A Rare Case of Hyoid Osteoma.

Solid primary tumors of the hyoid bone are extremely rare. Osteomas are benign, slow-growing, usually asymptomatic, and well-circumscribed tumors broadly attached to the bone surface composed of mature lamellar/cortical-type bone with unknown etiology. Osteomas commonly occur in bones formed by membranous ossification, almost exclusively occurring in the head and commonly involving the paranasal sinus, skull vault, mandible, and nasal bone. We discuss a rare case of osteoma involving the hyoid bone.

Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology.

INTRODUCTION: Computed tomography (CT) imaging is the choice of investigation for evaluation of extent of tumor under the mucosa, locally and regionally. This study was undertaken to assess the accuracy of preoperative CT imaging in the staging of carcinoma of the larynx and hypopharynx. MATERIALS AND METHODS: In this retrospective study, all cases who were clinically (c) staged T3-T4 and who underwent surgery were evaluated. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) of a preoperative CT scan to detect cartilaginous penetration and spread outside the larynx was evaluated. Clinical T-stage by CT imaging was compared with postoperative histopathological T-stage. RESULTS: There were 22 (96%) male patients and one (4%) female patient. Patients were aged from 48 to 64 years (mean, 56 years). Twenty (87%) patients had laryngeal carcinoma, whereas three (13%) had hypopharyngeal carcinoma. Four (17%) patients had T3 tumors and 19 (83%) had T4a lesions. Preoperative imaging over-staged one of five pathological (p) T3 cases and three out of three pT2 cases, and was accurate in the remaining 19 cases. In a comparison of the results of imaging with histopathological T-classification, T-staging was found to be 82.6% accurate. CONCLUSION: CT is a precise and non-invasive imaging method with high sensitivity but relatively lower specificity because of increased false positives. CT imaging may be useful to guide the choice of surgical procedure, which can heavily impact a patients' quality of life.

Vagal Schwannoma: A Rare Parapharyngeal Tumour.

Among the parapharyngeal tumours, salivary gland tumours are the commonest, followed by schwannomas, which are slow growing benign tumours. Half of the parapharyngeal schwannomas originate from the vagus. Complete surgical excision is the treatment of choice. We hereby present two cases of parapharyngeal schwannomas, one which had presented as an intraoral mass and the other as a swelling in the neck. The first case, a 57-year-old female patient complained of a slowly increasing swelling in the left side of the throat since 3 months, associated with pain and dysphagia. In the Contrast Enhanced CT scan of the neck, a well-defined cystic lesion with central enhancing solid components (4cm X 4.5cm X 3cm) was seen in the left parapharyngeal region. The second case, a 39-year-old male patient complained of a painless, gradually increasing swelling below the lobule of the right ear since one month. Examination revealed a solitary, nontender, firm and mobile swelling of 2cm X 2cm below the lobule of the right ear. In Contrast Enhanced CT scan of the neck, an enhancing lesion was seen involving the right parapharyngeal space, post-styloid compartment. Both the patients underwent trans-cervical surgical excision. Vagal nerve schwannoma is rare. The majority of the cases present with a slow growing neck swelling without neurological deficit. Complete surgical excision of the tumour is important to prevent recurrence.

Primary clear cell carcinoma of the nasopharynx.

A 22-year-old female with epistaxis and nose block had a pink, smooth, mucosa covered lesion occupying the nasopharynx. The histopathology and immunohistochemistry of the lesion confirmed the diagnosis of clear cell carcinoma (CCC). Detailed evaluation ruled out a primary tumor elsewhere in the body. After complete excision of the tumor patient received radiotherapy (60 Gray in 30 fractions over 6 weeks). Patient is recurrence free on her 3-year follow-up. Primary CCC of the head and neck is rare. In the past 30 years, less than 100 cases have been reported in English literature. Out of these, only nine cases had nasopharyngeal origin. The literature review of those cases along with our case report suggest that complete excision of nasopharyngeal CCC along with radiotherapy leads to prolonged recurrence free interval. However, extensive tumors of nasopharynx exhibit poor prognosis with repeated local recurrences.

Pneumomediastinum due to tracheal foreign body granuloma.

Primary tracheal masses are rare. Secondary masses of the trachea are commonly foreign body granuloma, intubation granuloma or viral granuloma. The differential diagnoses given in such cases include both benign and malignant lesions. The otolaryngologist is often asked to perform a biopsy of the lesion to arrive at a diagnosis. However, even malignant processes can cause a granulomatous reaction. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion. A rare case of tracheal granuloma leading to pneumomediastinum in a 53-year-old female is presented. The clinical features, investigations and treatment are detailed. The tracheal granuloma was managed by excision through bronchoscopy and the pneumomediastinum was managed conservatively.