1/33. Follicular dendritic cell tumor of the parapharyngeal region.BACKGROUND: Follicular dendritic cell (FDC) tumors are rare. A majority of the reported cases were confined to the lymph nodes. We report a case of FDC tumor occurring in the parapharyngeal region in a 45-year-old woman. methods: Characteristic histopathologic features of the excised primary and recurrent parapharyngeal tumors in conjunction with immunohistochemistry and electron microscopy helped us to arrive at a diagnosis of FDC tumor. RESULTS: Histopathology of primary excision revealed a lobulated tumor with a suggestion of ill-defined whorls. The most striking feature was regular occurrence of aggregates of lymphocytes within the tumor, especially around the blood vessels. The anatomic location together with the histology indicated the possibilities of either a meningioma, a salivary gland tumor, or a nerve sheath tumor. Immunostains for cytokeratin (CK), S-100 protein, and smooth muscle actin (SMA) were negative. However, the tumor cells showed strong immunoreactivity for epithelial membrane antigen (EMA) and vimentin. A diagnosis of parapharyngeal meningioma appeared to be the closest possibility. One year later, the patient developed a recurrence at the same site. A reexcision showed an identical tumor with an additional feature of lymphatic embolization and angioinvasion. A review of the entire case with further immunoreactivity for CD21 and CD35 confirmed the diagnosis of FDC. CONCLUSIONS: Follicular dendritic cell tumor has distinctive morphologic features and immunohistochemical profile. It is also characterized by considerable potential for recurrences.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/33. Successful surgical treatment of a solitary parapharyngeal metastasis from thyroid cancer, using the mandibular swing-transcervical approach: report of a case.A 72-year-old man presented with a right parapharyngeal mass, 4 cm in diameter, which was subsequently diagnosed as a metastasis originating from papillary carcinoma of the thyroid gland. The parapharyngeal tumor was successfully removed by the mandibular swing-transcervical approach with pharyngeal reconstruction, performed using a buccal mucosal island flap based on the facial artery. His postoperative course was uneventful, and the preoperative clinical symptoms such as dysphagia and headaches completely resolved after surgery.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/33. Transmucosal fine-needle aspiration diagnosis of intraoral and intrapharyngeal lesions.OBJECTIVES: The effectiveness of fine-needle aspiration biopsy (FNAB) for the diagnosis of neck, thyroid, and salivary gland masses is well documented. Very few reports explore the potential of an intraoral FNAB approach for the diagnosis of submucosal lesions. We describe our technique and present case examples of pertinent differential diagnostic entities. We recommend an expanded role for FNAB of the oral cavity and oropharynx. STUDY DESIGN: Retrospective review. methods: A uniform technique was employed for transmucosal FNAB of 76 patients with intraoral masses. In applicable cases, cytology results were compared with traditional biopsy methods and permanent histopathologic specimens for accuracy. RESULTS: Our experience demonstrates the high sensitivity (93%) and specificity (86%) of intraoral FNAB when compared with biopsy by conventional means. FNAB provides distinct advantages for the cytologic diagnosis of submucosal lesions, which may be difficult to reach and adequately sample through conventional biopsy. FNAB of the tonsil and tonsillar fossa provides a safe and effective means of diagnosing both lymphoma and squamous cell cancer. Transmucosal FNAB via the mouth led to rapid diagnosis of a number of benign and malignant lesions. Applying this uniform FNAB technique, we had no significant complications. CONCLUSION: We recommend transmucosal FNAB as an effective means for highly accurate diagnosis of submucosal lesions of the oral cavity and oropharynx. CLINICAL RELEVANCE: Traditional biopsy techniques in the oral cavity may require anesthesia and may have diagnostic difficulties, particularly for submucosal lesions. Transmucosal FNAB overcomes these shortcomings by providing a minimally invasive means to rapid diagnosis of intraoral lesions.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/33. dental caries after radiotherapy of the oral regions.Five cases of dental caries after radiation therapy of the oral regions for treatment of carcinomas are presented. The differences in clinical appearance and behavior between radiation caries and ordinary smooth-surface dental caries are described. The role of salivary gland irradiation and the resultant xerostomia in the development of these lesions is discussed. Some explanations are offered as to how these lesions develop in the light of current knowledge concerning plaque and the development of dental caries. Several measures that may be taken to reduce the incidence and severity of these lesions are suggested.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/33. Vallecular acinic cell carcinoma in a 9-year-old girl: report of an unusual case.An unusual case of acinic cell tumour of the vallecula is presented. Acinic cell carcinoma occurs usually in the major salivary glands. Minor salivary gland location is unusual and vallecular origin exceptional. This peculiar histologic tumour should now be classified as an low grade carcinoma and adequate treatment has to be initiated. The patient, a 9-year-old girl, had undergone a suprahyoid access for total tumor removal with a bilateral neck exploration. Postsurgical radiotherapy has to be done in case with perineural invasion, invaded margins, node invasion or high grade tumor. The clinical and histopathological findings are discussed in the light of the literature.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
6/33. Extended esophagolaryngeal resection with parathyroid autotransplantation.Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin d supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
7/33. meningioma presenting as a parapharyngeal tumor: report of a case with fine needle aspiration cytology.BACKGROUND: Meningiomas rarely extend out of their intracranial confines through skull foramina to present as cervical tumors, where they would be accessible to fine needle aspiration (FNA) and thereby create difficulties in cytodiagnosis by mimicking other, more commonly aspirated head and neck tumors. CASE: A psammomatous meningioma arising intracranially and extending through the jugular foramen presented as a mass at the angle of the jaw clinically. On FNA cytology the diagnosis was suggested, but the cytomorphologic features overlapped with those of more commonly aspirated head and neck tumors, such as acinic cell carcinoma arising primarily in a salivary gland, metastatic papillary thyroid carcinoma and paraganglioma (glomus jugulare tumor). These possibilities had to be excluded through correlation with radiologic and intraoperative findings, which showed a dural-based tumor extending through the jugular foramen to assume a parapharyngeal location. histology of the final excision specimen confirmed a psammomatous meningioma. CONCLUSION: The possibility of meningioma should be considered in the cytologic differential diagnosis of parapharyngeal tumors, particularly since its cytomorphologic features may mimic those of some of the more commonly encountered and aspirated head and neck tumors.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/33. Parapharyngeal metastasis from papillary microcarcinoma of thyroid: report of a case diagnosed by peroral fine needle aspiration.A parapharyngeal metastasis from primary thyroid carcinoma is rare and a search of relevant publications disclosed only seven previous reported cases. We describe a 46-year-old man who presented with a left parapharyngeal mass that was subsequently diagnosed by peroral fine-needle aspiration as a metastasis originating from a papillary carcinoma of the thyroid gland. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal mass. Fine-needle aspiration cytology is a simple, speedy, and cost-effective method of diagnosis of parapharyngeal masses.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
9/33. Papillary thyroid carcinoma metastasis to the parapharyngeal space.Thyroid papillary carcinoma presenting as a pharyngeal mass is a rare clinical occurrence and has only been reported sporadically. We present here two patients who had papillary carcinoma metastasis of the thyroid gland to the parapharyngeal space. Each patient had a different clinical progress. Upward lymphatic spread of the tumor to involve the parapharyngeal space via the lateral retropharyngeal nodes was indicated. This pattern of spread is in keeping with Rouviere's description of a direct lymphatic pathway from the thyroid gland to the retropharyngeal nodes and parapharyngeal space.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
10/33. Pharyngeal pituitary non-functioning adenoma with normal intra-sellar gland: massive tumor shrinkage on octreotide therapy.OBJECTIVE: Functioning or non-functioning ectopic tumors may develop from pharyngeal pituitary remnants. They constitute <1% of all obstructive pharyngeal masses and they have a strong tendency to bleed. We report a case of a non-functioning ectopic pituitary adenoma of the rhino-pharynx studied over a long-term somatostatin analog treatment. PATIENT AND TREATMENT: A 60-Year-old woman presented with severe posterior epistaxis. She had complained of nasal obstruction for the past 2 Years. magnetic resonance imaging (MRI) and endoscopic examination revealed a 2 cm exophytic, bleeding mass in the cavum, which was judged inoperable, and a biopsy was performed. On immunostaining, tumor cells were positive for pancytokeratins MNF 116 and C11, epithelial membrane antigen, chromogranin and neuron-specific enolase (NSE), and negative for synaptophysin, desmin, actin, estrogen and progesterone receptors, all anterior pituitary hormones and human chorionic gonadotropin. Blood levels of the above hormones and tumor markers were normal, except for a moderate elevation of NSE (33.8 microg/l, normal value <12 microg/l). It was concluded that this was a non-functioning pituitary adenoma of the rhino-pharynx. MRI showed a normal intra-sellar pituitary gland, including the normal bright signal of the posterior lobe. somatostatin receptor scintigraphy (SRS) disclosed intense tracer uptake in the tumor, indicating high somatostatin receptor content. There was also an intense uptake in the intra-sellar pituitary. Therapy with long-acting octreotide was started, 20 mg per Month i.m. RESULTS: The patient has been on octreotide for the last 12 Months. nasal obstruction rapidly subsided and bleeding did not recur. Repeated endoscopic examinations showed rapid tumor reduction, the mass shrinkage being almost complete at 3 Months. This was confirmed by MRI, while SRS showed markedly decreased uptake in the residual tumor and the intra-sellar pituitary, and NSE became normal. CONCLUSION: Pharyngeal pituitary remnant adenomas are rare, but they must be considered in the differential diagnosis of bleeding or obstructive masses of the rhino-pharynx. In this case, the positive SRS influenced the choice of octreotide, as an alternative to surgery. As we show for the first time in this location, octreotide can exert prolonged and marked anti-tumoral effects in non-functioning adenoma.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
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