Primary amyloidosis presenting as a nasopharyngeal mass.

Amyloid is defined as a pathologic proteinaceous substance which, when deposited between the cells of tissues and organs, leads to various clinical conditions. Immunohistochemistry has allowed for better classification and understanding of the pathophysiology of amyloidosis. In the upper aerodigestive tract, amyloidosis is a rare condition occurring most frequently in the larynx. We present the case of a 42-year-old woman with complete nasal obstruction due to primary nasopharyngeal amyloidosis. This represents the first reported case of primary nasopharyngeal amyloidosis containing both the lambda and kappa immunoglobulin light chains. The clinical and radiologic findings, as well as the management of primary amyloidosis of the upper aerodigestive tract, will be discussed. A review of the literature pertaining to nasal and nasopharyngeal amyloidosis will be presented.     

Actinomycosis presenting as a parotid tumor

Actinomycosis of the parotid gland is a rare chronic infection and can present with a slow-growing mass mimicking a tumor. The authors report five cases of parotid actinomycosis. All patients presented as having enlarging masses at the parotid area for 2-6 months without a history of obvious dental infection, trauma, or immunocompromised condition. Retrograde bacterial spread from colonization in the oral cavity via Stensen's duct is the possible pathophysiology. The diagnosis was made histopathologically by fine needle aspiration biopsy (FNAB). Treatment consisted of 1.5 months of intravenous penicillin, followed by 4.5 months of oral penicillin, with excellent results.     

艾滋病合并马尔尼菲青霉病累及咽部一例

滋病(acquired immune dericiency syndrome,AIDS)患者由于感染了人类免疫缺陷病毒(human immunodeficiency virus,HIV),患者的CD4阳性T淋巴细胞受HIV病毒特异性侵犯,使机体免疫功能严重受损以致低下,导致机体发生各种机会性感染,其中真菌感染相当严重,疾病的表现形式日趋复杂.现报道1例马尔尼菲青霉病(penicilliosisMarneffei,PSM)累及咽部,表现为咽部肿物的艾滋病患者诊治经过.     

Plexiform ameloblastoma presenting as a sinonasal tumor

Ameloblastomas are the most frequent odontogenic tumours, accounting for 1% of all tumours of the maxilla and mandible. Sinonasal ameloblastomas are most common between the ages of 55 and 65, and mandibular ameloblastomas between 40 and 50. Incidence is higher in males than in females, and there are no differences between races. These locally aggressive tumours originate in the mandible in 80% of cases and in the maxilla in 15–20%. We report an unusual primary nasosinusal ameloblastoma presented in a 68-year-old male. The tumour was completely resected by (para)lateral rhinotomy and treated with postoperative radiotherapy. Histological analysis demonstrated a plexiform ameloblastoma. The patient remains well without disease after 50 months of postoperative follow-up.     

Cholesterol granuloma presenting as an isolated middle ear tumor

Patients with cholesterol granuloma of the middle ear cleft will usually present with a secretory otitis media, and exhibit evidence of diffuse disease within the mastoid upon roentgenographic evaluation. The following patient with an isolated middle ear cholesterol granuloma presented with signs and symptoms more closely resembling a glomus tumor.     

Metastasis from an unknown primary presenting as a tumor in the internal auditory meatus

A 40-year-old male presented with a 2-month history of sudden hearing loss and tinnitus in his left ear. Mild vertigo was present initially but disappeared spontaneously without treatment. Facial nerve paralysis and retroauricular pain appeared 3 months after the onset of hearing loss on the same side. Computerized tomography and magnetic resonance imaging demonstrated a 1-cm mass in the left internal auditory canal. Translabyrinthine removal of tumor revealed metastatic adenocarcinoma. The patient died 3 months postoperatively from multiple metastatic deposits. A primary tumor was never found. The course of illness in this patient differs significantly from the typical course of other conditions involving the internal auditory canal. A metastatic work-up should be considered for patients with a similar history before a craniotomy is performed.     

Localized amyloidosis masquerading as nasopharyngeal tumor: a review

Amyloidosis comprises a diverse collection of disease characterized by the presence of amorphous extracellular eosinophilic deposits of unique protein fibrils that gives apple green birefringence under polarized light after staining with Congo red. Head and neck region is the commonest site for localized form of amyloidosis. We report a case of a 43-year-old man with localized amyloidosis of nasopharynx with oropharyngeal extension and its management, along with a review of relevant literatures.     

Tuberculosis of a periglandular lymphnode presenting as a parotid tumor

The presentation of tuberculosis as isolated cervical adenopathy is not a common entity. The presentation of this disease as a parotid mass has rarely been reported. In most instances, direct parenchymal involvement exists, although involvement of intraglandular lymphnodes has also been reported. In most cases, an initial misdiagnosis of a parotid tumor, usually a pleomorphic adenoma, was made. We report a case of a 57-year-old patient with a left parotid mass of two years' duration. The patient was referred because of the development of firm, nontender, ipsilateral cervical adenopathy, suggesting possible malignancy. The course of the disease, diagnosis, and treatment are reported. The relevant literature is reviewed.     

Nodular fasciitis presenting as parotid tumor

The clinicopathologic features of two rare cases of nodular fasciitis presenting as parotid tumor are described, and the literature is reviewed. In 1% of the nodular fasciitis cases, the lesion presents as a parotid mass. Pathologists and otolaryngologists should include nodular fasciitis in the differential diagnosis of parotid mesenchymal tumors so that misdiagnoses and the resulting unnecessary surgeries may be avoided.     

Extramedullary plasmacytoma presenting as a nasal mass in an immunosuppressed patient: treatment after failed primary radiotherapy

Most of the recent evidence suggests that extramedullary plasmacytoma should be treated initially with radiation, as response rates have exceeded 90% in many studies. Surgery is not considered a primary treatment modality for such tumors. We report the case of a chronically immunosuppressed 43-year-old man with bilateral extramedullary plasmacytomas of the nasal cavities. The right-sided mass was surgically excised, while the left-sided mass was initially treated with radiation. However, the left mass proved to be radioresistant, and it was subsequently excised surgically The patient showed no evidence of recurrence of either mass at 42 months of follow-up. We believe that the particulars of this case, combined with the results of some recent studies, provide good evidence that surgery should be considered in the treatment of certain cases of extramedullary plasmacytoma.     

Arnold-Chiari type I malformation presenting as benign paroxysmal positional vertigo in an adult patient

Arnold-Chiari malformations are a group of congenital hindbrain and spinal cord abnormalities characterized by herniation of the contents of the posterior cranial fossa caudally through the foramen magnum into the upper cervical spine. It is important to recognize Arnold-Chiari type I malformation in the differential diagnosis of adult vertigo cases. We present a 51-year-old patient with Arnold-Chiari type I malformation that was initially diagnosed as posterior semicircular canal benign paroxysmal positional vertigo.     

Primary tumor volume calculation as a predictive factor of prognosis in nasopharyngeal carcinoma

CONCLUSIONS: Primary tumor volume (PTV) has a close relationship with survival rates of patients with nasopharyngeal carcinoma (NPC) who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy. Besides the current AJCC staging system, measurement of PTV may be needed to predict prognosis of NPC and adjust treatment strategy. OBJECTIVES: We conducted a retrospective study to elucidate the effect of PTV on treatment outcomes in patients with NPC who were treated with CCRT or radiotherapy. PATIENTS AND METHODS: A total of 66 patients with newly diagnosed NPC were enrolled in this study. Computed tomography (CT)-derived or magnetic resonance imaging (MRI)-derived PTV was calculated. The correlation between AJCC disease stage, PTV, and disease-specific survival was analyzed. Correlations between different prognostic factors were assessed using a Cox regression model. RESULTS: The median PTV for the whole series was 12.01 ml (range 1.25-166.58 ml). The median PTV was 3.45 ml in T1 disease, 7.96 ml in T2 disease, 17.95 ml in T3 disease, and 64.73 ml in T4 disease. Disease stage and T stage carried no prognostic significance (p=0.25 and p =0.30, respectively). Four categories of PTV (<12.5 ml, 12.5-25 ml, 25-50 ml and >50 ml) had prognostic significance (p=0.02). Survival analysis demonstrated a significant difference in overall survival with larger tumor volume (risk ratio 5.447; p=0.044).     

Cervical meningocoele presenting as a neck mass in a patient with neurofibromatosis 1.

We report a case of an anterolateral cervical meningocoele presenting as a neck mass in a patient with neurofibromatosis 1. This lesion was diagnosed with the aid of computerized tomography and radionuclide scanning. The presentation, behaviour and treatment options of this uncommon lesion are briefly discussed.     

Hyperparathyroidism presenting as brown tumor of the maxilla

As it becomes common for hyperparathyroidism to be detected earlier in the course of the disease, the bony manifestations of the disease are rarely seen. Presented here is a rare case of brown tumor of the maxilla as the presenting symptom of primary hyperparathyroidism.     

Marjolin's ulcer presenting in the neck

'Marjolin's ulcer' is a term that has come to be used for epidermal squamous cell carcinomas that have developed in areas of chronic inflammation. To our knowledge this is the first ever report of a Marjolin's ulcer developing following long-term irritation of the skin of the neck. The history of the eponym is traced and reveals that Marjolin probably never actually described this pathological process.