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Baranski T, Piroth W, Seiffert P, William M, Tröbs RB. Stridor caused by duplication cyst in a female infant and temporary vocal cord paralysis. A case report. Int J Surg Case Rep 2022; 98:107557. [PMID: 36055173 PMCID: PMC9482990 DOI: 10.1016/j.ijscr.2022.107557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction and importance Congenital hypopharynx duplication cysts are a medical rarity; nevertheless, they offer an important differential diagnosis in neonatal dyspnea or feeding problems. Case report Herein, we describe a case of delayed diagnosis but successful surgical removal of a large congenital hypopharynx cyst in a 4-month-old infant presenting with stridor. Clinical discussion Early and proper diagnosis and surgical handling of hypopharynx cyst can help to achieve the best prognosis and outcome. Conclusion We present the successful management of a newborn with a pharyngeal duplication cyst. In our case, the temporary postoperative laryngeal nerve palsy resolved within four weeks. Overstretching of recurrent laryngeal nerve might have caused this complication. Surgical differential diagnoses of inspiratory and expiratory stridor in infants Therapeutic options to avoid relapse after surgery for neck duplication cysts Vocal cord paralysis caused by stretching may resolve Histological findings support the origin in the time of foregut separation
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Ahmed ME, Ahmed MER, El Batawi AM, Abdelfattah HM, Jelassi N. Internal Hypopharyngeal Cyst: A Review of Literature. Dysphagia 2019; 34:487-498. [PMID: 30927081 DOI: 10.1007/s00455-019-10003-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023]
Abstract
Detailed information on the hypopharyngeal cyst presentation, terminology, classification, diagnosis, management, and possible complication is scarce though it would lead to life-threatening symptoms. This review article, therefore, meticulously presents and analyzes the majority of the pertaining literature. In this context, a particular emphasis has been placed on the embryological development of the branchial arches while discussing each entity that would improve the current understanding of different pharyngeal cyst's pathologies.
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Affiliation(s)
| | - Mona El-Rabie Ahmed
- Department of Phoniatrics, Otorhinolaryngology-Head and Neck Surgery, Sohag University, Egypt-Sohag-Nasr City, Eastern Avenue, University Street, Sohag, 82524, Egypt.
| | | | | | - Noura Jelassi
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Tunisia University, Tunis, Tunisia
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Abstract
Oral foregut cysts are congenital choristomas that arise in the oral cavity during embryonic development from remnants of foregut-derived epithelium. This is an unusual report of a neonate with a large congenital sublingual cystic lesion, extending superficially from the left ventral tongue to the anterior floor of the mouth, impeding breast-feeding. The differential diagnosis included dermoid cyst, epidermoid cyst, mucous retention cyst, and oral lymphangioma. The treatment of choice was enucleation under general anesthesia. Histology showed a cystic lesion with a ciliated pseudostratified columnar epithelium with numerous goblet cells. Immunohistochemistry was positive for cytokeratin 7 and thyroid transcription factor 1 and negative for cytokeratin 20, resulting in a final diagnosis of an oral foregut cyst. Three weeks after surgery, the tongue had healed with good mobility, and breast-feeding could be established. No recurrence was present at 6 months of follow-up.
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Chai RL, Ozolek JA, Branstetter BF, Mehta DK, Simons JP. Congenital choristomas of the oral cavity in children. Laryngoscope 2011; 121:2100-6. [PMID: 21826675 DOI: 10.1002/lary.21758] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 01/21/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review our institutional experience with oral cavity choristomas in children. STUDY DESIGN Retrospective case series and medical record review. METHODS Medical records including clinic notes, operative reports, radiologic studies, and pathology specimens were reviewed. All imaging studies and pathology material were reviewed by a head and neck radiologist and pediatric pathologist, respectively. RESULTS Sixteen patients (10 males and 6 females) with congenital oral cavity choristomas were identified. Mean age at diagnosis was 1.8 months. Location of the lesions included tongue (n = 9) and floor of mouth (n = 7). Preoperative imaging included magnetic resonance imaging (n = 6), computed tomography (n = 5), plain radiography (n = 1), and no imaging (n = 4). Radiographically, the lesions were consistently lobular with well-defined margins, but other imaging features often mimicked other masses that can arise in the tongue and floor of mouth. Symptoms were present in five of 16 patients and included difficulty feeding, swelling with upper respiratory infection, and partial airway obstruction. Complete surgical excision was performed in 15 of 16 patients; mean age at the time of surgery was 12.7 months. One patient underwent marsupialization. No complications were noted perioperatively. No recurrences of choristoma were seen. On histologic examination, the predominant component was cystic with cyst linings of respiratory epithelium (n = 5), gastric (foveolar) epithelium (n = 1), or both (n = 10). CONCLUSIONS This study supports surgical excision as an effective intervention for children with oral cavity choristomas. Because the etiology of these cysts is unknown and diagnostic terminology is widely variable, we propose a more descriptive diagnosis based on the histology (i.e., lingual choristoma [or lingual developmental cyst] with respiratory epithelium or lingual choristoma [or lingual developmental cyst] with gastric epithelium).
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Affiliation(s)
- Raymond L Chai
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennyslvania 15224, USA
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Roy M, Rupa V, Deepthi AN, Chacko J. Unusual cystic hypopharyngeal mass in a child with obstructive symptoms. Indian J Otolaryngol Head Neck Surg 2011; 63:41-3. [PMID: 22754834 PMCID: PMC3146655 DOI: 10.1007/s12070-011-0184-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 03/29/2009] [Indexed: 11/26/2022] Open
Abstract
We present a rare case of a cystic posterior pharyngeal wall mass in a 5 year old child in whom prior surgery without biopsy led to considerable delay in both diagnosis and definitive treatment. The child presented with recurrent aspiration pneumonia, dysphagia and obstructed breathing from birth. Transoral wide excisional biopsy established the diagnosis of foregut duplication cyst. Only seven reported cases have been described in the English language literature till date.
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Affiliation(s)
- Mithun Roy
- Christian Medical College and Hospital, Vellore, Tamilnadu 632004 India
| | - Vedantam Rupa
- Christian Medical College and Hospital, Vellore, Tamilnadu 632004 India
| | - A. N. Deepthi
- Christian Medical College and Hospital, Vellore, Tamilnadu 632004 India
| | - Jacob Chacko
- Christian Medical College and Hospital, Vellore, Tamilnadu 632004 India
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Abstract
Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.
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Cappell MS, Lapin S, Rose M. Large right atrial myxoma containing gastric heterotopia presenting with dyspnea and bilateral leg edema due to pulmonary emboli and cardiovascular obstruction: the first known report of gastric heterotopia in the cardiovascular system. Dig Dis Sci 2008; 53:405-9. [PMID: 17592776 DOI: 10.1007/s10620-007-9894-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2004] [Accepted: 09/23/2004] [Indexed: 12/09/2022]
Abstract
A 52-year-old male presented with progressive dyspnea, bilateral leg edema, and elevated central venous pressure due to a large right atrial myxoma that caused vascular obstruction and pulmonary emboli. The myxoma contained gastric heterotopia. Other unusual features of this atrial myxoma included its large size, right atrial location, and attachment to the right atrial wall. Although gastric heterotopia has been reported throughout the gastrointestinal tract, and occasionally in other organs, this is the first report of gastric heterotopia in the cardiovascular system. This report confirms and extends previous reports of glandular elements or enteric glands within atrial, or cardiac, myxomas. The clinical presentation of the currently reported patient is explained as follows: the elevated central venous pressure resulted from cardiovascular obstruction and the dyspnea from multiple pulmonary emboli due to the large atrial myxoma. In this case, the clinical presentation was not attributable to the gastric heterotopia. The association of gastric heterotopia with atrial myxoma may, however, be clinically important because of the propensity of gastric heterotopia in the gastrointestinal tract to produce complications. The reported association may provide clues to the histogenesis of these two entities.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, MOB 233, Department of Medicine, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Abstract
Foregut duplication cysts of the hypopharynx are extremely rare, and only 6 cases, all of which have been described as solid lesions and contained heterotopic gastric epithelium, could be found during our literature review. We present a unique case of a hypopharyngeal foregut duplication cyst that was grossly cystic and had no heterotopic epithelium microscopically. The present case required intubation for stridor and airway obstruction shortly after birth. Congenital laryngeal cysts can appear similar to this lesion. However, the hypopharyngeal location of a cyst is a clue for the diagnosis of duplication on endoscopic examination.
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Affiliation(s)
- Jeong Kyu Kim
- Department of Otolaryngology-Head and Neck Surgery, Catholic University of Daegu School of Medicine, Nam-gu, Daegu 705-718, Korea.
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Marín Gabriel MA, Medina López C, Delgado Muñoz MD, Rodríguez Gil Y. Gastric heterotopia in the nasopharynx causing airway obstruction in the newborn. Int J Pediatr Otorhinolaryngol 2004; 68:961-4. [PMID: 15183589 DOI: 10.1016/j.ijporl.2004.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/02/2004] [Accepted: 02/03/2004] [Indexed: 11/17/2022]
Abstract
We describe a newborn boy with a gastric heterotopia located in the nasopharynx, which caused airway obstruction soon after delivery. Gastric heterotopia is an uncommon lesion generally found throughout the alimentary tract, but nasopharynx is an exceptional location. To our knowledge, this is the second reported case of gastric heterotopia located in the nasopharynx, and the first one presenting in a newborn with symptoms at birth and with an associated central nervous system mass.
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Affiliation(s)
- Miguel A Marín Gabriel
- Department of Neonatology, 12 October Hospital, Avda. De Córdoba s/n, C.P. 28041 Madrid, Spain.
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Desuter G, Plouin-Gaudon I, de Toeuf C, Gosseye S, Hamoir M. Gastric choristoma of the midline neck in a newborn: a case report and review of the literature. J Pediatr Surg 2003; 38:E1-3. [PMID: 12861589 DOI: 10.1016/s0022-3468(03)00210-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current report describes a 3-week-old boy presenting with a gastric choristoma of the anterior compartment of the neck. Initial examination at birth found 3 masses in the anterior region of the neck. The only remarkable symptom consisted of episodes of cyanosis induced by neck flexion. The neck mass was removed after computed tomography scan assessment. Pathology finding showed the diagnosis of gastric choristoma. Cervical location of a gastric choristoma in children is rare. Its presentation as a clinically palpable anterior compartment cervical mass at birth even more rare.
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Affiliation(s)
- G Desuter
- Department of Otolaryngology-Head & Neck Surgery, St-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
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Wacrenier A, Fayoux P, Augusto D, Laussel AC, Gosselin B, Leroy X. Gastric heterotopia in the nasopharynx. Int J Pediatr Otorhinolaryngol 2002; 64:65-7. [PMID: 12020916 DOI: 10.1016/s0165-5876(02)00035-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Heterotopic gastrointestinal mucosa is rare in head and neck area. Most cases are described in oral cavity especially in the floor of the mouth. We present herein the case of an 8-month old infant with a tumor-like mass in the cavum which consisted of an heterotopic gastric mucosa. This case is the first described in this localisation. A brief review of the literature and histopathologic differential diagnoses will be study.
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Affiliation(s)
- Agnes Wacrenier
- Department of Pathology, University Hospitals of Lille, Lille Cedex, France.
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12
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Hsu JM, Mortelliti AJ. Gastric choristoma of the hypopharynx presenting in an infant: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 2000; 56:53-8. [PMID: 11074116 DOI: 10.1016/s0165-5876(00)00378-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Normal gastric mucosa has been found throughout the alimentary tract, ranging from scattered rests of cells to well formed mucosa with submucosal smooth muscle. Many terms have been applied to these collections; however, the term gastric choristoma seems most appropriate. We present a case of hypopharyngeal gastric choristoma presenting with dysphagia and frequent emesis. Our literature review reveals that this is the seventh reported case of gastric choristoma found in the hypopharynx, and the first to present in an infant in the absence of respiratory distress. Excision or CO(2) laser ablation is useful for symptom relief; however, complete removal often requires multiple attempts.
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Affiliation(s)
- J M Hsu
- Department of Otolaryngology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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13
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Said-Al-Naief N, Fantasia JE, Sciubba JJ, Ruggiero S, Sachs S. Heterotopic oral gastrointestinal cyst: report of 2 cases and review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:80-6. [PMID: 10442949 DOI: 10.1016/s1079-2104(99)70197-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Oral heterotopic gastrointestinal cyst is a rare entity occurring in infants and children and showing a predilection for males. The cyst usually appears as an asymptomatic swelling in the floor of the mouth. Difficulty in feeding, swallowing, respiration, and speech have been reported in approximately 30% of those affected. The tongue-in particular, its anterior aspectis involved in up to 60% of reported cases. The clinical, radiographic, and histopathologic features of cases of heterotopic gastrointestinal cyst involving the anterior tongue in a 2-year-old girl and the anterior floor of the mouth in a 2-month-old boy are presented, and theories of pathogenesis are discussed.
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Affiliation(s)
- N Said-Al-Naief
- Department of Oral Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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14
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Gorlin RJ, Myers SL. Gastrointestinal cyst of the tongue: A possible duplication cyst of foregut origin. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90498-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
There have been numerous reports of various types of heterotopic tissue in the head and neck. Heterotopic cartilage, gastric tissue, thyroid, and salivary gland in such various locations as tongue, gingiva, palate, nasopharynx, parapharyngeal space, and neck have been frequently reported. Heterotopic brain in the parapharyngeal space causing airway obstruction in the neonate has been rarely described. These benign masses are capable of expansion and because of their location, can lead to significant airway and feeding difficulties. We describe 3 cases of heterotopic brain tissue in the parapharyngeal space causing feeding difficulties and airway obstruction in the neonatal period. Two were initially misdiagnosed as lymphatic malformations. In the third, a nine month delay in diagnosis occurred. The diagnostic features of heterotopic brain in this location and some management suggestions in treating such a lesion are discussed.
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Affiliation(s)
- V Forte
- Department of Pediatric Otolaryngology, Hospital of Sick Children, Toronto Oni, Canada
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Burton DM, Kearns DB, Seid AB, Pransky SM, Billman G. Tongue gastric choristoma: failure to localize by technetium-99m pertechnetate scan. Int J Pediatr Otorhinolaryngol 1992; 24:91-5. [PMID: 1328100 DOI: 10.1016/0165-5876(92)90070-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.
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Affiliation(s)
- D M Burton
- Children's Hospital and Health Center, San Diego, CA
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