Mucocele mimicking a Warthin's tumour recurrence

We report an unusual case of an extravasation mucocele complicating superficial parotidectomy. The tumour excised was a Warthin's tumour. Three months following the primary surgery a cystic lesion appeared in the parotid bed. It was initially thought to represent a recurrence. The area was re-explored and a mucocele excised. The pathogenesis of mucoceles and the difficulties encountered when dealing with parotid tumour recurrence are discussed.     

Merkel-cell tumor associated with a spinocelluar epithelioma. Apropos a case report

One case of Merkel cell carcinoma is reported in a 71 years-old woman. Lately treated by surgical excision (14 years after the occurrence of the tumour), this tumour was already associated with inguinal lymph node metastases. Its evolution was lethal within 3 months after local recurrence, cutaneous and visceral (lung, liver) metastases. This tumour, characteristic histologically and ultrastructurally (secretory granules), was accompanied by an infiltrative epidermoid carcinoma. This association and the presence of cytokeratin in tumoral Merkel cells are arguments for the common origin of keratinocytes and neuroendocrine Merkel cells from a common young epithelial cell.     

Extrafollicular Adenomatoid odontogenic tumour presenting as a periapical lesion: Report of a rare entity

Adenomatoid odontogenic tumour (AOT) has been known to the pathologists for the past 100 years as a benign slow growing tumour. Histologically, this tumour has a predominantly solid component and very few case reports have described the cystic nature of AOT. In the present case we review the literature of extrafollicular AOT presenting as a periapical disease and add to the literature a case of cystic extrafollicular AOT in a 17-year-old patient, initially diagnosed as a radicular cyst. Radiographically extrafollicular AOT frequently resembles other odontogenic lesions such as residual, developmental lateral periodontal or radicular cyst, however histopathological findings of this tumour are quite characteristic and present few diagnostic problems. Correlation of clinical and radiological information with histological features is important in the diagnosis of odontogenic cysts and tumours, to decrease the incidence of misdiagnosis for such cases and this in turn will help in preventing recurrences.     

Angiomyoma in the submandibular gland: a rare location for a ubiquitous tumour

Angiomyoma is a common soft tissue tumour of the head and neck that sometimes presents to the otolaryngologist; however, it seldom occurs in the major salivary glands. We present a case of angiomyoma arising in the submandibular gland, a tumour not described previously in the English literature.     

Lipoma of tongue — A rare site for a rare site for a common tumour

Lipoma is the commonest benign tumour occurring at any anatomical site where fat is present. In oral cavity and oropharynx it is a relatively uncommon neoplasm.. Tongue which is totally devoid of fat cells is also a site for lipoma albeit very rarely. This is one such rare case of the universal tumour, presenting at the lateral margin of the tongue, for which complete tumour excision was done.     

Primary neuroblastoma: a rare cause of a retropharyngeal mass in a neonate

Neuroblastoma is the most common extra-cranial solid malignancy in children and the most common tumour occurring during infancy. This tumour arises from undifferentiated precursor cells of the sympathetic nervous system. The abdomen (65 per cent) is the most common site for these tumours, followed by the throat (15 per cent), pelvis (5 per cent) and cervical region (5 per cent). We report a case of primary retropharyngeal neuroblastoma in a three-week-old baby boy presenting with upper airway obstruction.     

Pleomorphic adenoma of the nasal cavity: a case arising from the wall of the maxillary sinus

INTRODUCTION: Pleomorphic adenoma is a common and benign tumour, originating from sero-mucous glands. Location in the nasal cavity and particularly on the medial wall of the maxillary sinus is very rare. PATIENTS AND METHODS: One patient with a pleomorphic adenoma of the nasal cavity and a review of literature are reported in order to describe the diagnostic and therapeutic management of this tumour. RESULTS: A 63-year-old woman was referred to our institution for evaluation of an unilateral nasal tumour. Clinical and radiological studies revealed an intra-nasal tumour, slightly lytic in nature, arising from the mucosa of the medial wall of the maxillary sinus. More than 2 years after complete excision of the tumour using an endoscopic procedure, the nasal cavity was free of tumour. DISCUSSION: Pleomorphic adenoma of the nasal cavity is a rare and benign tumour, usually presenting as a unilateral nasal tumour. Prognosis of this tumour is mainly linked to recurrences in cases of incomplete resection and to possible metastasis, such as an eventual malignant evolution. The gold standard treatment is complete surgical resection. After a complete imaging study for patient selection (CT scan and MRI), endonasal endoscopic surgery seems to be a reliable therapeutic treatment. CONCLUSION: Intra-nasal pleomorphic adenoma originates from nasal seromucous glands. Radiological study reveals a slightly lytic tumour developed from the septum of the medial wall of the maxillary sinus. Resecton can be performed with endoscopic endonasal surgery as long as the orbital bony framework and the ethmoidal roof are free of tumour. Whatever technique is employed, long term follow-up has to be used to detect any recurrence.     

Adenoid cystic carcinoma presenting as a mass in the neck

Three of a personal series of 82 patients with adenoid cystic carcinoma presented with a node in the neck. Two of these patients had no discoverable primary tumour. One of the latter died rapidly, and might have had an undisclosed primary tumour in the lung. The other remains well 3 years after radical neck dissection, and it is possible that he had a tumour arising in an aberrant cervical salivary rest.     

Metastasis of a malignant melanoma simulating a primary mandibular sarcoma

The rare case reported here was a mandibular metastasis of a malignant melanoma located in the nape of the neck and surgically removed. 4 years later, occurred a fibrosarcomatous mandibular tumour without local recurrence. The metastatic nature of this tumour was difficult to prove by means of immunohistochemical and ultrastructural methods. This case illustrated the eventuality of a desmoplastic change in metastasis of a common malignant melanoma. The histogenesis of this rare type of melanoma was discussed.     

Inverted papilloma involving the frontal sinus: a management plan

Inverted papilloma is a benign but locally aggressive sino-nasal tumour. Although relatively uncommon, involvement of the frontal sinus by this tumour represents a significant surgical challenge. The objective of the study is to propose a scheme for management of inverted papilloma involving the frontal sinus, based upon the findings of the current study. All cases of inverted papilloma operated upon between July 1995 and June 2008 were retrospectively reviewed to identify cases in which the tumour involved the frontal sinus. Among 34 patients with inverted papilloma, 4 were found to have tumours involving the frontal sinus (11.76%). These patients were initially treated by endonasal endoscopic resection. At time of initial surgical excision, the tumour was found to involve the frontal sinus by expansion from the ethmoids in three of these patients. In the fourth patient, the tumour was found to be massively involving the frontal sinus mucosa. After a mean follow-up of 16.3 months, no recurrences were detected in the first three patients. In the patient with massive mucosal involvement, recurrence was detected 4 years after the initial endonasal endoscopic resection. Subsequently, an osteoplastic flap was performed to resect the tumour. Fifty months later the patient remained disease free. Surgeons managing patients with frontal sinus inverted papilloma should have a clear management scheme before embarking on surgery. The patient’s consent should be obtained pre-operatively for a possible osteoplastic flap. Tumours just expanding into the frontal sinus can be managed by either endoscopic or nonendoscopic approaches. On the other hand, in tumours significantly involving the frontal sinus mucosa, an osteoplastic flap is warranted to ensure complete tumour resection.     

Polymorphous low grade adenocarcinoma of the palate in a child

We report a case of polymorphous low grade adenocarcinoma involving the palate of a 12-year-old girl, the first example of this tumour occurring in the paediatric age group. The tumour displayed infiltrative growth, neural invasion, variegated histological patterns, and minimal cytological atypia. The patient remained disease-free four years after wide local excision of the tumour. The distinction of polymorphous low grade adenocarcinoma from pleomorphic adenoma and adenoid cystic carcinoma is also discussed.     

Malignant mixed tumor of the larynx: a case report

Malignant mixed tumour (MMT), which is a salivary gland tumour, is the malignant form of pleomorphic adenoma. Although the tumour can also originate from the minor salivary glands throughout the submucosa in the head and neck region, laryngeal involvement is quite rare. An additional case of laryngeal MMT presented in a forty-five year old man, and the diagnostic, immunohistochemical (S-100, actin, vimentin, epithelial membrane antigen) and therapeutic procedures were presented.     

Middle ear adenoma: a case report with ultrastructural findings

A 56-year-old woman presented with unilateral tinnitus and hearing loss for 18 months. A middle ear mass was detected clinically. At operation, the tumour was found to have eroded the stapes. The light and electron microscopic features of the tumour were those of a middle ear adenoma. This rare benign tumour has an excellent prognosis. Erosion of an ossicle has not been previously associated with this tumour. Benign adenomatous tumours arising from middle ear mucosa are rare (Mills and Fechner, 1984). The term adenoma of middle ear was proposed by Hyams and Michaels (1976), and their review of 20 cases emphasized the benign behaviour of these tumours. We report a case of middle ear adenoma in which ossicular erosion occurred.     

Pre-operative embolisation of the thyroid artery in a patient with a large papillary carcinoma of the thyroid

Objective: To demonstrate the usefulness of pre-operative selective embolisation of the thyroid arteries in an unusual case with a large, vascular thyroid tumour. Case report: A 29-year-old man presented with a large papillary carcinoma of the thyroid (weighing approximately 300?g on palpation) with extension to the mediastinum and compression of the trachea. A computed tomography scan of the neck and thorax revealed a large tumour the solid part of which was enhanced after contrast medium application, indicating a substantial vascular supply. Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery, using gelatin sponge particles, was performed 4 days before surgery, under conventional angiography. After selective embolisation of these thyroid arteries, the patient experienced mild anterior neck pain and mild fever. This procedure allowed a significant reduction in blood perfusion to the tumour, which facilitated its surgical removal without blood transfusion. Conclusion: Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery may be an effective, minimally invasive procedure for patients with a large, vascular thyroid tumour.     

Surgical approach to a giant fibrolipoma of the supraglottic larynx

This paper describes the surgical procedures for a fibrolipoma that first appeared as a giant tumour in the hypopharynx and extended to the cardiac antrum of the oesophagus. At the initial surgery, a pedunculated tumour originating from the left arytenoid of the larynx was found to occupy the cervical as well as thoracic oesophagus and was thus removed through a lateral pharyngectomy. A histological examination revealed fibrolipoma. However there was a recurrence of the tumour in the arytenoid and the patient suffered from dysponea. In addition, a submucosal tumour was also found in the left false vocal fold. At the second surgery, the masses in the arytenoid and false vocal fold were subtotally removed without damaging the mucosa. The mucosa of the arytenoid was sutured to the thyropharyngeal muscle on the same side and the arytenoid swelling disappeared almost completely. The post-operative course has been uneventful for more than two years.     

The rabbit VX2 tumour as a model for carcinomas of the tongue and larynx

Animal models of carcinomas can provide useful information for the evaluation of new treatments. In the rabbit, the VX2 tumour is a fast growing, transplantable squamous cell carcinoma. By implanting a cell suspension of the tumour into the tongue and/or the larynx, a useful new model for studying or treating tumours in this region has been developed. The tumours were evaluated histologically and showed features consistent with human carcinomas, including surface ulceration, lymphatic spread and encroachment of the airway. The VX2 tumours in these sites have features which offer advantages over existing models. These include the ability to study several sites of tumour growth in the same animal, to follow rapidly growing tumours, storage of the tumour in liquid nitrogen allowing experiments to be started when convenient, and the large size of the rabbit larynx which permits considerable tumour growth before airway embarrassment.     

A large atypical osteoma of the maxillary sinus: a report of a case and management challenges

An osteoma within the paranasal sinuses is a rare benign fibro-osseous tumour. Osteomas occurring in the maxillary sinus are exceedingly rare and account for only 5% of the cases. A case of a 38-year-old female with an osteoma of the maxillary sinus is presented and the disease and its management are discussed. A 2 cm spherical lesion in her right maxillary sinus was picked up incidentally on a magnetic resonance imaging scan whilst being investigated for unrelated neurological symptoms and in the absence of any sinonasal symptoms. An endoscopic biopsy demonstrated that the mass was an osteoma. The management of paranasal sinus osteomas is surgical and is governed by patient symptoms, tumour size and location, in the light of the risk of future intracranial or intraorbital complications. The choice of surgical approach is determined by the location of the tumour and, the experience of the surgeon. In this case a combined external and endonasal approach was the most appropriate management due to the size of the tumour and the risk of intraorbital complications. The patient underwent a combined Caldwell-Luc and transnasal endoscopic resection without complication.     

Endonasal removal of a large ethmoidal cementoblastoma

Cementoblastoma is a benign tumour, which pertains to the family of fibro osseous lesions of the jaws. A small number of clinical reports of cementum containing tumours locating in the paranasal sinuses have been published during the last three decades. Ethmoidal cementomas often attain a large size; they can destroy surrounding bone, invade the orbit and the skull base and usually require radical surgery for complete excision. We present a new case of a large cementoblastoma located in the left posterior ethmoid in the close vicinity of the optic nerve canal. In the 40-year old woman, endoscopic endonasal computer-assisted surgery allowed for complete tumour removal. No intraoperative damage to the orbit and the optic nerve occurred. No residual tumour was found at the follow-up visit three years after the surgery.     

Is Malherbe calcifying epithelioma in the ENT area of a rare tumor?

The calcifying epithelioma (pilomatrixoma) is a benign tumour of the skin originating from hair sheath cells. The head, especially the cheek and preauricular region with the parotid gland, is a very common site (about 50%). The tumour arises predominantly in younger people, with a 2:1 female to male ratio. It is not so rare as suggested by the few ENT publications. The histologic picture shows two characteristic epithelial cells, the basophilic and ghost cell. Calcification is present in most cases. The prognosis after removal of the tumour is good. Two personal cases are reported, multiple pilomatrixomas on the cheek of an 12 year old girl, and a tumour on the auricle, an unusual site.