Pilomatricoma.

Other Anatomic Sites, Skin
Thompson LD.
Ear Nose Throat J. 2012 Jan;91(1):18-20.
FIRST PARAGRAPH: Pilomatricoma, also referred to as pilomatrixoma and calcifying epithelioma of Malherbe, is a benign dermal-subcutaneous tumor derived from the matrix of the hair follicle. Its development is associated with a known mutation in the CTNNB1 gene, the gene that encodes for beta-catenin. Pilomatricomas are relatively common tumors. They usually arise during the first 2 decades of life, and they have no predilection for either sex.
PubMed ID: 22278863
Article Size: <1 MB

Sinonasal Tract Mucoepidermoid Carcinoma: A Clinicopathologic and Immunophenotypic Study of 19 Cases Combined with a Comprehensive Review of the Literature.

Head & Neck, Sinonasal Tract
Wolfish EB, Nelson BL, Thompson LD.
Head Neck Pathol. 2012 Jun;6(2):191-207.
Primary sinonasal tract mucoepidermoid carcinomas (MEC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. The design of this study is retrospective. Nineteen cases of MEC included 10 females and 9 males, aged 15-75 years (mean, 52.7 years); males, on average were younger by a decade than females (47.2 vs. 57.7 years). Patients presented most frequently with a mass, obstructive symptoms, pain, and/or epistaxis present for a mean of 12.6 months. The majority of tumors involved the nasal cavity alone (n = 10), maxillary sinus alone (n = 6), or a combination of the nasal cavity and paranasal sinuses (n = 3) with a mean size of 2.4 cm. Most patients presented at a low clinical stage (n = 15, Stage I & II), with only 4 patients presenting with Stage III disease. Histologically, the tumors were often invasive (bone or perineural invasion), with invasion into minor mucoserous glands. Surface involvement was common. The neoplastic cells were composed of a combination of squamoid cells, intermediate cells, and mucocytes. Cystic spaces were occasionally large, but the majoritywere focal to small. Pleomorphism was generally low grade. Necrosis (n = 5) and atypical mitotic figures (n = 6) were seen infrequently. Over half of the tumors were classified as low grade (n = 11), with intermediate (n = 4) and high grade (n = 4) comprising the remainder. Mucicarmine was positive in all cases tested. Immunohistochemical studies showed positive reactions for keratin, CK5/6, p63, CK7, EMA, and CEA in all cases tested, while bcl-2 and CD117 were rarely positive. GFAP, MSA, TTF-1, and S100 protein were non-reactive. p53 and Ki-67 were reactive to a variable degree. MEC need to be considered in the differential diagnosis of a number of sinonasal lesions, particularly adenocarcinoma and necrotizing sialometaplasia. The patients were separated into stage I (n = 9), stage II (n = 6), and stage III (n = 4), without any patients in stage IV at presentation. Surgery occasionally accompanied by radiation therapy (n = 2) was generally employed. Six patients developed a recurrence, with 5 patients dying with disease (mean, 2.4 years), while 14 patients are either alive (n = 9) or had died (n = 5) of unrelated causes (mean, 14.6 years). MEC probably arises from the minor mucoserous glands of the upper aerodigestive tract, usually presenting in patients in middle age with a mass. Most patients present with low stage disease (stage I and II), although invasive growth is common. Recurrences develop in about a third of patients, who experience a shorter survival (mean, 6.5 years). The following parameters, when present, suggest an increased incidence of recurrence or dying with disease: size ?4.0 cm (P = 0.034), high mitotic count (P = 0.041), atypical mitoses (P = 0.007), mixed anatomic site (P = 0.032), development of recurrence (P = 0.041), high tumor grade (P = 0.007), and higher stage disease (P = 0.027).
PubMed ID: 22183767
Article Size: 1.2 MB
 

Biomarkers predicting malignant progression of laryngeal epithelial precursor lesions: a systematic review.

Head & Neck, Larynx
Rodrigo JP, García-Pedrero JM, Suárez C, Takes RP, Thompson LD, Slootweg PJ, Woolgar JA, Westra WH, Brakenhoff RH, Rinaldo A, Devaney KO, Williams MD, Gnepp DR, Ferlito A.
Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1073-83
Some laryngeal epithelial precursor lesions progress to invasive carcinoma and others do not. Routine light microscopic classification has limited value in predicting the evolution of these lesions. This article reviews the experience to date with the use of molecular markers for the prognostic evaluation of laryngeal epithelial precursor lesions. We conducted a thorough review of the published literature to identify those studies using biomarkers to predict malignant progression of laryngeal epithelial precursor lesions. Of the 336 studies identified in this systematic search, 15 met the inclusion criteria and form the basis of this review. Limited studies suggest that certain biomarkers are potentially reliable predictors of malignant progression including various regulators of cell adhesion and invasion (e.g. FAK, cortactin, osteopontin, and CD44v6) and proliferation-associated markers such as TGF-?RII and Kv3.4. The predictive value of these markers, however, has yet to be confirmed in large-scale prospective studies. Although the cell cycle-related proteins are the most frequently studied markers, none have been consistently reliable across multiple studies. The absence of standardization in methodologies, test interpretation, and other parameters may contribute to study inconsistencies. Various biomarkers have proved to have potential prognostic value and could be clinically relevant. The utility and prognostic power of these biomarkers should be confirmed in large, well-designed, standardized prospective studies.
PubMed ID: 22081098
Article Size: <1 MB
 

Lymphadenoma of the salivary gland: clinicopathological and immunohistochemical analysis of 33 tumors.

Head & Neck, Salivary Gland
Seethala RR, Thompson LD, Gnepp DR, Barnes EL, Skalova A, Montone K, Kane S, Lewis JS Jr, Solomon LW, Simpson RH, Khan A, Prasad ML.
Mod Pathol. 2012 Jan;25(1):26-35.
Lymphadenomas (LADs) are rare salivary gland tumors. Their clinicopathologic characteristics and etiopathogenesis are poorly understood. We examined 33 LADs in 31 patients (17 women and 14 men) aged 11-79 years (median 65 years). There were 22 sebaceous LADs in 21 patients (9 women and 12 men) and 11 non-sebaceous LADs in 10 patients (8 women and 2 men). Two patients had synchronous double tumors. Twenty-six tumors (79%) arose in parotid, three in the neck, and two each in submandibular gland and oral cavity. Extraparotid tumors were seen in 2 of 21 (10%) patients with sebaceous and 4 of 10 (40%) patients with non-sebaceous LADs. Seven of twenty-three (30%) patients had immunosuppressive therapy for unrelated diseases. The tumors were well circumscribed, encapsulated (n=28, 84%) painless masses, varying in size from 0.6 to 6?cm (median 2.2). The cut surfaces were gray-tan to yellow, homogeneous and multicystic (n=24, 72%). The epithelial cells were basaloid, squamous and glandular, forming solid nests, cords, tubules, and cysts. Sebaceous differentiation was restricted to sebaceous lymphadenoma. The epithelial cells expressed basal cell markers (p63, 34BE12, and/or CK5/6, 18/18, 100%) and the luminal glandular cells expressed CK7 (12/12, 100%). Myoepithelial cells were absent (n=10/16, 63%) or focal. The lymphoid stroma was reactive, with germinal centers in 28 (84%). There was no evidence of HPV (0/11), EBV (0/7), and HHV-8 (0/8). Malignant transformation to sebaceous and basal cell adenocarcinoma was seen in one patient each. None of the 11 patients with follow-up (1-8 years) recurred. In summary, sebaceous and non-sebaceous LADs are benign, encapsulated, solid and cystic tumors affecting older adults. Non-sebaceous LADs affect women and extraparotid sites more frequently than sebaceous LADs. Altered immune status may have a role in their etiopathogenesis. Multiple synchronous tumors, origin in buccal mucosa, and malignant transformation may rarely occur.
PubMed ID: 21892186
Article Size: 1 MB
 

Hyalinizing trabecular adenoma of the thyroid gland.

Endocrine, Thyroid
Thompson LD.
Ear Nose Throat J. 2011 Sep;90(9):416-7.
FIRST PARAGRAPH: Hyalinizing trabecular ade-noma (HTA) is a very rare tumor (<1% of all primary thyroid gland tumors) of thyroid follicular cell origin with a trabecular pattern of growth and marked intratrabecular hyalinization. For all intents and purposes, this is a benign tumor, although there is a case report of pulmonary metastasis with invasion, suggesting the term tumor be used instead of adenoma. A few cases have occurred following radiation exposure, and there may be a relationship to thyroid papillary carcinoma, as there have been reports of RET/PTC rearrangements.
PubMed ID: 21938699
Article Size: <1 MB

Laryngeal spindle cell squamous cell carcinoma.

Head & Neck, Larynx
Thompson LD.
Ear Nose Throat J. 2011 May;90(5):214-6.
FIRST PARAGRAPH: Spindle cell squamous cell carcinoma (SCSCC) is a squamous cell carcinoma (SCC) with a biphasic appearance, yielding a spindle cell transformation. Many names have been used in the past, but the terminology used here highlights the spindled and squamous cell appearance. As with all cases of upper aerodigestive tract SCC, there is a strong association with smoking and alcohol abuse. Furthermore, radiation exposure is occasionally reported in patients with SCSCC. This SCC variant accounts for approximately 2 to 3% of all laryngeal tumors. Men are affected much more frequently than women (12:1 ratio), and the incidence peaks in the seventh decade of life.
PubMed ID: 21563088
Article Size: <1 MB

Ear ceruminous adenoma.

Ear & Temporal Bone, Head & Neck
Thompson LD.
Ear Nose Throat J. 2011 Jul;90(7):304-5.
FIRST PARAGRAPH: Ceruminous adenoma, also called ceruminoma, ceruminal adenoma, apocrine adenoma, or even cylindroma in the past (the latter three terms are discouraged) is a benign glandular neoplasm of ceruminous glands (modified apocrine sweat glands) that arises solely from the external auditory canal. By definition, this tumor type cannot involve the auricular cartilages, ear lobe, or other such external ear apparatus.
PubMed ID: 21792797
Article Size: <1 MB

Parotid Gland Solitary Fibrous Tumor: A Case Report and Clinicopathologic Review of 22 Cases from the Literature.

Head & Neck, Salivary Gland
Bauer JL, Miklos AZ, Thompson LD.
Head Neck Pathol. 2012 Mar;6(1):21-31.
Solitary fibrous tumors (SFTs) are rare tumors in the head and neck, and even more so in the parotid gland. The mass-like clinical presentation and histologic features result in frequent misclassification, resulting in inappropriate clinical management. There are only a few reported cases in the English literature. Twenty-one patients with parotid gland solitary fibrous tumor were compiled from the English literature (Medline 1960-2011) and integrated with this case report. The patients included 11 males and 11 females, aged 11-79 years (mean, 51.2 years), who presented with a parotid gland painless mass gradually increasing in size or with compression symptoms, with a mean duration of symptoms of 24.7 months. The mean tumor size was 4.5 cm. Grossly, all tumors were described as well-circumscribed to encapsulated, firm, homogenous white to tan masses. Seven patients had a preoperative fine needle aspiration performed, with the majority interpreted to represent pleomorphic adenoma or cementifying fibroma. Histologically, the tumors were well circumscribed, although many tumors showed focally entrapped normal salivary gland acini and ducts at the edge. The tumors were cellular, arranged in haphazard short interlacing fascicles of spindled to epithelioid cells. The spindled cells showed tapering cytoplasm with monotonous, round to oval nuclei with coarse nuclear chromatin distribution. Keloid-like to wiry collagen was present between the neoplastic cells. Mitoses were identified in most cases, while necrosis was absent. Isolated, patulous vessels were present, but a well developed ‘hemangiopericytoma-like’ vascular pattern was not seen. Three tumors were classified as malignant, showing marked nuclear pleomorphism and increased mitoses. When immunohistochemistry was performed, all tumors showed strong and diffuse vimentin, with a majority showing CD34, bcl-2 and CD99 immunoreactivity; all cases tested were negative for S100 protein, cytokeratin, EMA, CAM5.2, smooth muscle actin, muscle specific actin, desmin, MYOD1, myogenin, CD117, GFAP, CD31, FVIII-Rag, collagen IV, p63, p53, calponin, caldesmon, CD56, NFP, and ALK-1. The principle differential diagnoses include pleomorphic adenoma, myoepithelioma, nodular fasciitis, schwannoma, fibromatosis coli, spindle cell ‘sarcomatoid’ carcinoma, and spindle cell melanoma. All patients were managed with surgery, while two patients also received radiation therapy. Metastatic disease was identified in one patient immediately after excision. All patients with follow-up were alive without evidence of disease (n = 18), but the average follow-up is only 1.9 years. One patient is alive with disease at 12 months. Parotid gland SFT is a rare tumor, usually presenting in middle aged adults as a slowly growing mass. Characteristic histologic appearance with CD34 and bcl-2 immunoreactivity support the diagnosis. Surgery is the treatment of choice to yield a good outcome.
PubMed ID: 22002440
Article Size: 1 MB
 

Allergic fungal sinusitis.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2011 March;90(3):106-107.
FIRST PARAGRAPH: Allergic fungal sinusitis, also known as allergic mucin and eosinophilic fungal rhinosinusitis, is an allergic response in the sinonasal tract mucosa to aerosolized fungal allergens, amplified and perpetuated by eosinophils. The class II genes in the major histocompatibility complex are involved in antigen presentation and immune response (modulation), and an allergic reaction develops to inhaled fungal elements in immunocompetent people. Aspergillus species are the most common agents (widespread in soil, wood, and decomposing plant material), but Alternaria, Bipolaris, Curvularia, Exserohilum, and Phialophora species have also been reported
PubMed ID: 21412738
Article Size: <1 MB

Chordoma.

Head & Neck, Neck
Thompson LD.
Ear Nose Throat J. 2011 January;90(1):16-18.
FIRST PARAGRAPH: Chordomas are low- to intermediate-grade malignant tumors that recapitulate the notochord. They are divided into three broad categories: sacrococcygeal (60% of cases), spheno-occipital (25%), and vertebral (15%). About 10% of all tumors are cervical. Vertebral or neck chordomas typically develop in the fifth and sixth decades of life; they have no predilection for either sex. Nerve impingement, progressive pain, and headaches are common. When a chordoma arises within the parapharyngeal space, the mass may be detected clinically. Radiographically, chordomas are usually solitary, lytic lesions; they are associated with matrix calcification in as many as 70% of cases.
PubMed ID: 21229504
Article Size: <1 MB

Skin basal cell carcinoma.

Other Anatomic Sites, Skin
Thompson LD.
Ear Nose Throat J. 2010 Sep;89(9):418-20.
FIRST PARAGRAPH: Basal cell carcinoma (BCC) is a low-grade malignancy of basal keratinocytes, the cells responsible for epidermis formation. Melanocytes are seen between the keratinocytes, but they are not responsible for this tumor type. The etiology is multifactorial, related to ultraviolet sun exposure, radiation, and immunosuppression, among other factors. This is one of the most common cancers in humans. The tumors will typically present in older adults, although young adults can also develop this tumor. There is a slight male predilection, but this may be due to differences in sun exposure rather than gender variance. Caucasians and light-skinned people have a higher incidence than dark-skinned people.
PubMed ID: 20859866
Article Size: <1 MB

Salivary gland acinic cell carcinoma.

Head & Neck, Salivary Gland
Thompson LD.
Ear Nose Throat J. 2010 Nov;89(11):530-2.
FIRST PARAGRAPH: Acinic cell carcinoma (AcCC) is a malignant epithelial salivary gland neoplasm that demonstrates serous acinar cell differentiation with cytoplasmic zymogen secretory granules. While serous-type cells tend to predominate, ductal cells are also part of this neoplasm. There are a few cases that are thought to be related to radiation exposure. AcCC accounts for about 6% of all salivary gland tumors and 10 to 12% of all malignant salivary gland tumors. Patients present at a wide range of ages (mean: 40s). Children are also affected, as AcCC is the second most common neoplasm in the pediatric age group after mucoepidermoid carcinoma. Overall, females are more affected than males by a ratio of 3:2.
PubMed ID: 21086276
Article Size: <1 MB

Medullary thyroid carcinoma.

Endocrine, Thyroid
Thompson LD.
Ear Nose Throat J. 2010 Jul;89(7):301-2.
FIRST PARAGRAPH: Medullary thyroid carcinoma (MTC) is a malignant epithelial tumor of the thyroid gland that exhibits C-cell differentiation. C cells arise from the ultimobranchial body, which is derived from the fourth pharyngeal pouch, and they are found in the upper and middle areas of the thyroid lobes. These cells produce calcitonin, a hormone involved in calcium homeostasis. While a number (20%) of MTCs are associated with the autosomal-dominant inherited multiple endocrine neoplasia (MEN) syndromes (specifically MEN2A and MEN2B), most (80%) cases are sporadic. Germline or somatic mutations of the RET gene are characteristic of this tumor. They usually involve an activating point mutation of 10q11.2. Specifically, codon 634 in exon 11 is most common in MEN2A, while codon 918 in exon 16 is most common in MEN2B.
PubMed ID: 20628986
Article Size: <1 MB

Olfactory neuroblastoma.

Head & Neck, Sinonasal Tract
Thompson LD.
Head Neck Pathol. 2009 Sep;3(3):252-9.
Few neoplasms are unique to the sinonasal tract, but sinonasal undifferentiated carcinoma and olfactory neuroblastoma are malignant tumors which require unique management. Due to the rarity of these tumors, practicing pathologists are not always aware of their distinctive clinical, radiographic, histologic, immunohistochemical, and molecular features. These cases are frequently submitted for consultation, further suggesting the diagnostic difficulties inherent to these tumors. Specifically, olfactory neuroblastoma is a neoplasm that can histologically mimic many tumors within the sinonasal tract, making recognition of this tumor important, as the management frequently requires a bicranial-facial surgical approach, a trephination procedure which can be quite technically difficult and challenging to achieve a good result. The management is therefore quite unique in comparison to other sinonasal tract malignancies, setting it apart diagnostically and managerially from other lesions.
PubMed ID: 20596981
Article Size: <1 MB
 
 
 
 

Intestinal-type sinonasal adenocarcinoma.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2010 Jan;89(1):16-8.
FIRST PARAGRAPH: Adenocarcinomas of the sinonasal tract can originate in the respiratory epithelium or the underlying mucoserous glands. Most (60%) arise from the mucoserous glands. These tumors are divided into two categories: salivary-gland-type and nonsalivary-gland-type adenocarcinomas (table). The latter are subdivided into two major categories: intestinal-type adenocarcinomas (ITACs) and nonintestinal-type adenocarcinomas.
PubMed ID: 20155693
Article Size: <1 MB

Spindle-cell lipoma.

Other Anatomic Sites, Soft Tissue
Thompson LD.
Ear Nose Throat J. 2009 Jul;88(7):992-3.
FIRST PARAGRAPH: Histologically, spindle-cell lipoma is a distinctive type of lipoma on a continuum with pleomorphic lipoma. It accounts for approximately 1.5% of all adipose tissue neoplasms. Men are affected significantly more commonly than women (9:1) at a mean age in the sixth decade. The vast majority of tumors are located in the subcutaneous tissue of the posterior neck, upper back, and shoulders. Patients present with a painless, mobile, subcutaneous mass. In rare cases, these tumors develop in other head and neck mucosal sites, such as the buccal fat pad. Spindle-cell lipomas grow as large as 13 cm (mean: 3.5). Grossly, they resemble ordinary lipomas, although they may be somewhat firmer, especially if the spindle-cell component predominates.
PubMed ID: 19623524
Article Size: <1 MB

Cholesteatoma.

Ear & Temporal Bone, Head & Neck
Caponetti G, Thompson LD, Pantanowitz L.
Ear Nose Throat J. 2009 Nov;88(11):1196-8.
FIRST PARAGRAPH: Cholesteatoma is a lesion formed from keratinizing stratified squamous epithelium. It may present intradurally (an epidermoid) or extradurally. Extradural lesions most commonly involve the middle ear cleft; involvement of the mastoid or external auditory canal is less common. The term cholesteatoma is actually a misnomer as these masses rarely contain cholesterol. Although they are not true neoplasms either, clinically they can mimic malignant neoplasms because of their propensity to destroy surrounding tissue and recur after excision.
PubMed ID: 19924660
Article Size: <1 MB

Primary Paraganglioma of the Parathyroid: A Case Report and Clinicopathologic Review.

Endocrine, Parathyroid
Levy MT, Braun JT, Pennant M, Thompson LDR.
Head Neck Pathol. 2010 Mar;4(1):37-43.
Paragangliomas are relatively uncommon neoplasms that arise in adrenal and extra-adrenal paraganglia of the autonomic nervous system. Parasympathetic paraganglioma develop predominantly in the head and neck. It is exceedingly uncommon to develop a primary intraparathyroid paraganglioma. There is only a single case report in the English literature. The information from the single previous case report (Medline 1960–2009) was combined with this case report. Our patient was a 69 year old woman who presented with a thyroid gland mass, with extension into the substernal space. The patient had a history of renal cell carcinoma removed 18 months before. At surgery, a thyroid lobectomy and a parathyroidectomy were performed. The parathyroid tissue showed a very well defined zellballen arrangement of paraganglion cells within the parenchyma of the parathyroid gland. The cells had ample basophilic, granular cytoplasm. The nuclei were generally round to oval with ‘salt-and-pepper’ nuclear chromatin distribution. There was a richly vascularized stroma. Mitotic figures, necrosis, invasive growth, and profound nuclear pleomorphism were absent. The neoplastic cells were strongly and diffusely immunoreactive with chromogranin, synaptophysin, CD56, and focally with cyclin-D1. The paraganglioma showed a delicate S-100 protein positive supporting sustentacular framework. Keratin, CD10, PTH, calcitonin and RCC markers were negative. The patient showed no stigmata of Multiple Endocrine Neoplasia (MEN) and has no paraganglioma in any other anatomic site. She is alive without any additional findings 12 months after surgery. Isolated paraganglioma within the parathyroid is rare, and should be separated from parathyroid adenoma, hyperplasia or metastatic disease to assure appropriate management.
PubMed ID: 20237987
Article Size: <1 MB
 

Laryngeal granular cell tumor.

Head & Neck, Larynx
Thompson LD.
Ear Nose Throat J. 2009 Mar;88(3):824-5.
FIRST PARAGRAPH: Granular cell tumors, also called Abrikossoff tumors, are benign, slowly growing neoplasms, presumably of Schwann cell origin. They may occur anywhere in the body, although 50% occur in the head and neck. The most common site is the tongue; the larynx is involved in approximately 10% of all cases. Granular cell tumors typically develop in the fourth and fifth decades of life; they are quite rare in children. Blacks are affected more commonly than other races. A slight female preponderance has been reported. As many as 10% of patients experience multifocal synchronous or metachronous tumors.
PubMed ID: 19291628
Article Size: <1 MB

Primary extracranial meningiomas: An analysis of 146 cases.

Other Anatomic Sites, Soft Tissue
Rushing, EJ, Bouffard JP, McCall S, Olsen C, Mena H, Sandberg GD, Thompson LDR.
Head Neck Pathol. 2010 Mar;4(1):37-43.
Primary extracranial meningiomas are rare neoplasms, frequently misdiagnosed, resulting in inappropriate clinical management. To date, a large clinicopathologic study has not been reported. One hundred and forty-six cases diagnosed between 1970 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemistry analysis was performed (n = 85), and patient follow-up was obtained (n = 110). The patients included 74 (50.7%) females and 72 (49.3%) males. Tumors of the skin were much more common in males than females (1.7:1). There was an overall mean age at presentation of 42.4 years, with a range of 0.3–88 years. The overall mean age at presentation was significantly younger for skin primaries (36.2 years) than for ear (50.1 years) and nasal cavity (47.1 years) primaries. Symptoms were in general non-specific and reflected the anatomic site of involvement, affecting the following areas in order of frequency: scalp skin (40.4%), ear and temporal bone (26%), and sinonasal tract (24%). The tumors ranged in size from 0.5 up to 8 cm, with a mean size of 2.3 cm. Histologically, the majority of tumors were meningothelial (77.4%), followed by atypical (7.5%), psammomatous (4.1%) and anaplastic (2.7%). Psammoma bodies were present in 45 tumors (30.8%), and bone invasion in 31 (21.2%) of tumors. The vast majority were WHO Grade I tumors (87.7%), followed by Grade II (9.6%) and Grade III (2.7%) tumors. Immunohistochemically, the tumor cells labeled for EMA (76%; 61/80), S-100 protein (19%; 15/78), CK 7 (22%; 12/55), and while there was ki-67 labeling in 27% (21/78), 3% of cells were positive. The differential diagnosis included a number of mesenchymal and epithelial tumors (paraganglioma, schwannoma, carcinoma, melanoma, neuroendocrine adenoma of the middle ear), depending on the anatomic site of involvement. Treatment and follow-up was available in 110 patients: Biopsy, local excision, or wide excision was employed. Follow-up time ranged from 1 month to 32 years, with an average of 14.5 years. Recurrences were noted in 26 (23.6%) patients, who were further managed by additional surgery. At last follow-up, recurrent disease was persistent in 15 patients (mean, 7.7 years): 13 patients were dead (died with disease) and two were alive; the remaining patients were disease free (alive 60, mean 19.0 years, dead 35, mean 9.6 years). There is no statistically significant difference in 5-year survival rates by site: ear and temporal bone: 83.3%; nasal cavity: 81.8%; scalp skin: 78.5%; other sites: 65.5% (P = 0.155). Meningiomas can present in a wide variety of sites, especially within the head and neck region. They behave as slow-growing neoplasms with a good prognosis, with longest survival associated with younger age, and complete resection. Awareness of this diagnosis in an unexpected location will help to avoid potential difficulties associated with the diagnosis and management of these tumors.
PubMed ID: 19644540
Article Size: <1 MB
 

Malacoplakia of the tongue: a case report and clinicopathologic review of 6 cases.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Diapera MJ, Lozon CL, Thompson LD.
Am J Otolaryngol. 2009 Mar-Apr;30(2):101-5.
BACKGROUND: Extra-urogenital tract malacoplakia is uncommon, with tongue malacoplakia being exceptionally rare. The nonspecific clinical presentation and variable histologic patterns can make recognition of this lesion and separation from other lesions challenging. There are only a few reported cases in the English literature.
MATERIALS AND METHODS: Five case reports of tongue malacoplakia were compiled from the literature (MedLine 1960-2008) and integrated with this case report.
RESULTS: The patients included 4 males and 2 females, ranging in age from 9 to 98 years (mean, 64 years). Patients presented with difficulty swallowing, foreign body sensation, a mass lesion, or referred pain (neck or ear). Symptoms were present from a few days up to 18 months. The base of the tongue was the most frequent site, although midline tongue and half of the tongue were also affected. Radiographic studies demonstrated a mass, with a single lesion showing positron emission tomography positivity. Two patients had previous cancers (prostate and colorectal; larynx). This case report was a farm hand for horses, with gram-negative rods, suggestive of Rhodococcus equi identified. The lesions were 1 to 2 cm in greatest dimension. Histologically, there is pseudoepitheliomatous hyperplasia or ulceration with a heavy acute and chronic inflammatory infiltrate. The subepithelial spaces are completely filled with eosinophilic histiocytes, most of which contain granular material in their cytoplasm. Well-formed, blue, calcific bodies are noted, a few showing a ‘targetoid appearance’ and concentric lamination. These Michaelis-Gutmann bodies are positive with von Kossa, iron, and periodic acid-Schiff stains. These findings support a diagnosis of malacoplakia. The differential diagnosis includes granular cell tumor, poorly differentiated carcinoma, and Langerhans histiocytosis. Patients are managed with antibiotic therapy and excision.
CONCLUSIONS: Tongue malacoplakia is rare, often presenting as a mass lesion. Histologic recognition of this abnormal phagocytic disorder will prevent potentially disfiguring surgery.
PubMed ID: 19239951
Article Size: 3 MB
 

Laryngeal squamous papilloma.

Head & Neck, Larynx
Thompson L.
Ear Nose Throat J. 2007 Jul;86(7):379
FIRST PARAGRAPH: Squamous papilloma (SP) is the most common benign laryngeal tumor. It is caused by the human papillomavirus. Clinically, SP rarely occurs as a solitary lesion; most arise as multiple, recurrent tumors, usually in children. SPs generally originate in the true and false vocal folds; they may spread to other sites in the oral cavity and aerodigestive tract. They form at the juxtaposition of the squamous and respiratory epithelia. If an area of juxtaposition is artificially induced (such as by squamous metaplasia), spread of the disease may result. There is a characteristic bimodal age distribution, with a juvenile peak at 5 years and an adult peak between 20 and 40 years. The disease course tends to be more aggressive in children, who frequently develop recurrent and progressive disease. The relatively small diameter of the airways in children may account for some of the severe respiratory embarrassment they experience. There is a slight male predominance in adults. Patients usually present with dysphonia and hoarseness.
PubMed ID: 17702311
Article Size: <1 MB

Parathyroid carcinoma.

Endocrine, Parathyroid
Thompson LD.
Ear Nose Throat J. 2008 Sep; 87(9):502-504.
FIRST PARAGRAPH: Parathyroid carcinoma is rare, comprising less than 1% of all cases of primary hyperparathyroidism. Parathyroid carcinoma occurs in patients of all ages, and there is no predilection for either sex. Its clinical features are primarily attributable to the effects of hypercalcemia and excessive secretion of parathyroid hormone (PTH). Most of its symptoms–weakness, fatigue, anorexia, weight loss, and nausea–are nonspecific, but an excessively high serum calcium level (>16 mg/dl) can be associated with nephrolithiasis, renal insufficiency, and bone ‘brown tumors.’ A palpable neck mass suggests a parathyroid carcinoma. Parathyroid carcinoma is a suggested component of hyperparathyroidism-jaw tumor syndrome.
PubMed ID: 18800320
Article Size: <1 MB
 

Ceruminous Gland Carcinomas: A Clinicopathologic and Immunophenotypic Study of 17 Cases.

Ear & Temporal Bone, Head & Neck
Crain N, Nelson BL, Barnes EL and Thompson LDR.
Head Neck Pathol. 2009 Mar;3(1):1-17.
BACKGROUND: Ceruminal gland carcinomas are rare neoplasms confined to the skin lining the cartilaginous part of the external auditory canal.
STUDY DESIGN:Retrospective.
RESULTS: The patients included 11 men and 6 women, aged 33-82 years (mean, 59.5 years). Patients presented clinically with a mass of the outer half of the external auditory canal (n = 14), hearing changes (n = 5), drainage (n = 4), or paralysis of the facial nerve (n = 3). The polypoid masses ranged in size from 0.5 to 3 cm in greatest dimension (mean, 1.8 cm). Histologically, the tumors demonstrated a solid to cystic pattern, composed of an infiltrating glandular to cribriform arrangement of epithelial cells. Histologic features included a dual cell population (although not the dominant histology), increased cellularity, moderate to severe nuclear pleomorphism, irregular nucleoli, increased mitotic figures (mean, 3/10 HPF), including atypical forms, and tumor necrosis (n = 2). Tumors were divided into three types of adenocarcinoma based on pattern of growth and cell type (ceruminous, NOS [n = 12], adenoid cystic [n = 4], mucoepidermoid [n = 1]). CK7 and CD117 highlighted the luminal cells, while S1-00 protein showed a predilection for the basal cells of ceruminous and adenoid cystic carcinomas. Metastatic adenocarcinoma or direct extension from salivary gland neoplasms are the principle differential considerations. Surgical resection was used in all patients with radiation used in four patients. Eleven patients were alive or had died of unrelated causes without evidence of disease (mean, 11.2 years); six patients had died with disease (mean, 4.9 years), all of whom had developed local recurrence.
CONCLUSION: Ceruminous-type carcinomas, with the exception of ceruminous mucoepidermoid carcinoma, all demonstrated a dual cell population of basal myoepithelial-type cells and luminal apocrine cells. The specific histologic sub-type does not influence the long-term patient outcome.
PubMed ID: 20596983
Article Size: 1 MB
 

Gout.

Ear & Temporal Bone, Head & Neck
Hollowell M, Thompson LD, Pantanowitz L.
Ear Nose Throat J. 2008 Mar;87(3):132, 134
FIRST PARAGRAPH: Gout is caused by disordered purine metabolism resulting in hyperuricemia. Symptoms are related to the precipitation of monosodium urate (uric acid) crystals, typically in joint spaces or soft tissue. Primary gout is caused by an increase in uric acid production, while secondary gout is caused by either a decrease in urinary uric acid excretion or an overproduction of purine secondary to increased cell turnover (e.g., tumor lysis). Predisposing clinical factors include older age (fifth and older decade), male sex, obesity, heavy alcohol ingestion, a purine-rich diet, certain medications (e.g., thiazide diuretics), and genetic factors.
PubMed ID: 18404905
Article Size: <1 MB

Solitary fibrous tumor of the larynx.

Head & Neck, Larynx
Thompson LDR, Karamurzin Y, Wu ML, Kim JH.
Head Neck Pathol. 2008 Jun;2(2):67-74.
BACKGROUND: True mesenchymal, non-cartilaginous neoplasms of the larynx are rare. Extrapleural solitary fibrous tumor (SFT) is a localized neoplasm characterized by proliferation of thin-walled vessels and collagen-producing cells and is considered within the ‘hemangiopericytoma-solitary fibrous tumor’ spectrum. SFT primary in the larynx is exceptional.
DESIGN: Case report set in a comparison with other cases reported in the English literature (MEDLINE 1966 to 2007).
RESULTS: A 49-year old white male presented with difficulty breathing, progressive over the past 2 years. He denied dysphagia and weight loss. Past medical history was significant for asthma. He denied cigarette smoking or alcohol abuse. There were no cervical deformities on physical exam. Fiberoptic laryngoscopy was performed upon stabilization of respiratory function. A smooth, round, submucosal mass measuring 2.3 cm in greatest diameter arising from the inferior surface of left true vocal cord was causing near total obstruction of the endolaryngeal space. The mass was excised. The surface mucosa was intact and unremarkable. A cellular, spindle cell neoplasm was arranged in loose fascicles, associated with heavy collagen fiber deposition. The collagen was wiry and heavy. Cells were bland with cytoplasmic extensions. The nuclei were vesicular to hyperchromatic and elongated with inconspicuous nucleoli. Vessels were prominent and delicate, with patulous spaces. Mitotic figures were easily identified, but atypical forms were not present. The cells were strongly and diffusely immunoreactive with CD34 and bcl-2, while non-reactive with cytokeratin, EMA, actin, ALK-1, S100, desmin, and CD117. These findings confirmed a diagnosis of extraplural solitary fibrous tumor. Without further disease, the patient is alive without evidence of disease, 12 months after surgery. Conclusions The characteristic histologic pattern of solitary fibrous tumor can be noted in extrapulmonary locations. Development in the larynx is uncommon, but the tumor presents as a polypoid mass with characteristic histologic and immunophenotypic features. Conservative local excision is the treatment of choice to yield an excellent prognosis.
CONCLUSIONS: The characteristic histologic pattern of solitary fibrous tumor can be noted in extrapulmonary locations. Development in the larynx is uncommon, but the tumor presents as a polypoid mass with characteristic histologic and immunophenotypic features. Conservative local excision is the treatment of choice to yield an excellent prognosis.
PubMed ID: 20614325
Article Size: <1 MB
 

Update on Nasopharyngeal Carcinoma.

Head & Neck, Sinonasal Tract
Thompson LDR.
Head Neck Pathol. 2007 Sep;1(1):81-6.
FIRST PARAGRAPH: The most common type of nasopharyngeal tumor is nasopharyngeal carcinoma. The etiology is multifactorial with race, genetics, environment and Epstein-Barr virus (EBV) all playing a role. While rare in Caucasian populations, it is one of the most frequent nasopharyngeal cancers in Chinese, and has endemic clusters in Alaskan Eskimos, Indians, and Aleuts. Interestingly, as native-born Chinese migrate, the incidence diminishes in successive generations, although still higher than the native population.
PubMed ID: 20614287
Article Size: <1 MB
 

Sinonasal Tract Angiosarcoma: A Clinicopathologic and Immunophenotypic Study of 10 Cases with a Review of the Literature.

Head & Neck, Sinonasal Tract
Nelson BL, Thompson LDR.
Head Neck Pathol. 2007 Sep;1(1):1-12.
BACKGROUND: Primary sinonasal tract angiosarcoma are rare tumors that are frequently misclassified, resulting in inappropriate clinical management. There are only a few reported cases in the English literature.
MATERIALS AND METHODS: Ten patients with sinonasal tract angiosarcoma were retrospectively retrieved from the Otorhinolaryngic Registry of the Armed Forces Institute of Pathology.
RESULTS: Six males and four females, aged 13 to 81 years (mean, 46.7 years), presented with epistaxis and bloody discharge. Females were on average younger than their male counterparts (37.8 vs. 52.7 years, respectively). The tumors involved the nasal cavity alone (n = 8) or the maxillary sinus (n = 2), with a mean size of 4.3 cm; the average size was different between the genders: males: 2.8 cm; females: 6.4 cm. Histologically, all tumors had anastomosing vascular channels lined by remarkably atypical endothelial cells protruding into the lumen, neolumen formation, frequent atypical mitotic figures, necrosis, and hemorrhage. All cases tested (n = 6) demonstrated immunoreactivity with antibodies to Factor VIII-RA, CD34, CD31, and smooth muscle actin, while non-reactive with keratin and S-100 protein. The principle differential diagnosis includes granulation tissue, lobular capillary hemangioma (pyogenic granuloma), and Kaposi’s sarcoma. All patients had surgery followed by post-operative radiation (n = 4 patients). Follow-up was available in all patients: Six patients died with disease (mean, 28.8 months); two patients had died without evidence of disease (mean, 267 months); and two are alive with no evidence of disease at last follow-up (mean, 254 months).
CONCLUSIONS: Sinonasal tract angiosarcoma is a rare tumor, frequently presenting in middle-aged patients as a large mass usually involving the nasal cavity with characteristic histomorphologic and immunophenotypic features. Sinonasal tract angiosarcoma will often have a poor prognosis making appropriate separation from other conditions important.
PubMed ID: 20614274
Article Size: <1 MB
 

Traumatic fracture callus

Bone, Other Anatomic Sites
Gannon FH, Thompson L.
Ear Nose Throat J. 2007 Apr;86(4):200
FIRST PARAGRAPH: Bones of the craniofacial region are frequently broken, traumatically or iatrogenically. Whereas traumatic fractures can be readily identified clinically and radiologically, they can represent a diagnostic challenge histologically. A short discussion about the histologic evolution of traumatic fractures will help a pathologist know what to expect histologically, based on the time frames of development. The repair process follows a predictable histologic evolution of five distinct phases: culatory, cellular, vascular, metabolic, and mechanical.
PubMed ID: 17500387
Article Size: <1 MB

Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy.

Head & Neck, Oropharynx
Randall DA, Martin PJ, Thompson LD.
Laryngoscope. 2007 Sep;117(9):1600-4
OBJECTIVE: To determine whether the current practice and incurred cost of histologic examination of tonsillectomy and adenoidectomy specimens is warranted.
STUDY DESIGN: Review article based on medical literature.
SUBJECTS AND METHODS: A retrospective PubMed review of all pertinent literature regarding tonsillectomy, adenoidectomy, and related surgical pathology was conducted. References of the articles obtained were reviewed for additional sources.
RESULTS: Twenty studies report 54,901 patients and found 54 malignancies (0.087% prevalence). Of these, 48 (88% of the patients) had suspicious features such as tonsillar asymmetry, cervical lymphadenopathy, or abnormal tonsil appearance, preoperatively. The remaining six patients without any suspicious features (better representing true occult malignancy) were 0.011% of the total cases.
CONCLUSION: Submission of tonsillectomy, adenoidectomy, or both specimens is warranted only when patients demonstrate findings associated with malignancy: tonsillar asymmetry, history of cancer, neck mass, tonsil firmness or lesion, weight loss, and constitutional symptoms.
PubMed ID: 17762791
Article Size: <1 MB
 

Salivary gland lymphoepithelial cysts.

Head & Neck, Salivary Gland
Varnholt H, Thompson L, Pantanowitz L.
Ear Nose Throat J. 2007 May;86(5):265
FIRST PARAGRAPH: Lymphoepithelial cysts are benign, slowly growing unilocular or multilocular lesions that may appear in the head and neck. Among the reported head and neck sites are the salivary glands (typically the parotid gland) and the oral cavity (usually the floor of the mouth). These cysts are usually seen in adults and only occasionally in children. They range in size from 0.5 to 5.0 cm, and they can cause considerable cosmetic deformity and physical discomfort.
PubMed ID: 17580800
Article Size: <1 MB

Sinonasal polyps.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2007 Jun;86(6):322, 325
FIRST PARAGRAPH: Sinonasal polyps are caused by a multitude of factors. The most common causes are repeated bouts of sinusitis, allergy, vasomotor rhinitis, infectious rhinosinusitis, and asthma. Less often, they occur in association with diabetes mellitus, cystic fibrosis, and aspirin intolerance. They form as a result of an influx of fluids into the schneiderian mucosal lamina propria. Occasionally, antral (maxillary) polyps expand and prolapse through sinus ostia to present intranasally or in the nasopharynx (antrochoanal polyps). Sinonasal polyps have no predisposition to age or sex. Polyps are uncommon in children, but when they do occur, as many as 30% are associated with cystic fibrosis.
PubMed ID: 17703805
Article Size: <1 MB

Melanoma.

Other Anatomic Sites, Skin
Thompson LD.
Ear Nose Throat J. 2007 Sep;86(9):542, 545
FIRST PARAGRAPH: Melanoma is a malignancy of melanocytes that show a series of molecular events that result in the melanocytes going through a stepwise progression from dysplasia to invasion to metastasis. Melanomas account for approximately 4.4% of all malignancies. Approximately 62,000 new cases of melanoma are reported annually in the United States, and they are responsible for about 7,900 deaths. The incidence of melanoma worldwide has been increasing steadily.
PubMed ID: 17970142
Article Size: <1 MB

Ewing sarcoma and primitive neuroectodermal tumor.

Head & Neck, Sinonasal Tract
Thompson LDR.
Ear Nose Throat J. 2007 Feb;86(2):79-80.
FIRST PARAGRAPH: Ewing sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related, high-grade, round-cell tumors with a neuroectodermal phenotype. These tumors are histologically considered on a morphologic spectrum, and they express similar genetic alterations. ES usually develops in bone and is more undifferentiated, while PNET tends to involve soft tissue and demonstrates more pronounced neuroendocrine features.
PubMed ID: 17385610
Article Size: <1 MB

Parathyroiditis.

Endocrine, Parathyroid
Thompson LD.
Ear Nose Throat J. 2005 Oct;84(10):636.
FIRST PARAGRAPH: Parathyroiditis is a rare and poorly understood condition. Chronic parathyroiditis may occur in patients with hypoparathyroidism, as well as in those with primary chief-cell hyperplasia. Most patients are asymptomatic. Antibodies to parathyroid tissue are seen in only a few cases of parathyroiditis. It is thought that parathyroiditis represents an autoimmune process similar to thyroid gland Hashimoto’s disease. The presence of seronegative cases of parathyroiditis does not rule against an autoimmune etiology, because a similar phenomenon is observed in Hashimoto’s thyroiditis. Based on this assumption, it is believed that the lymphocytic infiltration is an ongoing destructive process.
PubMed ID: 16382744
Article Size: <1 MB

Mucinous cystic neoplasms of the pancreas: radiologic-pathologic correlation.

Endocrine, Pancreas
Buetow PC, Rao P, Thompson LD.
Radiographics. 1998 Mar-Apr;18(2):433-49.
Mucinous cystic neoplasms of the pancreas are rare primary tumors. They have pathologic and clinical similarities to biliary cystadenomas of the liver and mucinous cystic tumors of the ovary. Mucinous cystic neoplasms of the pancreas typically affect middle-aged women and arise in the tail of the pancreas. Gross pathologic and imaging features usually are those of a large, multilocular cystic mass. There is, however, a spectrum of radiologic findings that overlaps with those of other entities including pancreatic pseudocyst, other primary epithelial and nonepithelial tumors of the pancreas, and metastases. In most cases, ultrasound and computed tomography are the mainstays for radiologic evaluation, with magnetic resonance imaging having a complementary role. All mucinous cystic neoplasms should be considered as mucinous cystadenocarcinomas of low-grade malignant potential. Complete surgical excision alone results in an excellent clinical outcome and disease-free survival, irrespective of histologic or radiologic parameters in over 90% of cases studied.
PubMed ID: 9536488
Article Size: 1.5 MB
 

Monoclonal origins of malignant mixed tumors (carcinosarcomas). Evidence for a divergent histogenesis.

Endocrine, Pancreas
Thompson L, Chang B, Barsky SH.
Am J Surg Pathol. 1996 Mar;20(3):277-85.
Malignant mixed tumors (carcinosarcomas) are examples of unusual neoplasms whose occurrences have been observed in increasingly diverse sites but whose pathogenesis remains a complete mystery. Two antithetical hypotheses that have been advanced to explain the histogenesis of these tumors include the convergence hypothesis, which proposes an origin from two or more stem cells (multiclonal hypothesis), and the divergence hypothesis, which proposes an origin from a single totipotential stem cell that differentiates into separate epithelial and mesenchymal directions (monoclonal hypothesis). To test these hypotheses, a novel strategy for the determination of clonality from as few as 100 tumor cells obtained by enzymatic digestion of either fresh or formalin-fixed, paraffin-embedded tissues and cell sorting was used that exhibited the polymerase chain reaction (PCR) in amplifying a 511-bp region located within the first intron of the human hypoxanthine phosphoribosyl transferase gene, a site that contains inactive X chromosomal obligately methylated HpaII/MspI sites and single-base allelic polymorphisms in 5% females. Carcinoma cells gated on the basis of fluorescein isothiocyanate (FITC)-anti-cytokeratin and sarcoma cells gated on the basis of FITC-antivimentin or FITC-anti-desmin were sorted to homogeneity on FACSTAR and then subjected to genomic DNA extraction and Hpa II digestion before PCR amplification and subsequent analysis of the product on denaturing gradient gel electrophoresis. The comigrations of the single homoduplexes generated from both the carcinoma cells and sarcoma cells in six different malignant mixed tumors obtained from four different organs indicated clonal identity and monoclonality in all cases. These findings of monoclonality were confirmed independently by two other methods of clonality determination. The findings of a monoclonal origin of carcinosarcomas support the single totipotential stem-cell-divergence hypothesis.
PubMed ID: 8772780
Article Size: 2.5 MB
 

Temporal bone schwannoma.

Ear & Temporal Bone, Head & Neck
Thompson L.
Ear Nose Throat J. 2006 Nov;85(11):704.
FIRST PARAGRAPH: A schwannoma (acoustic neuroma or neurilemmoma) is a globular, firm, tan-yellow, solid to cystic neoplasm of nerve sheath (Schwann) cells. Schwannomas are the most common neoplasms of the ear and temporal bone. The vast majority arise at the cerebropontine angle, and 95% are unilateral and sporadic. Bilateral schwannomas and those that arise in young patients are highly associated with neurofibromatosis type 2 (NF2). Schwannomas affect men and women equally, usually in the fifth or sixth decade of life except in patients with NF2, who generally present at a younger age.
PubMed ID: 17168142
Article Size: <1 MB

Follicular lymphoma.

Head & Neck, Neck
Pantanowitz L, Thompson LD.
Ear Nose Throat J. 2006 Oct;85(10):636-7.
FIRST PARAGRAPH: Follicular lymphoma is defined as a neoplasm of follicle center B lymphocytes (centrocytes and centroblasts) that has at least a partially follicular growth pattern. It is a low-grade lymphoma, and its course is indolent. Most patients present during the sixth decade of life; the neoplasm is very rare in patients younger than 20 years of age. The female-to-male ratio is 1.7:1. Lymph node enlargement is the usual presentation; only about 20% of patients have B symptoms (i.e., fever, chills, night sweats, and weight loss). The disease is usually systemic at presentation (stage III or IV). In the head and neck region, follicular lymphoma may involve lymph nodes, Waldeyer’s ring, and/or skin.
PubMed ID: 17124929
Article Size: <1 MB

Olfactory neuroblastoma.

Head & Neck, Sinonasal Tract
Thompson L.
Ear Nose Throat J. 2006 Sep;85(9):569-70.
FIRST PARAGRAPH: Olfactory neuroblastoma (esthesioneuroblastoma) is an uncommon malignant neuroectodermal nasal tumor that accounts for approximately 5% of all malignant neoplasms. Olfactory neuroblastomas are thought to arise from the specialized sensory neuroepithelial (neuroectodermal) olfactory cells that are normally found in the upper part of the nasal cavity, usually including the cribriform plate of the ethmoid sinus. These tumors affect both sexes equally. A bimodal age distribution (the 2nd and 6th decades of life) has been documented, although patients of all ages can be affected. Patients present with nonspecific symptoms of nasal obstruction (70% of cases) and epistaxis (50%); less common symptoms include headache, pain, visual disturbances, and anosmia (<5%). Owing to the nonspecific nature of the presenting symptoms, patients often have a long history prior to diagnosis.
PubMed ID: 17044420
Article Size: <1 MB

Neoplasms metastatic to the thyroid gland.

Endocrine, Thyroid
Thompson L.
Ear Nose Throat J. 2006 Aug;85(8):480, 483.
FIRST PARAGRAPH: Tumors that occur in the thyroid gland as a result of lymph or vascular spread from distant sites are considered to represent metastatic disease rather than a direct extension of a primary from an adjacent organ. Metastatic deposits are identified at a higher frequency in abnormal glands—that is, those with adenomatoid nodules, thyroiditis, and follicular neoplasms. Further, metastatic deposits may be found within primary thyroid tumors, such as a renal cell carcinoma metastatic to a thyroid papillary carcinoma. Although a thyroid gland mass may be the presenting clinical sign, it is more often the underlying thyroid gland disease (e.g., thyroiditis, adenomatoid nodules) that prompts clinical evaluation. The thyroid gland metastatic deposit is the initial presentation of an occult primary tumor in as many as 40% of patients. Carcinomas are the most common metastatic tumors from (in order of frequency) the kidney (figure 1), lung, breast (figure 2), and stomach; melanoma is less common.
PubMed ID: 16999049
Article Size: <1 MB

Herpes simplex virus laryngitis.

Head & Neck, Larynx
Thompson L.
Ear Nose Throat J. 2006 May;85(5):304.
FIRST PARAGRAPH: Both infectious and inflammatory conditions can result in laryngitis, which is divided into acute and chronic forms. Some conditions are more frequent in adults, while others are more common in children. Laryngitis (‘croup,’ epiglottitis, and laryngotracheobronchitis) has many causes, including viral, bacterial, mycotic, or mycobacterial infections, trauma, neoplasms, vascular compromise during surgery, iatrogenic injury from feeding tubes or tracheostomy tubes, foreign-body impaction, and radiation therapy. A number of etiologies may be present synchronously, such that an infection may develop in association with radiation therapy, for example. Therefore, multiple etiologies may need to be addressed.
PubMed ID: 16771019
Article Size: <1 MB

Lymphangioma.

Head & Neck, Neck
Thompson L.
Ear Nose Throat J. 2006 Jan;85(1):18-9.
FIRST PARAGRAPH: Lymphangiomas are rare congenital tumors, with up to 70% reported in the head and neck. They are separated into three types: cystic (cystic hygroma), capillary, and cavernous. Lymphangiomas account for approximately 25% of all vascular neoplasms in children and adolescents. About 25% of cervical cysts are lymphangiomas.
PubMed ID: 16509236
Article Size: <1 MB

Teratoma.

Head & Neck, Neck
Thompson L.
Ear Nose Throat J. 2005 Feb;84(2):75.
FIRST PARAGRAPH: Teratomas are neoplasms made up of tissues foreign to the site of occurrence. They contain tissue from all three embryonic germ layers (endoderm, mesoderm, and ectoderm). Other terms–choristoma, hamartoma, heterotopia, epignathus, and dermoid–refer to separate, unique entities that are not covered here.
PubMed ID: 15794539
Article Size: <1 MB

Myeloid sarcoma.

Hematopathology, Other Anatomic Sites
Pantanowitz L, Thompson L.
Ear Nose Throat J. 2005 Aug;84(8):470-1.
FIRST PARAGRAPH: Myeloid sarcoma (MS) is an extramedullary myeloid tumor (granulocytic sarcoma) that can occur in one of three clinical settings: (1) in patients who have a history of acute myeloid leukemia (AML), during active disease or a recurrence; (2) in patients with chronic myeloproliferative disorder or myelodysplastic syndromes, who are at increased risk of blast transformation or acute leukemia; or (3) in patients with no history of hematologic disease, although it commonly predates the development of leukemia, often within 1 year.
PubMed ID: 16220848
Article Size: <1 MB

Nasopharyngeal carcinoma.

Head & Neck, Sinonasal Tract
Thompson L.
Ear Nose Throat J. 2005 Jul;84(7):404-5.
FIRST PARAGRAPH: The most common type of nasopharyngeal tumor is a carcinoma. The etiology of nasopharyngeal carcinoma (NPC) is multifactorial; race, genetics, Epstein-Barr virus (EBV) infection, and the environment all play a role. NPC is rare in white populations, but it is one of the most common cancers among Chinese. EBV is almost always present in NPC, indicating that this virus plays an oncogenic role. The viral titer can be used to monitor therapy or possibly as a diagnostic tool in the evaluation of patients who present with a metastasis from an unknown primary. Exposure to environmental carcinogens, especially high levels of volatile nitrosamines (specifically, those in Cantonese-style salted fish), has been implicated in this complicated disorder; carcinogens related to smoking, formaldehyde exposure, and radiation have also been implicated.
PubMed ID: 16813025
Article Size: <1 MB

Larynx contact ulcer.

Head & Neck, Larynx
Thompson LD.
Ear Nose Throat J. 2005 Jun;84(6):340.
FIRST PARAGRAPH: A larynx contact ulcer, also known as a pyogenic granuloma, is a benign lesion that is most common among adult men. Patients present with hoarseness and/or throat pain, and they often experience chronic throat-clearing or habitual coughing. Contact ulcer is associated with vocal abuse, intubation, and acid regurgitation. Intubation-induced contact ulcer is more common among females, especially in an emergent setting when an inappropriately sized endotracheal tube has been placed. Gastrolaryngeal reflux or gastroesophageal reflux disease (GERD) is frequently missed because physicians do not correlate the nonspecific gastric symptoms with the laryngeal symptoms. A hiatal hernia, peptic esophagitis, or gastritis can cause acid reflux, usually during sleep, thereby leading to the development of a contact ulcer without the cause being obvious to the patient.
PubMed ID: 16075851
Article Size: <1 MB