Hypopharyngeal Mass Research Articles

Hypopharyngeal paraganglioma with a paraneoplastic neurologic syndrome: A case report

We report an extremely rare case of hypopharyngeal paraganglioma that was accompanied by a paraneoplastic neurologic syndrome (PNS). The clinical, radiological, and histopathologic findings of the patient are presented. A 49-year-old woman presented with a history of progressive asthenia of the lower extremities persisting for 2 months. She also experienced numbness and sensory disturbance of the left lower limbs, 2 epileptic seizures, and constipation during the period. Clinical and radiological evaluations suggested the diagnosis of encephalomyelitis in combination with a left hypopharyngeal mass lesion. The patient underwent surgical excision of the lesion, which subsequently resolved her symptoms. Postoperative pathology was consistent with a paraganglioma. There was no evidence of local recurrence or distant metastasis of the tumor on recent follow-up. To the best of our knowledge, our patient represents the third reported case of hypopharyngeal paraganglioma, and the only one to have a paraneoplastic syndrome.

Adult rhabdomyoma: A challenging diagnosis on cytology

Adult rhabdomyoma: A challenging diagnosis on cytology

The GlideScope for videolaryngoscopy-assisted nasotracheal-to-orotracheal tube exchange in the intensive care unit in a patient with a known difficult airway

A 77 year old, nasally intubated man with a history of repeated episodes of airway obstruction requiring intubation due to recurrent laryngitis and a hypopharyngeal mass, needed nasotracheal-to-orotracheal tube exchange. The GlideScope videolaryngoscope was inserted, achieving a full view of the glottic inlet with the nasotracheal tube in situ. An endotracheal tube (ETT) loaded on a GlideRite Rigid Stylet was advanced through the oropharynx into view. Advancement of this ETT to the glottic opening was tested and achieved. With both tracheal tubes in view, the nasotracheal tube cuff was deflated and withdrawn from the glottic opening. While maintaining videoscopic visualization, the orotracheal tube was advanced through the vocal cords into the trachea. The benefits of this technique versus existing alternatives are discussed.

Synovial sarcoma of the pharynx causing airway obstruction

This is the first reported Australian case of synovial sarcoma of the pharynx. A 29-year-old man had a large hypopharyngeal mass excised and received radiotherapy and chemotherapy. No recurrence was seen 12months later.

The effects of Bt Cry1Ah toxin on worker honeybees (Apis mellifera ligustica and Apis cerana cerana)

We conducted feeding trials in a laboratory setting to test for possible adverse effects of Cry1Ah toxin mixed thoroughly into sugar syrup (60% w/v sucrose solution) at three concentrations (10 μg/mL, 10 ng/mL, and 1 ng/mL) on the survival, pollen consumption, and hypopharyngeal gland mass of Apis mellifera ligustica and Apis cerana cerana. No significant differences in the survival of A. mellifera or A. cerana were found among groups fed on sugar syrup with or without Cry1Ah toxin. No significant differences were found in the longevity of A. mellifera fed sugar syrup with Cry1Ah toxin compared with the control. No differences were detected in the pollen consumption of A. mellifera ligustica and A. cerana cerana. No significant differences were found in the hypopharyngeal gland weight of 12-day-old honeybees A. mellifera ligustica and A. cerana cerana fed on sugar syrup with Cry1Ah toxin compared with the control. The implications of these results are discussed in terms of the risks of transgenic corn crops for honeybees.

Pathology Quiz Case 2

A 46-YEAR-OLD MAN PRESENTED WITH A several-month history of dysphagia. He was otherwise healthy, denied tobacco or alcohol use, and reported a history of tonsillectomy. His voice was clear. Flexible laryngoscopy demonstrated a polypoid mass that filled the right piriform sinus and spilled into the laryngeal introitus (Figure 1). The vocal folds were mobile. A contrast computed tomogram of the neck showed a cystic-solid lesion in the region of the right piriform sinus, with an associated mass effect. The patient elected to undergo transoral laser excision of the hypopharyngeal mass. The resection was performed with suspension laryngoscopy and a handheld carbon dioxide laser (OmniGuide, Cambridge, Massachusetts). Multiple masses were resected, and it was confirmed that they emanated from the piriform sinus. Gross examination revealed multiple tan-gray, irregularly shaped tissue fragments measuring 4.1 3 1.2 cm, with 1 area showing smooth, gray mucosa. Sectioning showed tan-gray firm tissue. Histologic analysis demonstratedanodular areaofblandspindlecellproliferationwithout a capsule in the submucosa, with interspersed mature fatty tissue in the periphery (Figure 2). The spindle cells were arranged in a nondescript pattern with meshworks of small vessels (Figure3). No specific architecture, such as a herring bone or hemangiopericytic pattern, was noted. No significant nuclear pleomorphism, mitosis, necrosis, or hemorrhage was present. There was no evidence of dysplasia or malignancy. Immunohistochemical stains were strongly positive for vimentin and CD34 (Figure 4) and negative for smooth muscle antigen, S-100 protein, keratin, and neurofilament in the spindle cells. What is your diagnosis?

PET scan in a patient with pneumococcal sepsis

A 63-year-old man presented to the Otolaryngology department with severe dysphagia. On laryngoscopy, a whitish nodule 3 cm in size exiting from the posterior commissurae of the larynx, and almost obstructing the hypopharyngeal space, was observed. The excision biopsy specimen was diagnosed as moderately differentiated squamous cell carcinoma of the hypopharynx. A staging procedure with positron emission tomography-computer tomography (PET-CT) was recommended. The day before the procedure, the patient experienced chills, and his temperature increased up to 38.9 C. He was evaluated in the emergency department (ED) of our hospital. The plain film of the chest X-ray study revealed a small infiltrate in the right lower lobe (arrows Fig. 1a, b) and the patient was discharged on oral antimicrobial therapy to manage his pneumonia. The patient’s wife had been hospitalized with pneumococcal pneumonia 2 days earlier. The day after his ED visit, the patient underwent the previously arranged ambulatory PET-CT that revealed a significant increase of fluorine-18-fluorodeoxyglucose (F18-FDG) uptake in the hypopharyngeal mass (thick arrow Fig. 1a), diffuse uptake in the bone marrow of the spine, ribs, and pelvis without underlying bone lesions on a computed tomography (CT scan) (black arrows Fig. 2a–c), and an increased uptake in the right lower lobe consolidation consistent with pneumonia (white arrows Fig. 2b, c). The diagnosis of pneumonia was supported by significant

Giant fibrovascular polyp of the hypopharynx: per-oral endoscopic removal

We report an extremely rare case of giant fibrovascular polyp of the hypopharynx. We present a 49-year-old man who had increasing difficulty swallowing, advanced respiratory distress and weight loss, as well as a hypopharyngeal mass protruding from his mouth. Diagnosis was confirmed by endoscopic examination and computed tomography. A tracheostomy was required due to laryngeal obstruction by the regurgitated mass. The giant polyp was removed via per-oral endoscopic excision under general anaesthesia. Fibrovascular polyps occur most commonly in the cervical oesophagus, and are extremely rare in the hypopharynx. They can grow to a very large size over several years. We discuss the symptoms, diagnosis and surgical treatment techniques for upper aerodigestive tract fibrovascular polyps, in the light of the literature.

Iron Pill-induced Tumefactive Mucosal Injury of the Hypopharynx

Iron pill-induced mucosal injury of the airways with massive necrosis and stricture of the lower airways is known to occur, but symptomatic injury of the hypopharyngeal mucosa secondary to therapeutic oral iron ingestion has not been described. We report iron-sulfate-induced mucosal injury of the hypopharynx in a patient receiving therapeutic oral iron supplementation. The patient presented with dysphagia when swallowing pills, but not when eating or drinking. Imaging studies and clinical examination revealed an ulcerated and protuberant hypopharyngeal mass. Histology showed mucosal ulceration with deposits of extracellular crystalline iron particles. The histologic changes were identical to those seen in patients with "iron pill" gastritis.

Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction

Objective:  To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male. Methods: Design:  Case Report Setting:  Tertiary Government Hospital Patient:  One   Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications. Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies. Keywords:  tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction

Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction

Objective: To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male.
 Methods:
 Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 
 Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications.
 Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies.
 Keywords: tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction

Sudden death due to a hypopharyngeal mass during sleep: A case report

It is not frequent to find during the autopsy a lymphoid hyperplasia located in the hypopharynx. The literature reports numerous cases characterized by the presence of a mass, non-malignant too, in this particular anatomical district; in these cases the neoformation plays an important role in explaining the cause of death through different asphyxial mechanisms. We present a case of a 44-year-old man, in apparent good health, who suddenly died during sleep. The autopsy revealed an hypopharyngeal lymphoid hyperplasia that can provide the asphyxial mechanisms as cause of death. Furthermore, the anatomical finding could be integrated by a circumstantial piece of evidence: the death occurring during sleep. Some studies, in fact, have highlighted the physio-pathological mechanisms to explain sleep-disordered breathing, particularly the muscular and neural changes involving the pharynx. The asphyxial mechanism was also studied by an immunoistochemical analysis with the anti-Human Surfactant Apoprotein-A (SP-A) antibody.

Hypertrophic Anterior Cervical Osteophytes Causing Dysphagia and Airway Obstruction

Hyperostosis of anterior cervical vertebral osteophytes can produce otolaryngological symptoms ranging from mild dysphagia, dysphonia, and foreign body sensation to severe food impaction and stridulous dyspnea. Airway compromise necessitating a tracheostomy is very rare. We discuss the case of an elderly man who presented with progressive dysphagia and a large hypopharyngeal mass as his initial manifestations of hypertrophic anterior cervical osteophytes. After a biopsy of the mass, the patient went into airway distress due to bilateral vocal fold fixation by the enlarging mass and consequently required a surgical airway. A combined team approach to the removal of the osteophytes successfully resolved his symptoms. The clinical, diagnostic, radiologic, and therapeutic principles involved in this case are presented and discussed. The recognition of hypertrophic osteophytes as a potential cause of common otolaryngological symptoms in the elderly population is paramount, as these symptoms can rapidly progress and lead to life-threatening airway obstruction. Medical and surgical interventions can be employed for the treatment of hypertrophic anterior cervical osteophytes, and they often result in favorable outcomes.

Hypopharyngeal foreign body masquerading as malignancy

Foreign body ingestion in dental and ENT practice is a commonly encountered emergency. In most cases, particularly in adults, there is a definite history of its ingestion, the nature of the foreign body is usually identifiable and the patient almost always presents immediately. We report an unusual case of an elderly patient with a six month history of progressive dysphagia referred to us by the physicians after investigations which were highly suggestive of a hypopharyngeal malignancy. Surprisingly when a biopsy was attempted, the hypopharyngeal mass turned out to be a dental plate. Dentists and otolaryngologists should be aware that pharyngeal foreign bodies can present without a positive history and can have a clinical presentation mimicking malignancy. A history of head injury, dementia, alcohol and drug abuse should be specifically excluded. A routine examination of a patient with dysphagia should include eliciting a specific history of wearing dentures and examination of teeth. In future designs for dental plates, bridges and crowns the use of a radio opaque material should be considered.

Tortuous internal carotid artery presenting as a pulsatile hypopharyngeal mass

Otolaryngology–Head and Neck SurgeryVolume 139, Issue 2 p. 316-317 Clinical Photograph Tortuous internal carotid artery presenting as a pulsatile hypopharyngeal mass Deng-Shan Lin MD, Deng-Shan Lin MD Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanSearch for more papers by this authorYaoh-Shiang Lin MD, Yaoh-Shiang Lin MD Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanSearch for more papers by this authorJih-Chin Lee MD, Corresponding Author Jih-Chin Lee MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanCorresponding author: Jih-Chin Lee, MD, Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, 325 Cheng-Kung Road, Sec. 2, Neihu District, Taipei 114, Taiwan, Republic of China. E-mail address: [email protected].Search for more papers by this author Deng-Shan Lin MD, Deng-Shan Lin MD Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanSearch for more papers by this authorYaoh-Shiang Lin MD, Yaoh-Shiang Lin MD Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanSearch for more papers by this authorJih-Chin Lee MD, Corresponding Author Jih-Chin Lee MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanCorresponding author: Jih-Chin Lee, MD, Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, 325 Cheng-Kung Road, Sec. 2, Neihu District, Taipei 114, Taiwan, Republic of China. E-mail address: [email protected].Search for more papers by this author First published: 01 August 2008 https://doi.org/10.1016/j.otohns.2008.04.029Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume139, Issue2August 2008Pages 316-317 RelatedInformation

Foregut Duplication Cyst of the Hypopharynx

Foregutduplicationcystsareheterotopicrestsofforegut-derivedepitheliumthatareusually found in the abdomen and thorax but occur rarely in the head and neck. We describe the first case (to our knowledge) of a hypopharyngeal foregut duplication cyst containingbothgastricandpancreatictissue.Thecaseinvolvedaneonatewhowasborn with stridor and cyanosis and who required immediate intubation because of airway obstruction due to a large hypopharyngeal mass. Magnetic resonance imaging and computed tomography were helpful in localizing the lesion. Direct laryngoscopy revealed a 4.52.5-cm mass in the hypopharynx, originating 2 mm above the esophageal inlet. The mass was excised, which is the treatment of choice. We also review the literature and discuss the pathogenesis of foregut duplication cysts.

Bilateral cystic parotid masses and a hypopharyngeal mass: a case report and review of mucosa-associated lymphoid tissue lymphoma in the head and neck

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma that was first described in gastric mucosa. Although presentation in the parotid gland is not unusual, bilateral cystic masses and associated hypopharyngeal involvement are rare. We describe an 83-year-old man with a large painless facial swelling; he was otherwise asymptomatic. On examination, bilateral parotid masses and a mass in the hypopharynx were found. Biopsy of the hypopharynx was consistent with MALT lymphoma. The patient was treated with single-agent chemotherapy and had a good initial response. MALT lymphoma occasionally originates within the salivary glands and other sites in the head and neck region. This disease should be considered in the differential diagnosis of cystic or bilateral parotid masses and hypopharyngeal masses.

Unusual Cause Of Obstructive Sleep Apnea In A Pediatric Patient: Lipoma Of The Hypopharynx

A case of lipoma of the hypopharynx is described in a 14-year-old female. The patient presented with symptoms of obstructive sleep apnea without any voice changes for several years. The initial physical exam noted unimpressive tonsils and no neck masses palpated. A fiberoptic scope was subsequently performed which demonstrated a 2 x 3 cm hypopharyngeal mass. The therapy was endoscopic surgical removal with CO2 laser with complete cure. Pathology revealed normal mature adipocytes consistent with a lipoma. This case represents only the fourth reported pediatric case of lipoma of the larynx or hypopharynx.

Spindle Cell Lipoma of the Hypopharynx

Larynx and hypopharynx lipomas are reported to account for approximately 0.6% of benign laryngeal neoplasms. Spindle cell lipoma is a histologically distinct variant characterized by mature adipocytes mixed with collagen-forming spindle cells; only one case of spindle cell lipoma of the larynx has been previously reported. We here describe a new case of spindle cell lipoma of the pyriform sinus successfully treated by means of endoscopic surgical excision. A 77-year-old woman with a 40-year history of dysphagia reported that the condition had markedly worsened over the three years before she came to us. She had difficulty swallowing even semisolid food and she experienced occasional nasal regurgitation of liquid or solid food. Flexible videolaryngoscopy showed a very large mass, covered by normal mucosa that almost totally occupied the right pyriform sinus and was apparently attached to the right arytenoid. Functional endoscopic study and videofluoroscopy of swallowing showed that the bolus progressed exclusively in the left pyriform sinus, with postdeglutitory pooling in the right pyriform sinus and a reflux toward the valleculae during consecutive deglutitions. Computed tomography demonstrated that the hypopharyngeal mass had low attenuation values and negative densitometry. The entire mass was surgically removed during suspension microlaryngoscopy. The histological sections showed mature adipocytes mixed with small and slender spindle cells. Postoperative endoscopic and videofluorosocpic deglutition studies revealed the recovery of normal swallowing. This case indicates that hypopharyngeal lipomas should be included in the differential diagnosis of slowly occurring swallowing impairments.

Transient Myocardial Dysfunction Associated with Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema: Recognition by Serial Echocardiographic Studies

We report a case of a 58-year-old woman who had angiotensin converting enzyme inhibitor-induced angioedema after she underwent a biopsy of a hypopharyngeal mass. The angioedema was associated with severe transient myocardial dysfunction documented on echocardiography. She did not have anaphylaxis or coronary artery disease. To our knowledge this is the first reported case of transient myocardial dysfunction in the setting of angiotensin converting enzyme inhibitor-induced angioedema without anaphylaxis. (J Am Soc Echocardiogr 1999;12:1107-9.)