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Giant mediastinal parathyroid cyst masquerading substernal goiter
Otolaryngology Head and Neck Surgery P 194
August 1995
Scientific Posters
gation of the optic nerve often retains vision and mobility. We have treated two patients with abnormally elongated optic nerve as a result of tumor expansion. We report our observations. Patients: A nine-year-old girl presented with neurofibromatosis and meningoencephalocele of the right cranioorbital region, severe enlargement of the right orbit, and eye displacement. The patient had some extraocular movements and light perception in that eye. The right optic nerve was 4 cm in length. The left optic nerve was 1.8 cm in length. The patient underwent excision of the tumor with orbital exenteration. A 64-year-old man presented with progressive proptosis of the left eye. His extraocular movement was Dlly intact with a visual acuity of 20/100 in that eye. A dermoid tumor in the posterosuperior aspect of the orbit caused displacement of the globe. The left optic nerve was 1 cm longer than the opposite optic nerve. There was no tenting of the posterior globe. Surgical excision was performed with globe preservation. The observed optic nerve elongation was caused by gradual retrobulbar tumor expansion. In the first case, the eye was exenterated because of severe aesthetic deformity and the absence of useful eye function. In the second case, however, all orbital soft tissues were preserved after tumor removal. His preoperative vision and extraocular muscle function was preserved. The proptosis was lessened. We will attempt to observe this case over the long term to ascertain the degree of globe regression and optic nerve adaptation. Conclusion: From our observations, it appears that the optic nerve can undergo compensatory growth secondary to globe displacement by tumor with maintenance of its physiologic function.
120
Giant Mediastlnal Parathyroid Cyst Masquerading Substernal Goiter WILLIAM LYDIAI-f, MD, and ASHOK R. SHAHA, MD, New York, N.Y,
Mediastinal parathyroid cysts are extremely rare. We present a patient whose history and imaging studies were suggestive of substemal goiter. A 69-year-old man presented with an asymptomatic lump in the thyroid region with considerable substernal extension. This was an incidental finding during the routine chest x-ray. The computed tomography scan and chest x-ray were representative of substernal goiter with considerable tracheal deviation. The patient's serum chemistry, calcium, and phosphorus were within normal limits. During surgery the patient was noted to have a large translucent cyst involving the entire superior mediastinum on the right side with considerable tracheal deviation. It was adherent to but not invading the thyroid gland. It could be easily separated from the thyroid gland; however, the dissection in the superior mediastinum and posterior mediastinum was quite tedious. With meticulous dissection, the entire mass was removed by the cervical approach. Final pathology revealed that this was a parathyroid cyst. The poster will describe the differential diagnosis of superior mediastinal cyst and provide a discussion of functional and nonfunctional parathyroid cysts. Clearly this large parathyroid cyst presented masquerading as a substernal goiter. The poster will illustrate x-ray films, intraoperative pictures, and histology to highlight features of mediastinal cysts. 121
119
Lemierre's Syndrome: A Case Report STEVEN J. VANDENBERG, MD, and GREGORY K. HARTIG, MD, Madison, Wis.
Lemierre's syndrome is a rare complication of primary oral or pharyngeal infection that consists of internal jugular vein thrombophlebitis with subsequent septic embolization. The usual etiologic agent is Fusobacterium necrophorum. Treatment entails intravenous antibiotics and surgical drainage if a cervical abscess is present. Anticoagulation is controversial. The diagnosis of Lemierre's syndrome should be considered in any patient with oral or pharyngeal infection and symptoms or signs of pulmonary involvement. A patient with Lemierre's syndrome and an intraluminal jugular vein abscess is presented as an example. Relevant literature is reviewed.
Hemangiopericytoma of the Ethmoid Sinus: Endoscopic Management and Review HELEN H. KIM, MD, and DINESH MEHTA, MD, Bronx, N,Y.
Since 1949, only 55 cases of hemangiopericytoma of the nose and paranasal sinuses have been reported in the literature. The peak incidence of hemangiopericytoma is in the sixth and seventh decade of life. Historically, wide surgical resection has been the treatment of choice. However, in view of the less aggressive biologic behavior of hemangiopericytoma confined entirely to the nose and paranasal sinuses, endoscopic removal with close follow-up is a viable treatment option, particularly in elderly patients with significant medical problems. We report a case of hemangiopericytoma arising from the ethmoid sinus that was managed endoscopically with electrocautery. The patient is free of disease 3 years postoperatively. Treatment modalities, histologic diagnosis, and prognosis of hemangiopericytoma are reviewed.
August 1995
Scientific Posters
gation of the optic nerve often retains vision and mobility. We have treated two patients with abnormally elongated optic nerve as a result of tumor expansion. We report our observations. Patients: A nine-year-old girl presented with neurofibromatosis and meningoencephalocele of the right cranioorbital region, severe enlargement of the right orbit, and eye displacement. The patient had some extraocular movements and light perception in that eye. The right optic nerve was 4 cm in length. The left optic nerve was 1.8 cm in length. The patient underwent excision of the tumor with orbital exenteration. A 64-year-old man presented with progressive proptosis of the left eye. His extraocular movement was Dlly intact with a visual acuity of 20/100 in that eye. A dermoid tumor in the posterosuperior aspect of the orbit caused displacement of the globe. The left optic nerve was 1 cm longer than the opposite optic nerve. There was no tenting of the posterior globe. Surgical excision was performed with globe preservation. The observed optic nerve elongation was caused by gradual retrobulbar tumor expansion. In the first case, the eye was exenterated because of severe aesthetic deformity and the absence of useful eye function. In the second case, however, all orbital soft tissues were preserved after tumor removal. His preoperative vision and extraocular muscle function was preserved. The proptosis was lessened. We will attempt to observe this case over the long term to ascertain the degree of globe regression and optic nerve adaptation. Conclusion: From our observations, it appears that the optic nerve can undergo compensatory growth secondary to globe displacement by tumor with maintenance of its physiologic function.
120
Giant Mediastlnal Parathyroid Cyst Masquerading Substernal Goiter WILLIAM LYDIAI-f, MD, and ASHOK R. SHAHA, MD, New York, N.Y,
Mediastinal parathyroid cysts are extremely rare. We present a patient whose history and imaging studies were suggestive of substemal goiter. A 69-year-old man presented with an asymptomatic lump in the thyroid region with considerable substernal extension. This was an incidental finding during the routine chest x-ray. The computed tomography scan and chest x-ray were representative of substernal goiter with considerable tracheal deviation. The patient's serum chemistry, calcium, and phosphorus were within normal limits. During surgery the patient was noted to have a large translucent cyst involving the entire superior mediastinum on the right side with considerable tracheal deviation. It was adherent to but not invading the thyroid gland. It could be easily separated from the thyroid gland; however, the dissection in the superior mediastinum and posterior mediastinum was quite tedious. With meticulous dissection, the entire mass was removed by the cervical approach. Final pathology revealed that this was a parathyroid cyst. The poster will describe the differential diagnosis of superior mediastinal cyst and provide a discussion of functional and nonfunctional parathyroid cysts. Clearly this large parathyroid cyst presented masquerading as a substernal goiter. The poster will illustrate x-ray films, intraoperative pictures, and histology to highlight features of mediastinal cysts. 121
119
Lemierre's Syndrome: A Case Report STEVEN J. VANDENBERG, MD, and GREGORY K. HARTIG, MD, Madison, Wis.
Lemierre's syndrome is a rare complication of primary oral or pharyngeal infection that consists of internal jugular vein thrombophlebitis with subsequent septic embolization. The usual etiologic agent is Fusobacterium necrophorum. Treatment entails intravenous antibiotics and surgical drainage if a cervical abscess is present. Anticoagulation is controversial. The diagnosis of Lemierre's syndrome should be considered in any patient with oral or pharyngeal infection and symptoms or signs of pulmonary involvement. A patient with Lemierre's syndrome and an intraluminal jugular vein abscess is presented as an example. Relevant literature is reviewed.
Hemangiopericytoma of the Ethmoid Sinus: Endoscopic Management and Review HELEN H. KIM, MD, and DINESH MEHTA, MD, Bronx, N,Y.
Since 1949, only 55 cases of hemangiopericytoma of the nose and paranasal sinuses have been reported in the literature. The peak incidence of hemangiopericytoma is in the sixth and seventh decade of life. Historically, wide surgical resection has been the treatment of choice. However, in view of the less aggressive biologic behavior of hemangiopericytoma confined entirely to the nose and paranasal sinuses, endoscopic removal with close follow-up is a viable treatment option, particularly in elderly patients with significant medical problems. We report a case of hemangiopericytoma arising from the ethmoid sinus that was managed endoscopically with electrocautery. The patient is free of disease 3 years postoperatively. Treatment modalities, histologic diagnosis, and prognosis of hemangiopericytoma are reviewed.