1/12. 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 = vessel (Clic here for more details about this article) |
2/12. Extravascular papillary endothelial hyperplasia arising from parapharyngeal space.A 66-year-old man visited our clinic suffering from swelling of right pharyngeal space. He was not aware of other symptoms. The contrast CT showed patchy enhancement with calcification. The enhanced MRI revealed a non-homogeneous signal pattern and patchy central enhancement. During surgery, egg-shaped hard elastic tumor was observed in parapharyngeal space without any sign indicating an invasion into surrounding nerves or feeding vessels. Then the tumor was removed without significant hemorrhage or damage to the cranial nerve. Histological examination of the tumor revealed a nodular lesion with blood clot and hematoma encapsulated with fibrous tissue having vascular spaces of irregular shape and size. From those findings, the tumor was diagnosed as papillary endothelial hyperplasia (PEH). However, since the location of the tumor differed from that of PEH commonly observed in the intravascular space, the tumor was classified as extravascular PEH.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/12. Carotid blowout with infection: management with endovascular and open vascular approaches--a case report.The management of patients with head and neck cancer can be complicated by massive carotid artery hemorrhage, often requiring ligation owing to the emergent conditions and scarring from previous surgery and radiation. A case of emergent endovascular management of carotid artery hemorrhage in a patient treated for pharyngeal carcinoma is described. hemorrhage was controlled, but on follow-up the patient developed a carotid-cutaneous fistula with exposure of the coils. Further management required the use of autogenous vein to replace the involved vessels. This case demonstrates that endovascular control of carotid hemorrhage can be successful, but close follow-up is necessary to identify potential subsequent complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/12. Limited Wegener's disease presenting as pharyngolaryngeal tumor.Wegener's disease (WD) which is mostly a systemic illness rarely presents as isolated, monoorganic, limited disease. Limited pharyngolaryngeal WD is thus a very rare occurrence. We report the case of a 29 years old man who developed a pharyngolaryngeal tumor with clinically benign evolution, histologically showing granulomatous inflammation and small vessel vasculitis, with no signs of: tuberculosis, sarcoidosis, fungal disease, Hodgkin's disease or foreign body aspiration. p-ANCA's were positive. He was considered a limited form of WD and treated with moderate doses of corticoids and cotrimoxazole. One month later, the lesion diminished significantly. The finding of a pharyngolaryngeal tumor with granulomatous inflammation and vasculitis, in the context of p-ANCA positivity and without any evidence for another systemic granulomatous disease, suggested the diagnosis of limited WD. The response to treatment favoured this presumption. Limited pharyngolaryngeal WD is a rare disease, with a potential for life-threatening (even fatal) complications. It should be recognized early and treated promptly. Remissions can be achieved (even without the use of cyclophosphamide).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/12. Parapharyngeal branchial cleft cyst extending to the skull base: a lateral transzygomatic-transtemporal approach to the parapharyngeal space.Second branchial cleft cysts (BCCs) can occur anywhere from the tonsillar fossa to the supraclavicular area. Second BCCs usually lie on the great vessels of the neck, deep in the sternocleoidomastoid muscle or along its anterior border at the mandibular angle. Parapharyngeal second BCCs are an uncommon neoplasm and rarely extend to the skull base. We report the case of a 45-year-old male with symptoms of conductive hearing loss. temporal bone CT scan showed effusion in the left middle ear cavity. magnetic resonance imaging (MRI) revealed a cystic mass that was located at the left parapharyngeal space and eroded the skull table of the left temporal base. Excision of the lesion was achieved via a transzygomatic-transtemporal approach to the parapharyngeal space. Histopathological examination of the cyst wall showed a single layer of ciliated columnar epithelium without goblet cells or lymphoid tissue. The patient recovered without any complications and experienced complete resolution of left-sided hearing difficulty. We conclude the lateral transzygomatic-transtemporal approach allows surgeons direct access to the parapharyngeal space with satisfactory exposure for treating benign lesions of the parapharyngeal space.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/12. Neurogenic tumours of the parapharyngeal space in the paediatric age group.Two cases of neurogenic tumours of parapharyngeal space in children of 7 years old are presented. Difficulties during the diagnosis, investigations and management are discussed along with a review of the available literature. CAT scan with sialography, carotid angiography during surgery, angle mandibulectomy and liberal incision to expose the great vessels for better control of bleeding are stressed to minimise the peri-operative complication and to assist in complete removal of the tumours.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/12. Parietal occipital nape of neck flap. A myocutaneous flap for selected head and neck reconstruction.Reconstruction in head and neck surgery has been greatly advanced with the use of the pectoralis major and trapezius myocutaneous flaps. Most surgical defects can be repaired with one of these flaps alone, or in conjunction with cutaneous flaps. Specific problems, however, occur that cannot be successfully reconstructed by these standard flaps. The traditional scalp flaps are cutaneous flaps. Use of these flaps is limited because of their shortened arc of rotation and accompanying forehead deformity. Three patients underwent reconstruction with a parietal occipital nape of neck myocutaneous flap. Its advantages include the following: large segments of hairless skin from the contralateral side of the neck can be used, an extensive arc of rotation and distance can be achieved with excellent vascularity in the overlying skin, and cosmetic results are superior. Angiographic studies were used to demonstrate the vascular pattern and supply to this flap. cadaver dissections were performed to determine the pattern of distribution of the perforating vessels to the skin from underlying muscle.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/12. Radical neck dissection after prosthetic repair of carotid artery.A carcinoma of the pyriform fossa developed ten years after a Teflon patch graft angioplasty of the common and internal carotid vessels. The graft was embedded in fibrous tissue and covered by pseudoadventitia, which could be dissected free without difficulty. If radiation therapy is used, it should be administered postoperatively. The Teflon graft can be protected from possible salivary fistulae by a dermal graft that is covered by a levator scapulae muscle flap, which is sutured to the prevertebral fascia to separate the carotid vessels from the pharynx, but it is not recommended that the tumor resection be staged to achieve this carotid protection.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/12. Free peroneal and its composite flap: a distant donor for head and neck reconstruction.Free peroneal or its composite flap from the leg has been transferred in four patients for oro-mandibular and hypopharyngeal defects following surgery for malignancy. These flaps were successfully transplanted in all patients: two cases of free peroneal flap and two of free fibular graft with skin with no resulting problems with the leg. The peroneal osteocutaneous flap offers the following advantages: The axial vessels are preferable for microvascular surgery. Two flaps can be used with two cutaneous branches. A flap measuring up to 16 x 4.5 cm can be utilized with primary closure at the donor site. A long bone can be obtained together with skin. Surgery on the neck and harvesting of the flap can be done at the same time. The donor site is not conspicuous.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/12. The value of magnetic resonance imaging in the differential diagnosis of parapharyngeal space tumours.Between 1987 and 1993 14 patients with a parapharyngeal space tumour were imaged by magnetic resonance imaging (MRI). The vagal body tumours, presenting in the poststyloid compartment, all showed flow voids with anterior and medial displacement of the internal carotid artery. None of the salivary gland tumours, all presenting in the prestyloid compartment with posterior displacement of the internal carotid artery, showed flow voids. MRI is superior compared with other modalities in evaluating the differential diagnosis, especially regarding vascular vs non-vascular tumours. It should encompass T1 SE images to assess the presence or absence of flow voids. In vascular tumours angiography must be used to assess feeding vessels, multiplicity, and sides involved. T1 GE images are useful as they allow superior identification of the internal carotid artery and its relation with the tumour accordingly. In addition to T1 SE images, T2 SE images may help in the evaluation of the differential diagnosis. In all non-vascular tumours aspiration cytology is required to differentiate between benign and malignant disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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