Intra-Adenoid Cyst: A Case Report with an Immunohistochemical Study and Review of Literature

Scoping review of head and neck neoplasms presenting with obstructive sleep apnoea: the importance of flexible nasendoscopy

BACKGROUND

Obstructive sleep apnoea (OSA) can be caused by neoplasms involving the upper aerodigestive tract. Currently, many of these patients have this diagnosis missed, as most adults diagnosed with OSA do not undergo adequate head and neck examination including flexible nasendoscopy. We performed a review of the literature to shed light on this phenomenon and outline the pathologies and issues surrounding this sub-population of patients diagnosed with OSA.

METHODS

A scoping review of the literature was conducted on head and neck neoplasms presenting with OSA. Data were extracted on demographics, clinical presentation, histopathology, treatment and patient outcomes.

RESULTS

Sixty-seven articles were included, describing 79 patients. Mean age was 45.8 years, and 77.2% were male. Symptoms of OSA were present for an average of 29.2 months before a diagnosis of causative neoplasm was made. Forty-two different benign and malignant histopathological entities were reported. At diagnosis, the causative pathology of 100% of patients was visible on head and neck examination including flexible nasendoscopy, while only 53.2% were visible on trans-oral examination. One-third of patients had commenced inappropriate treatment for OSA, including three who had undergone sleep surgical procedures. The majority of patients were treated with surgery alone (72.2%).

CONCLUSION

Although rare, neoplasms of the upper aerodigestive tract should be considered as a cause of OSA, especially in patients experiencing other symptoms in addition to the typical symptoms of OSA. They should particularly be considered in patients with comparatively lower body mass index or those with worsening OSA without an apparent cause identified.

[Observation of the intra-adenoid cysts in the nasopharynx]

The objective of the present study was to demonstrate the clinical significance and possibilities of diagnostics and treatment of the intra-adenoid cysts in the nasopharynx as exemplified by an original observation of an individual case. The cystic structures in the nasopharynx rarely manifest themselves clinically and are known to produce the non-specific symptoms. The patients admitted to the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology for the surgical treatment of nasopharyngeal cysts account for 0.05% of the total number of the hospitalized subjects. This article reports a case of two large intra-adenoid cysts in the nasopharynx of one patient complicated by bilateral exudative otitis media. The successful outcome of the surgical treatment of this condition was achieved by means of endonasal marsupilization of the cysts under the laser-assisted endoscopic control with simultaneous bilateral shunting of the tympanic cavity.

[Differential diagnostics and the treatment strategy for the management of the nasopharyngeal cystic lesions]

The nasopharyngeal cystic lesions are quite common (affecting up to 14% of the general population) even though the majority of the cases are asymptomatic. Sometimes this condition is associated with the obstruction of nasal breathing, runny nose, hearing impairment, and other non-specific clinical manifestations. The endoscopic examination of the nasal cavity allows the preliminary clinical diagnosis to be established, however, MRI and CT visualization are necessary for more reliable differential diagnostics of this pathology and adequate planning of its treatment. The nasopharyngeal cysts require the surgical treatment, with endoscopic transnasal marsupialization in the combination with coblation, radiowave or laser irradiation being the main currently available option.