Postcricoid hemangioma presenting as dysphagia: a report of 4 cases

Hemangiomas involving the postcricoid region of the hypopharynx are rare. This report reviews our experience with 4 cases of postcricoid hemangioma, including a set of twin siblings. All patients underwent panendoscopy. All patients were managed nonsurgically. Three patients did well with dietary modification. One patient, with multiple medical problems, remains partially dependent on her gastrostomy tube. To our knowledge this report represents the largest series in the literature and the first to describe similar lesions in twin siblings. This report highlights the importance of a complete fiberoptic office examination of children who present with symptoms of dysphagia or aspiration.     

Pediatric postcricoid vascular malformation: a diagnostic and treatment challenge

Hemangioma of the upper aerodigestive tract is a rarely reported occurrence in the pediatric literature. To date, there have been three published case reports of postcricoid hemangiomas contributing to unexplained dysphagia and respiratory distress. We present three children with a history of swallowing difficulty and stridor who were found to have an occult postcricoid mass. Valsalva maneuvers confirmed the suspicion of a vascular malformation in both patients. Transoral laser therapy (KTP and CO2) was used to ablate the lesions. The patients are symptom-free at 5 months, 5 years, and 2 weeks, respectively. The diagnostic challenge in evaluating these children and the therapeutic choices are described.     

Management of laryngeal hemangioma in adults: a case report

Hemangiomas are the most common vascular tumors mostly (60%) seen in the head-neck region. Head-neck hemangiomas are seen frequently in the oral cavity, rarely in the larynx. Adult laryngeal hemangiomas are rare and often seen in the supraglottic region, therefore causing dysphagia/dysphonia. We presented two-cases with laryngeal hemangioma, discussed the diagnosis, treatment and follow-up of adult cavernous hemangiomas. A forty-one-year-old female patient applied to hospital with hoarseness and breathing difficulty lasting for three years. A cavernous hemangioma located on laryngeal surface of the epiglottis was excised through a transoral endoscopic approach. The patient had no symptoms after the operation but on the postoperative 34th month follow-up she was admitted to our clinic again because of difficulty during swallowing. Relapsed hemangioma was diagnosed and reoperated by open surgery (laryngofissure). After reoperation the patient had symptomatic relief in three months and videolaryngoscopic examination showed granulation tissue. The patient's regular follow-up was continued. A forty-year-old female other patient was applied to hospital with hoarseness and swallowing difficulty worsening in three months. Hemangioma located in the postcricoid area with extensive to hypopharynx-esophagus junction was diagnosed. The location of the lesion in imaging techniques was evaluated with the thoracic surgery and gastroenterology department and we decided not to do any operation and follow-up patient by considering the severity of symptoms, location of lesion and complications of operation.     

Management of hemangiomas of the head and neck in children

Hemangiomas occur in approximately 1% of Caucasian children, and the head and neck is a common site of presentation. Lesions in this region may cause morbidity and occasionally mortality by virtue of complications such as ulceration, infection, hemorrhage, hemodynamic change, aerodigestive tract obstruction and disfigurement. The majority of hemangiomas regress spontaneously. Those with impending complications may require treatment with several modalities. Embolization, surgery, laser therapy, cryotherapy and medical therapy with steroids and antifibrinolytic agents may be used in selected situations. Radiotherapy is now rarely favored due to potential induction of late malignancies. The natural history of these lesions is discussed along with the treatment modalities available and indications for use. Several representative cases are presented.     

Management of postcricoid and upper esophageal hemangioma

To discuss management of postcricoid and upper esophageal hemangiomas in infants. Four children presenting with progressive feeding and/or respiratory disturbance underwent endoscopy including systematic esophagoscopy revealing the hemangioma of the postcricoid area and extending to the lumen of the upper esophagus. In the three children with severe disturbance, systemic steroids were insufficient and open surgical excision brought the hemangioma under control. No significant stenosis occurred despite prolonged progressive oral feeding up to 1 month after surgery. The fourth child whose disturbance was moderate, was managed by intralesional steroids. Various solutions have been proposed for the treatment, i.e. conservative approach or partial or complete destruction or excision, management of postcricoid hemangioma by intralesional steroids or by open surgical excision. Indications will require greater series.     

Evaluation and management of benign, non-congenital tongue masses in children.

Lingual tumors are rare, primarily benign, lesions in the pediatric population. Congenital lesions, such as hemangiomas, lymphatic malformations, dermoids, hamartomas and thyroglossal ducts cysts, are seen more commonly. Primary, non-congenital lingual neoplasms are less common in children. We present three patients with benign lingual neoplasms. Evaluation, management, pathology and follow-up are discussed.     

影响鼻内镜鼻窦术后主观症状的相关因素分析

目的 探讨影响慢性鼻．鼻窦炎内镜鼻窦术后主观症状改善程度的临床相关因素。方法 回顾性研究本科内镜鼻窦术后随访6～29个月的主观症状无改善患者94例的临床资料，分析相关影响因素。结果94例中，患有抑郁症5例次，鼻腔鼻窦病变55例次，内科疾病54例次，其它原因12例次。结论 慢性鼻窦炎内镜鼻窦术后主观症状无改善与伴随的抑郁症及内科疾病等有关。在积极治疗鼻腔-鼻窦病变的同时，也要加强相关疾病的处理。     

Clinical aspects of osseous hemangiomas of the skull base

Osseous hemangiomas are distinctly unusual tumors of the skull base. They clinically mimic other, more common lesions in this region, and their diagnosis is rarely made preoperatively with currently available techniques. Three cases of osseous hemangiomata, 2 involving the geniculate region and 1 arising from the jugular bulb, are described in relation to the perioperative assessment and management of these lesions. A review of 21 previously reported skull base hemangiomas is included.     

Kavernöses Hämangiom der Glandula parotis im Erwachsenenalter

Parotid hemangiomas are rare in adults. Whereas both capillary and cavernous hemangiomas are seen in children, only cavernous hemangiomas have thus far been reported in adults. Clinically, cavernous hemangiomas usually present as slowly growing, soft or firm, movable, painless parotid masses. Severe pain and swelling can occur, however, depending on the size of the hemangioma or in particular in the presence of acute hemorrhage or thrombosis. CT and MRI are the diagnostic tools of choice. Prior to surgery, magnetic resonance angiography or intra-arterial digital subtraction angiography should be performed to investigate the vascular supply of the tumor. Surgical excision is the treatment of choice for small lesions. Large cavernous hemangiomas usually require superficial or total parotidectomy. Especially in the case of extended lesions, the facial nerve may be difficult to identify and should be monitored intraoperatively.     

Submandibular gland hemangioma: clinicopathologic features and a review of the literature

We conducted a retrospective study to determine the incidence and characteristics of submandibular gland hemangioma at our institution. We reviewed the records of all patients who had undergone submandibular gland excision from January 1998 through December 2006. We found a total of 230 such cases. Of these, submandibular gland hemangioma was found in 4 patients (1.7%)-3 women and 1 man, aged 20 to 47 years (mean 34.8). Their duration of symptoms had ranged from 26 to 78 months (mean: 49.3). These symptoms had included submandibular swelling, pain or discomfort, and features of sialadenitis. Computed tomographic angiography had revealed that the hemangiomas were supplied by the facial and lingual arteries. Two of the 4 patients had undergone preoperative vascular embolization, but it had failed to significantly reduce the amount of intraoperative blood loss. Final histopathologic examination had revealed that all 4 lesions were cavernous hemangiomas and that they had replaced the normal glandular structure. No recurrence was seen during a follow-up that ranged from 47 to 72 months (mean: 56.3).     

Use of potassium titanyl phosphate (KTP) laser in management of subglottic hemangiomas

OBJECTIVE: to study the role of KTP laser in management of subglottic hemangioma. DESIGN: retrospective analysis of patients with subglottic hemangioma treated by the senior authors. Setting: tertiary care teaching hospital. PATIENTS: twelve patients with subglottic hemangiomas. INTERVENTION: patients were treated with KTP laser (eight cases), CO(2) laser (two cases) or observation (two cases). MAIN OUTCOME MEASURE: resolution of symptoms, decrease in size of subglottic hemangioma or tracheotomy decannulation. RESULTS: All patients treated with KTP laser or CO(2) laser had resolution of symptoms and five tracheotomy-dependent children were decannulated. CONCLUSION: subglottic hemangioma is a potentially life-threatening disease seen in young children. Most authors recommend use of either CO(2) or open surgical excision. There is very little data available on the use of KTP lasers in the management of subglottic hemangiomas. The KTP laser beam is preferentially absorbed by hemoglobin making this laser system more applicable to the treatment of vascular tumors such as the hemangioma. KTP laser is a good tool for management of subglottic hemangioma with a low incidence of complications.     

Hemangiomas and vascular malformations of the head and neck

This paper presents the review of current knowledge regarding vascular lesions of the head and neck. For many years the term hemangioma was used to describe all vascular lesions. Mulliken and Glowacki classified congenital vascular lesions and recognized two distinct entities, hemangiomas-vascular tumors and vascular malformations. Hemangiomas are usually not present at birth, proliferate during first year of life and then involute. They are composed of proliferating endothelial cells. Vascular malformations are always present at birth although not always apparent, increase slowly in size throughout whole life and never involute. They enlarge by hypertrophy of malformed vessels. Vascular malformations can be further subdivided according to the type of involved vessels as arterial, arteriovenous, venous, capillary or lymphatic. Accurate diagnosis of hemangiomas and vascular malformations remains a challenge for physicians. Although majority of hemangiomas are self limiting lesions some of them may develop complications such as; ulceration, airway obstruction, ophthalmic complications, psychosocial consequences. Segmental hemangiomas are associated with the risk of structural anomalies such as those that occur in PHACE syndrome. Clinical presentation and forms of treatment of various forms of vascular malformations are presented. Vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features shown by radiological examinations.     

The importance of early surgery in preventing the esthetic sequelae of cervicofacial mucocutaneous hemangiomas in children

Infants with cutaneous hemangiomas are classically managed medically, well-defined surgery being planned for esthetic correction at the age of 8 to 10 years. We present a series of 65 cases of early surgery in children with head and neck cutaneous or mucosal hemangiomas where irreversible and unesthetic scars were predictable. The surgical procedure was simple and the cosmetic result was better than could be expected after late surgery, limiting psychological consequences. In our opinion, the abstention rule should be changed. A multidisciplinary check-up at 2 years to identify cases with a predictably unesthetic scar after complete resolution of the angioma would help select cases where early surgical correction, taking advantage of the exceptional quality of skin in these young children, would be most beneficial.     

Ancient schwannoma of the true vocal cord

Ancient schwannomas are benign nerve origin neoplasms that may cause difficulties in the differential diagnosis with other benign or malignant tumors. They usually occur in the head and neck region (epiglottis, arytenoepiglottic fold, false vocal cord). Involvement of the true vocal cords is extremely rare (less than 10 cases have ever been reported in the English literature--mainly in women). The present case describes a 27-year-old man who presented with a 2-year history of hoarseness. Indirect laryngoscopy showed a small polypoid mass in the middle of the left vocal cord. During microlaryngoscopy under general anesthesia, the polypoidal mass was removed and sent for histology. Immunohistochemistry and detailed histological examination revealed an ancient schwannoma. The present case in a male patient aims to increase awareness of the possibility that these tumors may also exist in the true vocal cords mimicking other more frequent lesions.     

Congenital head and neck masses in infants and children. Part II

Congenital head and neck masses in children are a diverse group of lesions. Thyroglossal duct abnormalities are the most common, followed by branchial apparatus abnormalities, lymphangiomas (cystic hygroma), and subcutaneous vascular abnormalities (hemangioma, AVM). It is important to note that cutaneous hemangiomas are not included in this discussion of congenital masses. If they are considered within the general topic of congenital head and neck masses, vascular lesions by far are the most common. Teratomas and dermoid cysts represent true congenital neoplasms and are relatively uncommon. Several rare lesions have been noted in the discussion and should be included in the differential diagnosis. The diagnosis of these particular masses depends largely on history and physical examination. The location of the mass itself greatly limits the differential diagnosis. Ancillary studies such as plain x-rays, ultrasound, CT scanning, and angiography are useful in further limiting the possible diagnoses. Subcutaneous hemangiomas, ectopic thyroid, congenital goiter, and fibromatosis colli can be treated medically or with simple observation. Surgery is reversed for enlarging lesions or lesions affecting vital structures. The remainder of the congenital head and neck masses generally require early excisions to avoid complications of infection, airway obstruction, nutritional compromise, or the risk of malignant transformation.     

Pilomatrixoma of the head and neck in children

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign tumor of hair cell origin. It is an unusual, but not particularly rare, tumor. Fifty percent or more of pilomatrixomas occur in the head and neck, and 40% occur in patients under 10 years of age. Pilomatrixomas may be mistaken for cysts, calcified lymph nodes, calcified hematomas or hemangiomas, or parotid gland tumors. We describe our experience with 15 children, 1 1/2-12 years of age, in whom we have excised pilomatrixomas from the head and neck.     

环后癌的手术治疗

目的 探讨环后癌手术治疗的相关技术方法。方法对21例环后癌患者进行手术治疗，其中T3NOM0 5例，T3N1M0 1例，13N2M0 2例，T4NOM0 7例，T4N1M0 4例，T4N2M0 1例。T4N3M0 1例。在彻底切除肿瘤的前提下，保留可利用的正常组织进行咽喉功能重建。共行保留喉功能手术10例，不保留喉功能手术11例，同时行单侧颈清扫术8例，双侧颈清扫术3例，术后行辅助放疗。结果随访时间60～276个月，平均96个月。全组患者3年生存率61．9％(13／21)，5年生存率52．4％(11／21)。随访期间死于颈淋巴结转移4例，肿瘤局部复发3例，心肺功能衰竭1例，原因不明2例。喉功能保留病例仅恢复了发音和吞咽保护功能。术后出现咽瘘5例，下咽狭窄3例，严重误吸1例。结论在彻底切除肿瘤的前提下谨慎选择环后癌手术方法，利用保留下来的正常喉组织进行喉功能重建，从而恢复喉的部分功能是可行的。患者可获得较好的生存率和生存质量。     

Chondroid tumors of the larynx: computed tomography findings

PURPOSE: Chondromas and chondrosarcomas of the larynx are rare cartilaginous tumors making up less than 1% of all laryngeal tumors. Patients typically present with symptoms of hoarseness, dysphagia, or dyspnea. The most common location in the larynx for these tumors is the cricoid cartilage. Radiographically, these lesions are typically hypodense, well-circumscribed masses containing mottled calcifications with smooth walls centered within the cartilage. MATERIALS AND METHODS: We present 6 cases of chondroid tumors of the larynx. RESULTS: One patient had a chondroma, 4 patients had low-grade chondrosarcomas, and 1 patient had an intermediate-grade chondrosarcoma. Two partial laryngeal resections and 4 total laryngectomies were performed. CONCLUSIONS: In most cases of chondroma or chondrosarcoma of the larynx, conservative surgery should be attempted, but total laryngectomy may be required for large or recurrent lesions.     

Rare tumors of the internal auditory canal

The study was performed to identify the incidence and histology of rare tumors with growth restricted to the internal auditory canal (IAC) that are different from vestibular schwannoma (VS). Furthermore, the question was addressed whether a preoperative diagnosis would be possible in these cases. A series of 351 patients that were operated on for IAC tumors through a transtemporal or translabyrinthine approach was investigated retrospectively. Cases with a tumor entity other than VS were analyzed for symptoms, radiological diagnosis, intraoperative findings and postoperative histolopatology to determine if a differential diagnosis to the common VS can be established prior to surgery. In 15 out of 351 cases (4.3%), uncommon processes of the IAC were determined by histology (6 lipomas, 3 hemangiomas, 2 neurofibromas, 2 menigiomas, 1 facial neuroma and 1 case of bilateral malignant lymphoma). The symptoms and the clinical manifestations were typical for patients with VS so that a preoperative differential diagnosis was not possible in the majority of cases. An analysis of the operation reports revealed that in 10 out of the 15 cases the surgeon suspected an unusual tumor of the IAC during surgery. The results of the present investigation suggest that rare lesions of the IAC can be expected in less than 5% of the cases and that preoperative diagnosis of rare IAC tumors is difficult. Intraoperative findings such as adhesion to cranial nerves and consistency of the tumor often indicate unusual processes, but histological analysis of the removed tissue is essential for the definite diagnosis.