Epitheloid hemangioendothelioma of the submandibular region

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To  present  an  uncommon  cause  for  a  submandibular  mass  and  review  of  the literature.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A  25-year-old  lady  presented  with  a  painless  chronic  submandibular  swelling. Ultrasound identified a solid mass following which an uncomplicated core biopsy was performed obtaining    an    accurate    pre-operative    histopathological    diagnosis.    Pre-operative    arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.<br /><strong>CONCLUSION:</strong> Epitheloid  Hemangioendothelioma  is  an  uncommon  cause  for  a  submandibular mass.   A malignant   vascular   soft   tissue   tumor   with   morphologic   characteristics   similar   to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.</p>

Complications following tracheoesophageal puncture: a tertiary hospital experience.

INTRODUCTION: In laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period. MATERIALS AND METHODS: A retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted. RESULTS: Eighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain. CONCLUSIONS: TEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.