RESUMEN
Castleman disease is a relatively uncommon lymphoproliferative disorder. A presentation as an isolated lesion in the neck is extremely rare. We report the case of a 26-year-old man who presented with a 4-month history of an enlarging right neck mass that was identified as Castleman disease on excisional biopsy. The biopsy was curative. In localized forms of Castleman disease, excisional biopsy is both diagnostic and curative. However, in multicentric forms, additional treatment is required.
Asunto(s)
Enfermedad de Castleman/diagnóstico , Cuello/patología , Adulto , Biopsia , Enfermedad de Castleman/complicaciones , Enfermedad de Castleman/patología , Humanos , Masculino , Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Chondroid syringoma is a generally benign, adnexal tumor most commonly found in the head and neck. It is typically diagnosed retrospectively from histopathology, and careful evaluation must differentiate it from tumors of salivary gland origin. It presents as a slowly growing, subcutaneous or intradermal nodule. Treatment consists of wide local excision with a margin of normal tissue. We report a case involving a 51-year-old man with a chondroid syringoma arising from the scalp. Clinical features, histopathology, and treatment are discussed.
Asunto(s)
Adenoma Pleomórfico/patología , Neoplasias de Cabeza y Cuello/patología , Cuero Cabelludo , Neoplasias Cutáneas/patología , Neoplasias de las Glándulas Sudoríparas/patología , Adenoma Pleomórfico/diagnóstico , Adenoma Pleomórfico/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/cirugíaRESUMEN
Chronic parotitis is a troubling clinical condition characterized by repeated infection and inflammation of the parotid gland caused by decreased salivary flow or obstruction. Unilateral swelling, pain, and other associated symptoms occur during acute exacerbations of the disease. A variety of laboratory and radiographic tools are available to aid in the diagnosis. Multiple treatment options have been proposed, ranging from conservative medical management to surgical interventions. We present 2 patients with bilateral chronic parotitis who attempted prolonged medical management and ultimately required surgical parotidectomy for control of their disease.
Asunto(s)
Parotiditis/terapia , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Parotiditis/diagnóstico , Parotiditis/etiologíaRESUMEN
Hepatocellular carcinoma (HCC) is one of the most frequently encountered malignancies. Distant metastasis is a common sequela, occurring in approximately 50% of cases. Metastasis to the oral cavity is very rare. Careful immunohistochemical evaluation is critical in differentiating HCC from other metastatic malignancies. An understanding of the possibility that HCC may initially present as a mandibular metastasis is crucial to guide management. We describe the case of a 76-year-old man with a 3- to 4-month history of a painless, slowly enlarging, left-sided jaw mass. Biopsy findings were consistent with HCC. While the patient was a known hepatitis C carrier, the presence of HCC had been previously unknown. Additional workup revealed a large hepatic lesion. In view of his poor health, the patient elected to forgo chemotherapy, and he entered a hospice facility. This case provides an illustration that an isolated mandibular mass may represent the initial presentation of HCC. Subsequent identification of the primary tumor via radiographic and pathologic evaluations is important for the guidance of further management.
Asunto(s)
Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/secundario , Neoplasias Hepáticas/diagnóstico , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/secundario , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Resultado Fatal , Humanos , Masculino , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/radioterapia , RadiografíaRESUMEN
Neuroblastoma is an uncommon cause of a mandibular mass. We describe an 8-month-old child who presented with loosening of his dentition, poor oral intake, and a large mandibular mass. Thorough radiographic study and subsequent biopsy of the oral lesion revealed the diagnoses of metastatic neuroblastoma. Ultimately, he was successfully treated with surgery and chemotherapy. The unusual presentation and pathophysiology of this malignancy will be reviewed. Neuroblastoma presenting as a mandible mass associated with natal teeth is rare, but it should be considered in the differential diagnosis of pediatric mandibular lesions.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias Mandibulares/patología , Neuroblastoma/secundario , Neoplasias Orbitales/secundario , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/terapia , Biopsia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/terapia , Terapia Combinada , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Lactante , Masculino , Neoplasias Mandibulares/terapia , Estadificación de Neoplasias , Neuroblastoma/diagnóstico , Neuroblastoma/terapia , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/terapia , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma/secundario , Conducto Auditivo Externo/patología , Neoplasias del Oído/secundario , Neoplasias Esofágicas/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Conducto Auditivo Externo/cirugía , Neoplasias del Oído/diagnóstico , Neoplasias del Oído/cirugía , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirugía , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otológicos/métodos , Resultado del TratamientoRESUMEN
Tubular occlusion from red blood cell casts secondary to immunoglobulin A nephropathy (IgAN) is a rare, serious complication of tonsillitis that can cause acute renal failure, also referred to as acute kidney injury. IgAN is the most common primary glomerulonephritis with up to 20% of cases resulting in renal failure worldwide. Tonsillectomy is an effective treatment option for patients suffering from IgAN secondary to recurrent acute tonsillitis. Tonsillectomy alone or in combination with additional medical modalities improves renal function and can have a positive effect on long-term renal survival.
Asunto(s)
Glomerulonefritis por IGA/etiología , Glomerulonefritis por IGA/terapia , Tonsilectomía , Tonsilitis/complicaciones , Adulto , Enfermedad Crónica , Femenino , Humanos , Recurrencia , Tonsilitis/cirugíaRESUMEN
BACKGROUND: Extranodal nasal-type natural killer (NK)/T-cell lymphoma is a very uncommon disease process often mimicking refractory sinusitis. The diagnosis may be discovered after an extensive exclusion process. Careful immunohistochemical evaluation is crucial to differentiate NK/T-cell lymphoma from other malignancies. METHODS AND RESULTS: We describe a 46-year-old white man presenting with a 4-month history of refractory sinusitis and new onset visual field loss in his right eye, right facial tingling, and pain. Examination revealed right periorbital edema and scleritis, and necrotic appearing turbinates with purulence and fibrinous debris. CT/MRI delineated extensive paranasal sinus involvement. Immunohistopathology demonstrated extranodal nasal-type NK/T-cell lymphoma. Additional radiography revealed widespread involvement. CONCLUSION: Severe recalcitrant sinusitis with orbital involvement may be the initial presentation of NK/T-cell lymphoma. Ulcerative or necrotic lesions in the midline of the head and neck should raise concern for this disease. In addition to radiographic and laboratory testing, large biopsies should be taken for immunohistochemical analysis to achieve diagnosis and guide further management.
Asunto(s)
Linfoma Extranodal de Células NK-T/diagnóstico , Diagnóstico Diferencial , Dolor Facial/etiología , Parálisis Facial/etiología , Resultado Fatal , Pérdida Auditiva Conductiva/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Sinusitis/diagnóstico , Tomografía Computarizada por Rayos X , Trastornos de la Visión/etiología , Campos VisualesRESUMEN
BACKGROUND: Pulsatile tinnitus is an uncommon otologic symptom, which may be the presenting complaint of a potentially devastating pathology. Understanding this manifestation as a possible symptom of a significant vascular abnormality is crucial to guide management and treatment. METHODS AND RESULTS: We describe a 38-year-old woman with sudden-onset right-sided pulsatile tinnitus. A right extracranial internal carotid artery (ICA) dissection was diagnosed with MRI/magnetic resonance angiography (MRA) and treated with anticoagulation. Follow-up MRI/MRA demonstrated complete resolution. Two months later, left-sided pulsatile tinnitus evolved. An MRI/MRA of the neck demonstrated left-sided extracranial ICA dissection. She was treated in a similar fashion and a repeat MRI/MRA demonstrated its resolution. CONCLUSION: Spontaneous extracranial ICA dissection may present with pulsatile tinnitus as the only symptom in 4% to 50% of patients. Subsequent evolution of a contralateral dissection is even more uncommon. Generally, treatment of this phenomenon is conservative utilizing anticoagulation or aspirin; however, surgical intervention may be necessary.
Asunto(s)
Disección de la Arteria Carótida Interna/complicaciones , Disección de la Arteria Carótida Interna/diagnóstico , Acúfeno/etiología , Adulto , Disección de la Arteria Carótida Interna/terapia , Femenino , Humanos , Angiografía por Resonancia Magnética , Radiografía , Recurrencia , Acúfeno/diagnóstico por imagen , Acúfeno/patologíaRESUMEN
Ondine's curse or central alveolar hypoventilation (CCAH) syndrome is a disorder of the autonomic nervous system resulting in respiratory dysregulation. The clinical outcome is typically poor, with few individuals living into adulthood and even fewer surviving to adulthood with normal neurological function. Our patient initially presented following an uncomplicated delivery with hypotonia, poor respiratory effort, and hypoxemia that required ventilatory support. Laboratory workup, radiographic evaluation, and ancillary testing ruled out brain stem lesions, neuromuscular diseases, cardiovascular and pulmonary disease, and metabolic disorders, resulting in a diagnosis of CCAH syndrome. The patient underwent tracheotomy and chronic ventilatory support. Close long-term management and appropriate treatment modifications have provided for an excellent outcome and good quality of life. The patient is currently 22 years old and is earning her teaching degree for K-12 art education. A combination of early recognition and a multidisciplinary approach may lead to a successful outcome in patients with CCAH syndrome.
Asunto(s)
Trastornos Intrínsecos del Sueño/terapia , Adulto , Femenino , HumanosRESUMEN
Securing the airway in a dyspneic patient is a challenging task because of the myriad causes and presentations. Initial assessment may demonstrate factors indicative of upper airway abnormalities; however, they may not be specific nor sensitive enough to accurately predict difficult intubation. A well-equipped airway cart must be immediately available. A standardized escalating approach to secure the airway in a difficult situation begins with a rapid sequence of attempts at standard intubation, followed by attempted tube introduction over a bougie or using a flexible endoscope or laryngeal mask, and finally surgical interventions including cricothyrotomy or tracheotomy.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Adulto , Obstrucción de las Vías Aéreas/cirugía , Diagnóstico Diferencial , Estado de Salud , Humanos , Máscaras Laríngeas , Laringoscopía , Traqueotomía/métodosAsunto(s)
Endoscopía/métodos , Cóndilo Mandibular/lesiones , Traumatismos Mandibulares/cirugía , Heridas por Arma de Fuego/cirugía , Adulto , Estudios de Seguimiento , Humanos , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Traumatismos Mandibulares/diagnóstico por imagen , Boca , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/diagnóstico por imagenRESUMEN
OBJECTIVES: Carcinosarcoma (true malignant mixed tumor) of the parotid gland is an extremely uncommon tumor composed of both carcinomatous and sarcomatous components. An understanding of this manifestation is crucial to guide management and treatment of this disease. METHODS: A patient who presented with facial nerve weakness and a painful mass of the parotid gland underwent fine needle aspiration, laboratory testing, and computed tomography of the neck that demonstrated a large parotid malignancy. The patient underwent surgical treatment followed by radiotherapy. Histologic and immunohistochemical examination of the specimen was performed. RESULTS: This report of a slow-growing parotid mass with otalgia and facial nerve weakness was treated with radical parotidectomy, supraomohyoid neck dissection, and cable graft repair of the excised facial nerve, which was completely encircled by tumor. Postoperative radiotherapy was administered. Histologic and immunohistochemical evaluation demonstrated carcinosarcoma. CONCLUSIONS: Carcinosarcoma is an unusual tumor of the parotid gland. Treatment generally involves surgery with subsequent radiotherapy. Long-term close follow-up is recommended, for this tumor has a high propensity for both local and regional recurrence and metastasis.
Asunto(s)
Carcinosarcoma/diagnóstico , Inmunohistoquímica/métodos , Neoplasias de la Parótida/diagnóstico , Biopsia con Aguja Fina , Carcinosarcoma/radioterapia , Carcinosarcoma/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Neoplasias de la Parótida/radioterapia , Neoplasias de la Parótida/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Paragangliomas are uncommon tumors that present in the head and neck. Rarely, this benign tumor may occur in the nose and paranasal sinus. We report a case of paraganglioma involving the sphenoid sinus, discuss histologic characteristics, and review this tumor.
Asunto(s)
Paraganglioma/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Seno Esfenoidal , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paraganglioma/patología , Paraganglioma/cirugía , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/cirugíaRESUMEN
Canalicular adenoma is a rare benign salivary gland tumor that occurs almost exclusively in the upper lip. Rarely, this benign tumor may occur multifocally in the oral cavity. We report a case of canalicular adenoma in bilateral parotid glands, discuss histological characteristics, and review this tumor.
Asunto(s)
Adenoma/patología , Neoplasias de la Parótida/patología , Adulto , Humanos , MasculinoRESUMEN
Gallbladder rupture following blunt abdominal trauma is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon. Delay in the diagnosis of the injury for several days due to no, or vague, symptoms and an insidious course is common. Early diagnosis is essential, as protracted treatment may result in significant morbidity and mortality. We report the case of a patient who suffered isolated gallbladder rupture due to blunt abdominal trauma from a fall. We propose laparoscopic cholecystectomy as a safe and effective surgical treatment for this solitary injury.
Asunto(s)
Traumatismos Abdominales/complicaciones , Colecistectomía Laparoscópica , Vesícula Biliar/lesiones , Heridas no Penetrantes/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Rotura/etiología , Rotura/cirugíaRESUMEN
Adult extracardiac rhabdomyoma is an uncommon primary tumor of striated muscle origin that almost exclusively presents in the head and neck region. The occurrence of multifocality is a rare manifestation of this unusual lesion. In this study, we report a rare case of multifocal adult extracardiac rhabdomyoma in a patient presenting with an asymptomatic neck mass and provide a brief review of the literature on this entity.