Cases reported "Head and Neck Neoplasms"

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1/201. E.N.T. manifestations of Von Recklinghausen's disease.

    Von Recklinghausen's disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe-au-lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist. case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment. The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofibromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. "elephantiasis" of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The over-all malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular blockade.
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keywords = nerve, block
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2/201. Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment.

    OBJECTIVES/HYPOTHESIS: Abnormalities of the fourth branchial arch are much less common than those of the second arch and present in a different manner. The authors report their experience with five cases of fourth arch sinuses. methods: Retrospective chart review of patients at a tertiary care center. RESULTS: All patients presented in the first or second decade of life, and all but one had left-sided neck involvement. Four patients presented with recurrent low neck inflammatory episodes, and one with respiratory compromise. Diagnostic studies performed included ultrasound, computed tomography (CT) scan, barium swallow, magnetic resonance imaging, and fine-needle aspiration. barium contrast studies and CT scan were the most useful in demonstrating a fourth arch sinus tract preoperatively. Surgical treatment with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the lateral piriform sinus to facilitate complete sinus tract excision was successful in all patients. CONCLUSION: The clinical history of recurrent low neck inflammatory episodes in young patients, especially on the left side, should raise the suspicion of this entity. Investigation using barium swallow in combination with CT scanning is useful. Excision of the sinus tract taking care not to injure the recurrent laryngeal nerve is curative.
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ranking = 1.9556400309388
keywords = nerve
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3/201. Removal of catecholamine-secreting chemodectoma. The use of neuroleptanaesthesia, adrenergic blockade and sodium nitroprusside.

    A case of catecholamine-secreting chemodectoma of the neck in a 47-year-old male who also had temporal lobe epilepsy is described. Details of presentation, diagnosis and successful treatment are given. He was fully alpha blocked with phenoxybenzamine and given neuroleptic drugs but his blood pressure rose to dangerous levels when the tumour was handled and did not respond to intravenous phentolamine. sodium nitroprusside was successfully used to achieve blood pressure control.
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ranking = 0.11089992265306
keywords = block
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4/201. Fine needle aspiration cytology of a cervical lymph node lymphangioma in an adult. A case report.

    BACKGROUND: Although the cytologic features of cervical cystic lesions are well established, no cytology reports on lymphangioma in adults have been published. CASE: A 60-year-old male presented with a slowly growing, upper laterocervical, painless enlargement. Fine needle aspiration (FNA) obtained 15 mL of yellowish fluid, consisting predominantly of a uniform population of small and round lymphocytes without mitosis or atypia and with some histiocytes intermingled with them. Some centrocytes and occasionally centroblasts and plasma cells could also be observed. immunohistochemistry performed on cell block sections displayed polyclonal B lymphocytes mixed with T cells. The specimen showed a clearly circumscribed, 50-mm, cystic lesion with a multilocular appearance and abundant, yellowish liquid. Microscopic examination demonstrated cystic lymphangioma arising from the medullary portion of a lymph node. CONCLUSION: FNA cytology permits a suggested diagnosis of lymphangioma. This is one of the few reports of FNA cytology of lymphangioma and, to the best of our knowledge, this entity has not previously been found as a neck mass in an adult.
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ranking = 0.022179984530612
keywords = block
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5/201. Solitary schwannoma of the cervical vagus nerve.

    A case of benign, solitary schwannoma of the cervical vagus nerve with ipsilateral vocal cord paralysis is presented. The differential diagnostic aspects are discussed, with special reference to neurologic deficit in association with this lesion. The possible occurrence of concomitant unrelated malignancy is emphasised.
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ranking = 4.8891000773469
keywords = nerve
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6/201. Excision of cervical cystic lymphangioma using injection of hydrocolloid dental impression material. A technical case report.

    A lymphangioma, arising in an adult patient, was completely removed after injection of hydrocolloid dental impression material. The postoperative course was uneventful, with no sign of foreign-body reaction. The agar impression material, which had excellent tractability during operation, may be used as a filling material, as long as preoperative examinations show that the tumor does not involve major vessels or nerves.
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ranking = 0.97782001546939
keywords = nerve
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7/201. Schwannoma of the cervical sympathetic chain. The virginia experience.

    We present 4 cases of schwannomas arising from the cervical sympathetic chain. These lesions are uncommon and most often present as an asymptomatic solitary neck mass. Preoperative diagnosis can be difficult, even with the aid of computed tomography, magnetic resonance imaging, ultrasound, and angiography. While a paraganglioma can often be ruled out, exact determination of the nerve of origin is frequently elusive until the time of surgery. Operative excision remains the treatment of choice, often requiring sacrifice of a portion of the sympathetic chain. Postoperative Horner's syndrome is common, but does not appear to have an adverse effect on the patient.
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ranking = 0.97782001546939
keywords = nerve
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8/201. Primary melanocytic schwannoma of cervical sympathetic chain.

    BACKGROUND: Primary melanocytic schwannoma arising from the cervical sympathetic chain is a rare pigmented nerve sheath tumor. Two cases are presented from an academic medical center. patients and methods patients were initially seen with an enlarging neck mass associated with sympathetic nervous system dysfunction. radiography demonstrated a mass located posterior to the carotid sheath. Primary therapy consisted of surgical excision and postoperative radiation therapy. RESULTS: The tumors were found to be melanocytic schwannomas arising from the cervical sympathetic chain. The pathologic characteristics of this neoplasm are reviewed. One patient remained disease free for 12 years after treatment, whereas 1 patient died as a result of local recurrence and distant metastases. CONCLUSIONS: Melanocytic schwannoma of the cervical sympathetic chain is a rare nerve sheath tumor of the head and neck that may be misdiagnosed as malignant melanoma. The clinical behavior of this neoplasm is variable. Preoperative neurologic findings, anatomic location, electron microscopy, and immunohistochemistry findings help to establish the diagnosis, and electron microscopy may have a role in distinguishing between benign and malignant lesions. Complete surgical excision is the treatment of choice.
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ranking = 1.9556400309388
keywords = nerve
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9/201. Malignant peripheral nerve sheath tumor arising in benign ancient schwannoma: a case report with an immunohistochemical study.

    A rare example of malignant transformation in an ancient schwannoma arising in the right side of the neck of a 51-year-old man without any clinical manifestations suggesting neurofibromatosis is described. The tumor, approximately 4 cm at its largest dimension, was well circumscribed and had a direct connection with the sympathetic nerve. Microscopically, the central portion of the tumor showed features of ancient schwannoma characterized by extensive hyalinization with cystic degeneration, scattered spindle cells with hyperchromatic and tapered nuclei, and some symplastic changes. However, predominantly in the outer portion, a proliferation of spindle-shaped cells with enlarged nuclei was present. The nuclei of these cells showed irregular contours, coarse granular chromatin texture, and conspicuous nucleoli. Mitotic figures and small necrotic foci with scattered apoptotic bodies were also seen. Immunohistochemically, S-100 protein was almost negative in areas consisting of overtly atypical cells where the mitotic index evaluated with MIB-1 antibody was 30.5%. In contrast, S-100-positive bland spindle cells were scattered in an extensively hyalinized area with a labeling index less than 3%. P53 protein was strongly positive in atypical spindle cells. Although it is a very uncommon event, definite nuclear atypia, frequent mitotic figures, and the existence of small necrotic foci should be recognized as indicating a diagnosis of malignant degeneration of benign schwannoma. immunohistochemistry would be useful as an ancillary technique in such a setting.
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ranking = 4.8891000773469
keywords = nerve
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10/201. The use of intensity modulated radiotherapy for the treatment of extensive and recurrent juvenile angiofibroma.

    These case series are presented to describe the application and advantages of intensity modulated radiotherapy (IMRT) for the treatment of extensive and/or recurrent juvenile angiofibroma. Two patients were diagnosed with recurrence at 11 and 13 months postoperatively, and one was surgically unresectable. The affected areas included the base of skull, cavernous sinus, pterygopalatine fossa, infratemporal fossa, posterior orbit and nasopharynx. Highly conformal IMRT was delivered with limited radiation doses to the optic nerves, optic chiasm, brainstem, brain, spinal cord, lens, retina, mandible, and parotid. The total dose delivered to the tumor varied from 3400 to 4500 cGy. The tumor shrunk radiographically in all three cases and there was no endoscopic evidence of disease in two cases at 15 months and 40 months. There was no acute toxicity. Late toxicity was limited to one episode of epistaxis and persistent rhinitis in one patient. In conclusion, IMRT provides several advantages over conventional radiotherapy in the treatment of recurrent juvenile angiofibroma.
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ranking = 0.97782001546939
keywords = nerve
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