Malakoplakia of the neck

Malakoplakia that presents in the head and neck is very rare. We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia. To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck. Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host. The symptoms are nonspecific and the diagnosis is based on the histologic findings. In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia. Bacteriologic analysis identified Escherichia coli. The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.     

Malakoplakia of the parotid gland

Xanthogranulomatous inflammation is an ubiquitous process that is most commonly observed in the kidney but may be observed in other organs. We report a case of xanthogranulomatous inflammation occurring in an enlarged parotid gland of a 65-year-old man as a result of salivary duct obstruction from sialolithiasis. We discuss the common histologic features and probably common aetiology of several inflammatory xanthograulomatous processes including malakoplakia.     

Malakoplakia of the tongue--a case report

Malakoplakia of the tongue occurring in a nine year old Caucasian boy is reported. This rare chronic inflammatory disease usually occurs in the urinary tract, especially the bladder, and is uncommon in children. Presenting symptoms included a tongue mass mimicking tumor and dysphagia. Treatment consisted of biopsy and subsequent antibiotics toward suspected gram-negative organisms. The patient recovered uneventfully and has remained well.     

Chondrolipoma of the oropharynx

We describe the startling case of a man who was able to extend and retract a smooth round mass in and out of his oropharynx at will. On examination under anesthesia, the mass was found to be attached to the posterior tonsillar pillar by a stalk. The lesion was excised, and histopathology determined that it was a chondrolipoma. We believe that this is the first report of a chondrolipoma at this anatomic site.     

Cancer of the oropharynx

Cancer of the oropharynx is an extremely lethal cancer associated with poor prognosis in its advanced stage. Therapeutic options are presented and discussed along with the factors that may influence the prognosis.     

Squamous carcinoma of the oropharynx

One hundred and ten patients with an oropharyngeal carcinoma seen in the period 1961-1971 at the Antoni van Leeuwenhoek Hospital in Amsterdam are analysed. Approximately 75% of the patients were older than 60 years. About 60% of the patients had a cervical lymph node metastasis at the time of admission. Virtually all patients were treated exclusively by radiotherapy. Of the total group, the absolute survival was 26%, for tumours of the tonsil 35%, and for the base of the tongue 17%. There was no significant correlation between the histological degree of differentiation and the survival. The possibility of improving the results of selected patients is discussed.     

Cytomegalovirus ulceration of the oropharynx.

Cytomegalovirus (CMV) is a common opportunistic infection in both iatrogenic and HIV-induced immunosuppression. The usual sites of involvement are the gastro-intestinal tract, retina and lung. We present three cases of CMV ulceration of the oropharynx. All three patients presented with symptoms localized to the oropharynx and in each case the diagnosis was only made on histological examination of ulcer biopsy specimens. The patients all responded well to ganciclovir treatment and at writing none have required maintenance therapy (7-11 months post diagnosis).     

Spindle cell angiosarcoma of the oropharynx

Angiosarcomas are uncommon malignant tumours of vascular endothelium. In the head and neck, the scalp is the commonest site of origin. A rare case of spindle-cell angiosarcoma of the oropharynx, treated by surgery and post-operative radiotherapy, is reported. We discuss the clinical presentation and histopathological diagnosis of this lesion.     

Malakoplakia of the temporal bone in a nine-month-old infant

A case of malakoplakia, of the temporal bone in a nine-month-old male child is reported. The lesion presented as an aural polyp, associated with a lower motor neuron facial palsy. On exploration, the granuloma was noted to involve the temporal bone, eroding the bony labyrinth. It was successfully treated with surgical debridement, and antibiotics. A review of the relevant literature is presented.     

Surgery of the palate and oropharynx

Progress in successful surgical treatment of the obstructive sleep apnea/hypopnea syndrome (OSAHS) has been based on adjunctive treatment of the hypopharynx. Still the palate and oropharynx are the major areas of intervention, and certainly the most commonly operated upon. To ensure a successful outcome, appropriate surgical candidates must be identified. The authors present a method of clinical staging based on the position of the tongue relative to the soft palate as well as the size of the tonsils, aimed at identifying the most likely level of obstruction in patients who have OSAHS. We also present several surgical techniques that address obstruction at the level of the soft palate and oropharynx.