Epstein-Barr virus-induced natural killer/T cell lymphoma arising in tonsil and cervical node tissue.

Infection with Epstein-Barr virus (EBV) has been linked to approximately 10%-15% of lymphomas diagnosed in the USA, including a small percentage of Natural Killer (NK)/T cell lymphomas, which are clinically aggressive, respond poorly to chemotherapy and have a shorter survival. Here, we present a case of a patient found to have EBV-induced NK/T cell lymphoma from a chronic EBV infection. While the EBV most commonly infects B cells, it can infect NK/T cells, and it is important for the clinician to be aware of the potential transformation to lymphoma as it is clinically aggressive, warranting early recognition and treatment. NK/T cell lymphoma is a unique type of non-Hodgkin's lymphoma that is almost always associated with EBV. The disease predominantly localises in the upper aerodigestive tract, most commonly in the nose.

Glomangiopericytoma of the sphenoethmoid complex.

Sinonasal glomangiopericytoma is a rare sinonasal tumour accounting for less than. 5% of all sinonasal tumours. This tumour often presents as another, more common type of vascular lesion and is similarly prone to haemorrhage. The optimal treatment includes complete surgical resection. We, herein, present two such cases adding to the world literature of this rare tumour.

Giant nasal granuloma gravidarum.

Nasal granuloma gravidarum usually presents as a small vascular lesion on the septum or turbinates during pregnancy. We present a case of a giant nasal granuloma gravidarum and its management.

A case report of parotid mammary analogue secretory carcinoma and reviews.

INTRODUCTION: Mammary analog secretory carcinoma (MASC) is a new diagnosis of head and neck tumors first reported in 2010. It was often misdiagnosed as salivary acinic cell carcinoma (AciCC). We present a patient with an asymptomatic parotid tumor that underwent deep lobe parotidectomy and postoperative radiation therapy. The final pathology showed MASC. CASE PRESENTATION: A 57-year-old male presented with an asymptomatic enlarging right parotid mass. A CT neck with IV contrast showed a 1.2 cm heterogeneously enhancing mass in the center of the right parotid gland without extraparotid extension. An FNA showed an epithelial neoplasm with papillary features. The patient underwent a right deep lobe parotidectomy with facial nerve dissection. The final pathology confirmed the diagnosis of MASC. He subsequently completed a 6-week course of radiation therapy and remained asymptomatic at his 30-month follow up. DISCUSSION/CONCLUSION: Although MASC is considered a low-grade tumor in most cases, recurrence and disseminated disease are not uncommon. No standard treatment protocol has been established. This report aims to enhance the awareness of this diagnosis and provide a review of current treatments for head and neck oncology care providers.

Sebaceous lymphadenoma requiring superficial parotidectomy.

An 82-year-old woman presented with a painless, progressively enlarging right neck mass of 2 years' duration. CT with contrast showed a 5.0 cm confluence of nodes just inferior to the right parotid gland. Fine-needle aspiration showed a lymphoproliferative disorder. Incisional biopsy showed sebaceous lymphadenoma. She subsequently underwent superficial right parotidectomy with neck dissection of level II-V (performed for enlarged lymph nodes causing significant pain). Facial nerve was preserved. She remained free of disease nearly 1 year postoperatively.

Imaging characteristics and findings in thyroglossal duct cyst cancer and concurrent thyroid cancer.

Thyroglossal duct cyst cancer is rare, while synchronous thyroglossal duct cyst cancer with thyroid cancer is still rarer. The radiographic features of this case are instructive and crucial when evaluating a thyroglossal duct cyst.

Follicular cell dendritic sarcoma of cervical nodes in a patient with significant WTC exposure.

A patient who worked at the World Trade Center (WTC) site presented with right cervical lymphadenopathy. He underwent right neck dissection. The final pathology showed follicular dendritic cell sarcoma. He was treated with radiation and chemotherapy and remained free of disease initially. He then presented with left cervical lymphadenopathy 2.5 years later and underwent a left neck dissection with similar pathology. A discussion of the disease process and WTC exposure is presented. Clinicians should be cognisant of this disease process and the latency between WTC exposure and the onset of sarcomas.

An unexpected finding of a bronchogenic cyst presenting as a thyroid mass.

Herein we present a case of a bronchogenic cyst masquerading as a thyroid mass. Bronchogenic cysts are rare congenital malformations that result from an abnormal development of the ventral foregut during organogenesis. They are commonly asymptomatic lesions rarely found in the neck. In our case, a young male presented with complaints of neck discomfort over a long period presumed to be secondary to a thyroid mass based on imaging studies. Fine needle aspiration was inconclusive. Post-operative pathological sectioning revealed evidence of a bronchogenic cyst. These lesions have a low incidence of malignancy, and complete surgical excision has been recommended.

Platysma myocutaneous flap for oral cavity reconstruction.

A retrospective study was conducted to assess outcomes of reconstruction of the oral cavity with the platysma myocutaneous flap, in terms of flap survival, complications, and quality of life. Included were 10 patients with squamous cell carcinoma (stage T1 to T4; nodal status N0 to N2) of the oral cavity who were treated between 2002 and 2006. Each patient underwent tumor resection, modified radical neck dissection, and primary reconstruction with a platysma myocutaneous flap. Operating time, length of stay, time to swallow, and complications were assessed, and the University of Washington Quality of Life questionnaire was administered. Mean operating time was <4 hours, mean length of stay was 11 days, and mean time to swallow was 9 days. One patient had distal flap necrosis and one had wound dehiscence. No total flap failures or fistulas occurred. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity. The additional operating room time is negligible, the surgical complications minimal, and the overall quality of life very good. This flap should be used more frequently in the reconstruction of oral cavity defects.

Solitary fibrous tumor of the parapharyngeal space.

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definitepattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.

Current technique for resection of mediastinal goiter.

We have developed a combined surgical technique involving traction sutures, the harmonic scalpel, and laryngeal nerve monitoring for the removal of mediastinal goiters. This technique is safe, expeditious, and effective; it minimizes the risk of blood loss or nerve injury; and it obviates the need for sternotomy. During a 4-year period, we performed this operation on 21 patients. We observed only two complications: one patient developed postoperative seroma 1 week after surgery and another experienced vocal fold paralysis after intentional sacrifice of the recurrent laryngeal nerve, which was encompassed by cancer. No other recurrent laryngeal nerve was injured. Operative blood loss was negligible, no systemic infection or permanent hypoparathyroidism was observed, and no patient required a chest tube or chest incision. Almost all patients were discharged home on postoperative day 1.

Office-based intralesional cidofovir injections for nasal septal papilloma: a pilot study.

OBJECTIVES: To determine if nasal septal papilloma is responsive to intralesional cidofovir injections. METHODS: Five adult males, ages 37 to 57, presented with nasal septal or columellar papilloma. Three lesions had been previously excised with the laser and recurred. The lesions were injected with cidofovir on a monthly basis until complete resolution or any residual lesion was excised afterwards with the laser. RESULTS: All patients achieved disease remission sustained over 10 to 24 months. Overall doses were much lower than those described for laryngeal papillomatosis and no toxic effects were observed. CONCLUSIONS: Office-based intralesional injections of cidofovir may show benefit in the treatment of nasal septal papilloma. EBM RATING: C-4.

Electrophysiologic laryngeal nerve monitoring in high-risk thyroid surgery.

We recently began performing intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during high-risk thyroidectomies. Neuromonitoring can detect stimulation of these nerves and thereby prevent a mechanical or thermal injury that can result in neurapraxia or axonotmesis. Monitoring is also useful during dissection in an already operated-on field, when performing thyroidectomy on patients who depend on their voice for their livelihood, and when removing a large goiter or mediastinal mass.

Infiltrating, moderately differentiated neuroendocrine tumor of the larynx: a brief report.

We report a rare case of moderately differentiated neuroendocrine carcinoma of the larynx. We describe the clinical and pathologic findings relevant to this case, and we review the literature on the pathologic features of this malignancy. We also discuss treatment options.

Hidradenoma papilliferum of nasal skin.

Pathologic examination of an excisional biopsy specimen of a subepidermal nodule from the nasal tip of a 37-year-old black man demonstrated papillae covered by eosinophilic columnar epithelial cells, suggesting cylindric cell papilloma or well-differentiated papillary adenocarcinoma of nasal mucosa. The patient did not submit to further investigation of the sinonasal tract but sought attention 15 months later because of local recurrence of the lesion. A protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and tip was excised completely and found to have characteristics of hidradenoma papilliferum, an apocrine gland neoplasm most commonly occurring in the anogenital skin of white women. This case demonstrates how easily an apocrine neoplasm arising near a mucocutaneous junction can be confused with a mucosal tumor, potentially leading to inappropriate treatment.

Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases.

OBJECTIVE: The purpose of this report was to evaluate the technical benefits, if any, of thyroidectomy using the harmonic scalpel versus conventional thyroidectomy. STUDY DESIGN: One hundred five consecutive patients underwent thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent thyroidectomy 1 year earlier using conventional techniques. RESULTS: The incision length for those undergoing thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional thyroidectomy group. The operating time for a hemithyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional thyroidectomy group. CONCLUSION: The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few. SIGNIFICANCE: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field.