Case Reports in Otolaryngology最新文献

Background: Laryngeal granular cell tumors (GCTs) are rare lesions, particularly in pediatric patients. We present a case of GCT of the right true vocal cord in a 12-year-old male. Methods: The electronic medical record was utilized to review the patient's clinical and surgical history. Results: A 12-year-old male presented with a 2-year history of worsening dysphonia and cough. Flexible laryngoscopy revealed a submucosal pedunculated mass of the right mid and anterior true vocal cord. Gross resection was performed. Final pathology confirmed a benign GCT; however, a positive margin was identified. A right subligamentous cordectomy was pursued for complete excision of the residual GCT. The patient achieved an excellent voice outcome. Conclusions: This case demonstrates that subligamentous cordectomy can be an effective treatment method for laryngeal GCT in pediatric patients. It also adds valuable data regarding pediatric GCT location and propensity for submucosal tumor spread.

Objectives: To describe a rare case of granulomatosis with polyangiitis (GPA) initially presenting at the petrous apex, accompanied by a brief literature review. Methods: A detailed retrospective single-case study of a 29-year-old male diagnosed with GPA. A review of the scientific literature of GPA affecting the petrous apex, causing cranial neuropathies and/or ottorhrea was conducted. Results: A 29-year-old male with a history of schizophrenia presented with right-sided otalgia, initially diagnosed as acute otitis media. Despite antibiotics, his symptoms persisted. Weeks later, he returned with cranial neuropathies and clear otorrhea. Imaging findings lead to a working diagnosis of skull base osteomyelitis despite noninfectious signs. His course was further complicated by his discharge against medical advice. Eventually, he was found to have a septal perforation and diffuse nasal inflammation. An autoimmune workup revealed c-ANCA-positive GPA. Subsequent kidney biopsy confirmed GPA, and appropriate therapy led to clinical improvement and near-complete resolution of skull base inflammation. Conclusions: This case underscores the diagnostic complexity of GPA. Initial misdiagnosis of infection delayed appropriate treatment. Awareness of the varied presentations of GPA, including rare manifestations like skull base involvement and symptoms such as otorrhea and conductive hearing loss, is valuable. Early consideration of autoimmune etiologies and timely serological and histopathological analyses can prevent diagnostic delays and unnecessary treatments, improving patient outcomes.

Introduction: Sarcomas account for less than 1% of malignant tumors of the larynx. Synovial sarcomas account for 5%-7% of all soft tissue sarcomas and 0.1% of sarcomas in the head and neck region. Clinical Report: A 45-year-old patient presented with hoarseness of voice and breathing difficulty. Contrast-enhanced computed tomography showed a well-defined mass originating from the laryngeal surface of the epiglottis, obstructing the supraglottis, for which emergency tracheostomy was done. Pathology confirmed monophasic synovial sarcoma. He underwent a supraglottic partial laryngectomy with complete removal of the tumor. The patient is on a 6-month postoperative course, with monthly follow-up, and there is no sign of recurrence. Discussion: Clinical diagnosis can be challenging, as patients often present with ill-defined symptoms in the throat and larynx, which may delay diagnosis. The current approach relies on immunohistochemistry analysis for diagnostic purposes, and imaging is generally used to define the tumor location and extent and to rule out other tumors. Most reported studies put surgery as a first-line mode of management, and adjuvant radiotherapy is currently advocated, as it is associated with better overall survival. Synovial sarcoma is considered a high-grade tumor, although head and neck subsites tend to have a slightly better prognosis. Tumor size of more than 5 cm and higher tumor stage are associated with poor overall survival. Conclusion: Synovial sarcoma of the larynx is a rare clinical entity, and every case should be examined individually.

Sphenoid sinus fungal ball is an uncommon disease that often occurs in adult patients, due to the rarity of sphenoid diseases in the pediatric population. To our knowledge, we were able to describe the first case of isolated sphenoid fungal ball, or mycetoma, in a child. No previous cases have been mentioned in the literature. We are presenting the case of a pediatric patient who presented with a long-standing refractory headache.

This report presents a rare case of acute bacterial rhinosinusitis with orbital and intracranial complications caused by Capnocytophaga sputigena in a pediatric patient. A 15-year-old male presented with orbital cellulitis, acute sinusitis, and meningismus. Brain imaging showed evidence of early intracranial abscess formation and areas of cerebral infarction. He underwent urgent endoscopic sinus surgery (ESS) and drainage of an orbital subperiosteal abscess. This case underscores the critical role of timely diagnostic imaging, multidisciplinary care, appropriate surgical management, and effective culture-directed antimicrobial therapy in treating sinusitis and its complications.

Angioleiomyoma (ALM) is a subtype of leiomyoma characterized by vascular involvement alongside the proliferation of smooth muscle cells. These tumors are generally found in the lower limb and rarely occur in the head and neck region. Herein, we present a rare case of ALM of the external auditory canal (EAC) in a 12-year-old female. To our knowledge, this is the sixth case and the second youngest patient reported with ALM occurring in the EAC. Initially, this patient was diagnosed with otitis externa with polypoid change and prescribed a course of Ciprodex. Follow-up CT demonstrated a soft tissue density in the right EAC, consistent with medial canal fibrosis, and an exam under anesthesia with local excision of the mass was scheduled. Surgical findings showed a cartilaginous, firm mass originating from the fissure of Santorini that was carefully excised completely along with an EAC cholesteatoma seen lateral to the tympanic membrane. The foramen of Huschke was uninvolved and the tympanic membrane was intact without perforation. Final pathology confirmed benign ALM. The EAC was packed with floxin-soaked gelfoam and left packed for 2 weeks with instructions for daily floxin drop placement. Once the gelfoam was removed in the clinic, the EAC was found to be healing well and the patient noted improved subjective hearing. There has not been any subsequent recurrence over a period of 5 months. This case documents a rare presentation of an ALM in an extremely rare anatomical position which was managed successfully.

Introduction: Epidermoid cysts are benign lesions that may occur in many different sites of the body. They are classified into 3 types: epidermoid cysts when the lining presents only epithelium, dermoid cysts when skin adnexa are found, and teratoid cysts when mesodermal elements are present. Case Presentation: A 13-year-old boy presented with a gradually enlarging sublingual mass over a period of 4 years. The mass was painless at start but in the last 3 months, it was associated with pain and difficulties during eating and dysarthria. The general examination was unremarkable and examination of the oral cavity showed a 5∗6 cm mass in the right side of the tongue and within the tongue. The mass was soft and nontender, fluctuation was positive, there was no pulsation over the mass, transillumination was negative, and other parts of the oral cavity were normal. Neck examination was also normal with no enlargement of the cervical lymph nodes. Aspiration of the lesion showed turbid yellow fluid (keratin like substance) with no blood. Complete surgical excision of the cyst was done, which was dermoid cyst of the tongue containing hair and fat. The patient was discharged on the same day of surgery with no postoperative events. Conclusion: Dermoid cyst of the tongue is an extremely rare condition. High index of suspicion is required for the diagnosis. Aspiration of the cyst helps in the diagnosis due to the typical yellow color because of cholesterol contents. The prognosis is excellent after complete surgical excision.

Renal cell carcinoma is an aggressive malignancy with up to 30% of patients experiencing metastases. The authors report a case of a patient status post right radical nephrectomy with 6 years of clear surveillance scans seeking evaluation of recurrent epistaxis. A friable, hypervascular mass was discovered on outpatient nasal endoscopy. The mass was surgically removed, and pathology results were consistent with metastatic renal cell carcinoma. Further workup following the operation led to the discovery of disseminated metastases of the malignancy to the scrotum, skin of the back, gluteal musculature, and frontal bones. This unique case of disseminated metastases after many years of negative routine screening demonstrates the importance of interdisciplinary care and routine screenings when managing unforgiving malignancies such as renal cell carcinoma and their insidious manners of metastasis.

A 68-year-old man previously treated for a large laryngeal neoplasm (pT4 pN0 squamous cell carcinoma) developed osteomyelitis of the medial third of the right clavicle with the formation of a fistula between the sternoclavicular joint and tracheal wall near the tracheostomy border. The clinical course was tedious, required prolonged antibiotic trials, and extended surgical bone resection to control the infection. The final outcome was favorable with wound closure although the patient was left with permanent limitation of shoulder abduction (his shoulder mobility had been normal prior to this process). Histopathological examination of the resected bone suggested a diagnosis of both osteoradionecrosis and osteomyelitis. Indeed, differential diagnosis between these two entities can be challenging after radiotherapy. Here, we present a review of the relevant academic literature and discuss the therapeutic options.

Background: Submucosal laryngeal carcinoma (SLC) is a rare subtype of transglottic laryngeal carcinoma (TLC) and usually originates from the center of the laryngeal ventricle. Nearly 70% of TLC cases are confined to the larynx and 30% show external laryngeal infiltrations. Early stage asymptomatic TLC usually shows occult lesions and tends to grow into lateral parapharyngeal space. Case Summary: We present an unusual case of submucosal moderately poor differentiated laryngeal squamous cell carcinoma (SCC) characterized by thyroid mass, hoarseness, and dyspnea as the main symptoms. In this case, a 60-year-old Chinese male was made a preliminary diagnosis of suspected thyroid carcinoma (TC) with laryngeal metastases to the cricoid cartilage. No laryngeal neoplasms were observed under nasopharyngo-fiberoscope. After giving 1-month therapy with anlotinib, the tumor lesion had minimal response while the patient insisted on surgical section to relieve dyspnea. Intraoperative frozen section biopsy confirmed that the tumor was moderately poor differentiated SCC of the larynx, and in this case, thyroid metastases might result in SLC penetration of cricothyroid membrane. Conclusion: SLC should be taken into consideration in the case of suspicious TC with laryngeal cartilage infiltration and subglottic area infiltration. Further coarse needle puncture or surgical biopsy should be carried out to clarify diagnosis to optimize treatment strategy.