Pleomorphic adenoma causing acute airway obstruction

Giant Parapharyngeal Space Pleomorphic Adenoma Causing Acute Airway Obstruction

Primary parapharyngeal space (PPS) tumors are rare, representing only 0.5% of all head and neck neoplasms. About 80% of tumors of this space are benign, and 20% are malignant. They often pose therapeutic and diagnostic problems due to variable non-specific symptoms and the complex anatomy of this space. Pleomorphic adenoma is the most common benign tumor of this space. It presents as an asymptomatic mass causing mild bulging in the soft palate or tonsillar region, or fullness near the angle of the mandible in the neck. We report the case of a 60-year-old male admitted to the emergency department with breathing difficulty and acute stridor. He was unable to maintain oxygen saturation, and an emergency tracheostomy was performed. Radiological and cytological evaluation were performed, and the patient was diagnosed as having primary PPS pleomorphic adenoma. The tumor was excised via the transcervical approach. The rarity of tumor in this space and unusual life-threatening presentation prompted the authors to report this case. To our knowledge, this is the third case reported worldwide of a pleomorphic adenoma causing upper airway obstruction and acute respiratory failure.

Myoepithelial cell-rich pleormorphic adenoma of minor salivary gland of parapharyngeal space

Parapharyngeal space tumors are rare and constitute only 0.5–1.0% of head and neck tumors. Minor salivary gland tumor is still rare in parapharyngeal space. We are reporting a case of pleomorphic adenoma of minor salivary gland of parapharyngeal space. A 42-year-old female presented with a history of mass in the oropharynx for 3 years. She presented with “hot potato voice” and dysphagia. CECT and MRI were done, showing large parapharyngeal space tumor. FNAC was suspicious for tumor of nerve cell origin. Tumor was excised using “paramedian mandibulotomy with mandibular swing approach”. Histopathological examination was inconclusive, suggesting possibility of extraskeletal myxoid chondrosarcoma, solitary fibrous tumor, neurogenic tumor. On immunohistochemistry, tumor was positive for cytokeratin, EMA (dim), S-100, and P 63 and negative for SMA thus proving the case as myoepithelial cell-rich pleomorphic adenoma.

[Diagnostic and therapeutic problems in parapharyngeal space tumor--case report]

Only 0.5% of head and neck tumors originate from parapharyngeal space. Malignant neoplasms of parapharyngeal space are exceptionally rare (20% of all tumors in this area). Their rarity form a complex diagnostic and therapeutic problem. Authors reports a case of 53-year old woman with squamous cell carcinoma of parapharyngeal space that caused particular difficulties in diagnosis. Diagnostic and therapeutic procedures and preliminary outcome of treatment are presented.

[Parapharyngeal tumors: diagnosis and treatment]

OBJECTIVES

Parapharyngeal space tumors are rare and usually benign. Their treatment is surgical and many approaches have been described. We report our experience in managing these neoplasms. Two points are developed more fully: the correlation between imaging and surgical observation and the reliability of the cervical approach.

MATERIAL AND METHODS

A retrospective review of primary parapharyngeal space tumors treated at the Rennes University Hospital between 1992 and 2004 is presented. Nine patients were included, all treated surgically with a cervical approach without parotidectomy.

RESULTS

Eight MR imaging and seven CT scans were done. Two retrostyloid tumors and six prestyloid tumors, all independent of the deep lobe of the parotid gland, were found. They were benign in all cases (five salivary tumors and four schwannomas). Two patients treated for a pleomorphic adenoma presented recurrence and were reoperated successfully. The average follow-up was 66 months. None of the patients died. Definitive postoperative complications occurred only for neurogenic tumors.

CONCLUSION

The cervical approach is safe and allows the surgical excision of retrostyloid and prestyloid tumors, independent of the deep lobe of the parotid gland. Large tumor (8cm in our study) excision can be done with few complications. An attentive study of preoperative imaging is necessary to choose the best surgical approach.