasal polyposis, yet all 4 of our cases occurred in the absence of concurrent rhinosinusitis. This suggests that the etiology of REAH is multifactorial. In addition, we review the literature on REAH, and we discuss its presentation, differential diagnosis, radiology, histopathology, and underlying treatment principles.

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