Parapharyngeal Mass Research Articles

A thyroid tumor extending to the parapharyngeal space

BackgroundThe metastasis of papillary thyroid carcinoma to the parapharyngeal space is rare and discussed in the English literature before. Encountering a parapharyngeal mass with cystic appearance on imaging, one should rule out thyroid malignancy as differential diagnosis.Case presentationThe case presented here is a 22-year-old woman who was referred to our clinic with complaints of painless neck mass, dysphagia and hoarseness for two years. After radiologic and pathological examination, the mass thought to be relevant with the thyroid gland. Peroperatively, the tumor was found to originate from the superior pole of the right thyroid gland, with a narrow stalk, and extended following the neurovascular bundle to the lower part of the parapharyngeal space. The bulk was removed via transservical approach with total thyroidectomy.ConclusionThe occurrence of the follicular variant of papillary thyroid carcinoma in the parapharyngeal space is extremely rare. The management of this rare case was discussed with the review of literature.

Lipoma of the parapharyngeal space

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.

Adenoma pleomorfo gigante de lóbulo profundo de la parótida: a propósito de un caso

AbstractParapharyngeal space tumors are rare. Salivary neoplasms being the most frequent ones. The important volume they can reach, their silent character, and the complex anatomic relationships of this area makes their surgical resection difficult. This report describes a case of a pleomorphic adenoma in the deep lobe of the parotid gland presented like a parapharyngeal mass, and its diagnosis and treatment

Tumeurs cervicales et para-pharyngées d’origine osseuse: A propos de deux observations

The purpose of the study was to report two cases of cervical and para-pharyngeal bone tumors.Patients were two 29 and 67-year-old men. Presentation of the lesions included respectively a right cervical mass and a left para-pharyngeal mass. Clinical features and radiological, anatomopathological and therapeutic characteristics of the tumors were retrospectively studied.A cervical approach was made in both cases. Tumor biopsies revealed a vertebral aneurismal cyst and a corporeo-pedicular chordoma respectively.Vertebral bone tumors with cervical expression are very uncommon entities. Diagnosis could be systematically evoked in patients with a cervical or para-pharyngeal tumor presenting vertebral lysis.

Management of parapharyngeal minor salivary neoplasms in children: A case report and review

Parapharyngeal neoplasms are rare entities in children. Benign minor salivary gland neoplasms of the parapharyngeal space have been described in the adult literature, but there is little guidance in the pediatric literature. We present the case of an adolescent male with a primary minor salivary gland pleomorphic adenoma presenting as an enlarging, asymptomatic parapharyngeal mass. We discuss the clinical presentation, radiologic findings, differential diagnosis and our surgical management with a summary of the current literature on the topic.

Parapharyngeal metastasis from papillary thyroid carcinoma: a case diagnosed by thyroglobulin measurement in peroral fine-needle aspiration of a cystic metastatic lymph node

We report a case of a parapharyngeal cystic metastatic lymph node arising from papillary thyroid carcinoma (PTC). Parapharyngeal metastases arising from PTC are rare and correct diagnosis of the parapharyngeal mass before surgery is difficult. In this case, the diagnosis of a parapharyngeal mass was made pre-operatively by thyroglobulin measurement in peroral fine-needle aspiration with negative cytology.

Surgical management of parapharyngeal space masses

We sought to examine surgical techniques used to remove parapharyngeal space (PPS) masses. This retrospective search was conducted from 1980 to 2003. Age, sex, diagnosis, surgical approach, complications, and outcome were collected. One hundred sixty-six PPS masses were identified: 21 (12.7%) were malignant, 145 (87.3%) were benign, 76 (45.8%) were vascular, and 69 (41.6 %) involved the skull base. Transcervical techniques were used in all cases. Removing the styloid and its musculature and level II lymphadenectomies enhanced exposure for vascular and skull base tumors. Thirty transcervical-transmastoid dissections (20.4%) facilitated removal of vascular skull base tumors. To identify the facial nerve, 20 transparotid-transcervical approaches (13.6%) were performed. Three mandibulotomies (2.0%) were required for internal carotid artery involvement. Expected neurologic sequelae resulted from cranial nerve involvement by tumor. Three patients (2.0%), all presenting with recurrent cancer, had local recurrences. Careful patient assessment and surgical techniques allow the oncologically safe removal of benign, vascular, and skull base PPS tumors.

Anévrysme de l’artère carotide interne dans sa portion extracrânienne

Extracranial aneurysm of the internal carotid artery is an exceptional finding. An 89-year-old woman consulted for a peritonsillar mass. Physical examination revealed a parapharyngeal pulsatile mass in the oropharynx. Computed tomography (CT) provided the diagnosis of extracranial internal carotid artery aneurysm. Endovascular or surgical treatment were declined. Anticoagulation medication was given. We reviewed the CT and magnetic resonance imaging findings and the clinical manifestations of extracranial internal artery aneurysm. Endovascular treatment is an alternative to open surgery.

An unusual case of adult airway obstruction from a lymphatic/venous malformation

Objectives: Lymphatic, venous and mixed lymphovenous malformations are low-flow lesions that are present at birth and become clinically apparent before the age of 2 in 90% of cases. This case report puts forth an unusual presentation of a lymphovenous malformation in an adult. Methods: This is a case report of an unusual lymphovenous malformation. Results: A 19-year-old male presented to the emergency department with a 4-day history of worsening left sided odynophagia, fever, and voice changes. Exam revealed a left peritonsillar bulge consistent with a peritonsillar abscess; however, needle aspiration was negative. He was admitted for intravenous antibiotics, and over the ensuing 24 hours, his upper airway became acutely compromised. He was taken to the operating room emergently where he underwent an awake tracheotomy. Subsequent MRI revealed a large, poorly circumscribed heterogeneous left parapharyngeal mass that was isointense on T1 and hyperintense on T2 images consistent with a venous/lymphatic malformation. His lesion regressed after a course of steroids and antibiotics, and he was subsequently decannulated. Follow-up MRI shows marked reduction in the bulk of the lesion. Conclusion: A majority (70%-80%) of lymphatic and venous malformations present in the head and neck, primarily before 2 years of age. Rapid enlargement is common with trauma, spontaneous internal hemorrhage, or secondary infection, which is the likely scenario in our case. Treatment usually consists of sclerotherapy and/or surgical resection; however, the location and microcystic nature of our patient’s lesion was not amenable to these modalities. He remains asymptomatic over a year after his hospitalization.

Epistaxis due to traumatic internal carotid artery aneurysm

Epistaxis due to internal carotid artery (ICA) trauma is uncommon, and that due to aneurysm of the artery is rarer still. Most cases result in fatality due to severe, uncontrolled blood loss. The ICA is vulnerable to oropharyngeal trauma as it ascends beside the lateral pharyngeal wall. We describe a case of an 11-month-old girl who sustained oropharyngeal wall trauma from the handle of a wooden spoon. After a characteristic latent period of several days, upper airway obstruction occurred due to a right parapharyngeal mass, which extended inferiorly to the level of the larynx. Angiography confirmed a large dissecting ICA aneurysm. This was treated successfully by radiological coil occlusion.

Parapharyngeal metastasis from papillary microcarcinoma of thyroid: report of a case diagnosed by peroral fine needle aspiration

A parapharyngeal metastasis from primary thyroid carcinoma is rare and a search of relevant publications disclosed only seven previous reported cases. We describe a 46-year-old man who presented with a left parapharyngeal mass that was subsequently diagnosed by peroral fine-needle aspiration as a metastasis originating from a papillary carcinoma of the thyroid gland. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal mass. Fine-needle aspiration cytology is a simple, speedy, and cost-effective method of diagnosis of parapharyngeal masses.

Ancient schwannoma masquerading as a thyroid mass

Schwannomas are benign, encapsulated nerve sheath cell neoplasms. Cervical sympathetic chain (CSC) schwannomas are rare, with less than 50 cited cases in the literature. CSC schwannomas may mimic a number of parapharyngeal masses. We report a rare variant, «ancient» schwannoma, which presented cytologically and radiologically as a thyroid mass. This is the first report of a CSC schwannoma mimicking a thyroid mass and the first report of an ancient schwannoma of the CSC.

Vertebral hydatid disease presenting as a parapharyngeal and neck mass: A case report

Echinococcus granulosus is a cestode causing disease in human beings. Both the vertebral column and cervicofacial region are uncommon sites for hydatid involve‐ment, even in countries of the Middle East, South America, Australia, and New Zealand, where Echinococcus infestation is high.1 It was stated that only 1 in 1000 cases will exhibit cervical spine infestation, if the spine is infected in 1% to 2% of hydatid cases.12

Giant Parapharyngeal Space Lipoma: Case Report and Surgical Approach

Large parapharyngeal space tumors near critical neurovascular structures pose challenging management problems. Only eight cases of a lipoma in the parapharyngeal space have been reported. We present a surgical approach that permits safe resection of such unusual tumors.A 49-year-old man had a 2-year history of progressive pain in the left neck radiating from the shoulder to the occiput. Contrast-enhanced computed tomography (CT) of the neck demonstrated a fat-attenuation mass located in the poststyloid parapharyngeal space. The mass extended into the foramen transversarium at the level of the second cervical vertebra and encased the vertebral artery. The tumor was removed through an extended transcervical approach that included transection of the attachments of the sternocleidomastoid, trapezius, splenius capitus, and the longissimus capitus muscles. The approach provided access to the first cervical vertebra, allowing dissection of the tumor from the vertebral artery in the foramen transversarium. An extended transcervical approach provides exposure from the carotid artery to the vertebral artery and facilitates the complete excision of large parapharyngeal space masses.

Management of the carotid artery at the skull base

Purpose: To determine appropriate management of benign lesions with significant involvement of the carotid artery at the skull base and present an algorithm for safe treatment of these patients. Materials and Methods: From 1982 to 1999, 115 patients with significant parapharyngeal space masses were treated at our institution. Of these patients, 43 had lesions involving the carotid artery at the skull base and served as the basis for this study. All patients underwent preoperative computed tomography or magnetic resonance imaging scans to determine carotid involvement, and all had preoperative 4-vessel arteriograms and carotid occlusion tests with continuous electroencephalography or neurologic examination monitoring to predict safety of carotid sacrifice. Results: Of 43 patients, 41 passed carotid occlusion testing and were treated surgically. Of these patients, 33 (81%) underwent resection of their lesions with preservation of the internal carotid artery, 5 (12%) had resection with bypass or reconstruction of the artery, and 3 (7%) had en bloc resections without artery reconstruction. There were no transient or permanent neurologic sequelae in any patient. Conclusions: When carotid artery encasement occurs in the setting of benign lesions at the skull base, safe resection with vascular preservation is possible in most cases. If carotid artery resection is necessary, vascular bypass or reconstruction is recommended to minimize neurologic morbidity. (Am J Otolaryngol 2001;22:336-342. Copyright © 2001 by W.B. Saunders Company)

Occult papillary thyroid carcinoma presenting as a parapharyngeal metastasis

The neoplastic involvement of the parapharyngeal space is a rare condition that represents only 0.5% of all head and neck tumors.1-3 The benign salivary gland tumors and tumors of neural tissue origin constitute the great majority of these cases. 3-6 To encounter a metastatic thyroid cancer in the parapharyngeal space is an extremely unusual occurrence. The literature review showed only six cases published previously.7-*2 In this article, we report a patient presenting with a left parapharyngeal mass. The pathological examination showed a metastatic thyroid papillary cancer. Besides the unusual localization of the lesion, this case also confirms the anatomic study of Rouviere13 showing the existence of lymphatic channels between the thyroid lymphatics and the parapharyngeal space.

眼か偽腫ように発症したウェゲナー肉芽腫症例

A 44-year-old male who complained of left eye pain and double vision consulted our outpatient clinic in July 1996. He was diagnosed as having left orbital pseudotumor 3 years previously. Although steroids and radiotherapy were administered, his ocular symptoms did not remit.A tumorous mass with crust was found in his left nasal cavity. CT findings showed a tumorous legion occupying his left orbita and ethmoid sinus. Microscopic examination of the biopsy specimen from his nasal cavity suggested Wegener's granulomatosis. Cyclophosphamide and prednisolone were administered. The tumor in the nasal cavity and ethmoid sinus shrank and he was discharged in December. Right parapharyngeal mass which was suspected to be recurrence of Wegener's granulomatosis was detected in January 1997. Following re-treatment with cyclophosphamide and prednisolone, a second remission was induced.

Evaluation of suspected recurrent papillary thyroid carcinoma with [18F]fluorodeoxyglucose positron emission tomography.

We evaluated 10 patients with suspected recurrent papillary thyroid cancer using [18F]fluorodeoxyglucose positron emission tomography (FDG PET). Prior therapy included total (n = 8) or subtotal (n = 2) thyroidectomy, radiation therapy (n = 2) and radioiodine ablation (n = 2). All patients had an 131I scan and one or more of the following imaging studies: 99Tcm-sestamibi scan. 111In-octreotide scan, sonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). Both the PET and 131I scans were negative in four patients. The PET and 131I scan results were discordant in six patients. Of the six discordant cases, five had true-positive PET scans and false-negative 131I studies. Three of these patients underwent neck lymph node dissection that showed positive histology for metastatic papillary carcinoma. Another patient had fine-needle aspiration (FNA) of a parapharyngeal mass that was also positive for papillary carcinoma. One patient was treated with radiation to the thyroid surgical bed based on an elevated serum thyroglobulin and a positive PET finding. Tumour response with a decrease in the size of the lesion was documented by a follow-up MRI scan. The remaining patient had a presumed false-positive PET scan, since a difficult hypocellular FNA of a small palpable lymph node was negative for tumour. We conclude that FDG PET is useful in the evaluation of patients with suspected recurrent papillary thyroid cancer when the 131I scan is negative.

副咽頭間隙に転移した甲状腺乳頭癌の２例

The parapharyngeal space is an anatomically complex region in which a variety of neoplasms can arise. Metastasis of a thyroid carcinoma to the parapharyngeal space is very rare. We recently treated two cases of this disease. The first case was a 66 year-old male with recurrent thyroid carcinoma presenting as a parapharyngeal mass, who had previously undergone a hemi-thyroidectomy and modified neck dissection. The second case was a 61 year-old male with accidental thyroid carcinoma metastasis to the parapharyngeal space during surgery for the treatment of hypopharyngeal and esophageal carcinoma. The possibility of metastatis to this region should be considered in the treatment of thyroid carcinoma.

Papillary Carcinoma of the Thyroid Metastatic to the Parapharyngeal Space

The parapharyngeal space is a complex anatomic area which can give rise to a variety of both primary and metastatic neoplasms. Squamous cell carcinoma can also present as a parapharyngeal space mass, either by direct extension or by metastases. Occult thyroid carcinoma presenting as a parapharyngeal space mass is a rare clinical occurrence which has been only sporadically reported in the medical literature. We present a case of occult papillary thyroid cancer with parapharyngeal space metastasis in the form of an isolated tumor, as well as a review of the literature on similar presentations. This rare situation has been previously described only once in the medical literature. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal space mass.