ABSTRACT
From January 1978 through July 1989, 360 patients underwent primary removal of an acoustic neuroma at the Mayo Clinic. Seventy of these patients were women under the age of 46 years; six of them were pregnant between the time of onset of their symptoms and the removal of their tumor. A review of the records of these six women revealed the presenting complaint in most to be central neurologic symptoms rather than labyrinthine symptoms. All had unilateral tumors. These tumors tended to be larger and more vascular than those in the nonpregnant cohort, and to have greater surgical morbidity. The pure-tone hearing levels were normal in four of these patients. All women experienced normal vaginal delivery without complication. Based on our experience with these women, we believe that acoustic neuroma present during pregnancy may be managed by close observation until the postpartum period, provided there are no impending neurologic complications.
Subject(s)
Cranial Nerve Neoplasms/pathology , Neuroma, Acoustic/diagnosis , Vestibulocochlear Nerve/pathology , Adolescent , Adult , Audiometry , Female , Hearing Disorders/complications , Hearing Disorders/diagnosis , Humans , Magnetic Resonance Imaging , Neuroma, Acoustic/complications , Neuroma, Acoustic/surgery , PregnancyABSTRACT
We reviewed all cases of possible primary squamous cell carcinoma of the parotid gland treated at Mayo Clinic, Rochester, Minn, from 1960 through 1988. Eighteen cases of primary squamous cell carcinoma of the parotid gland were identified. We report the clinical behavior and results of treatment of these rare parotid gland neoplasms. The age at diagnosis ranged from 48 to 86 years; the majority of patients were aged 65 years or older. Half of the patients presented with an asymptomatic parotid gland mass; a painful mass occurred in 33% of patients. Facial paralysis was noted in 17%, and a neck was the presenting symptom in 11% of patients. All patients underwent parotidectomy, and all or part of the facial nerve was sacrificed in 66% of patients. A neck dissection was performed in 12 patients, five of whom had pathologic confirmation of neck metastasis. Adjunctive radiation therapy was performed in 55% of patients. The overall survival at 5 years was 50%. Deep fixation and facial nerve paralysis were associated with a poor prognosis. Most recurrences developed within 1 year of initial treatment. Regional recurrence was always associated with a rapid death. Our data suggest that aggressive treatment and early detection may result in a better prognosis than is commonly associated with these tumors.
Subject(s)
Carcinoma, Squamous Cell , Parotid Neoplasms , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Parotid Gland/surgery , Parotid Neoplasms/mortality , Parotid Neoplasms/pathology , Parotid Neoplasms/therapy , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
Subglottic stenosis is one of the lesser known manifestations of Wegener's granulomatosis and poses great difficulty in confirming the diagnosis. We present the use of the anticytoplasmic autoantibodies (ACPA) blood test, which has been shown to be highly specific for Wegener's granulomatosis, for corroboration of Wegener's granulomatosis in a patient with subglottic stenosis for whom tissue biopsies were nondiagnostic. The ACPA test and the presentation, diagnosis, and management of subglottic stenosis due to Wegener's granulomatosis are discussed. Otolaryngologists must be aware of the varied manifestations of Wegener's granulomatosis and the availability of the ACPA blood test as an aid in confirming the diagnosis.
