Oncocytic Cysts of the Nasopharynx: A Case Report

Abstract

Background Nasopharyngeal oncocytic lesions are a spectrum of benign lesions that represent a reactive or hyperplastic response to chronic inflammation. Though oncocytic lesions are typically asymptomatic, unilateral, and benign, this article discusses a rare case of large, bilateral oncocytic cysts and downstream otologic sequelae with a focus on identifying and discussing similar disease processes. Methods Case report and literature review. Case Presentation: A 67-year-old patient with 57 pack year smoking history presented for one year of left sided hearing loss and aural fullness. Clinic endoscopic exam demonstrated severe inflammatory and cystic changes lining the bilateral tori. Imaging and tissue sampling confirmed the cause was minor salivary gland cysts with papillary projections lined by oncocytic cells within bilateral tori tubarius. He was successfully treated with myringotomy with pressure equalizing tube, counseling on tobacco cessation, and surveillance with serial nasopharyngoscopy. Conclusions Chronic eustachian tube dysfunction is a possible rare presentation and sequelae of large oncocytic cysts of the nasopharynx. Oncocytic cysts should be considered on the differential diagnosis for nasopharyngeal masses causing such dysfunction.

Unilateral Tubarial Oncocytic Papillary Cystadenoma Presenting with Epistaxis

“…The lesion resembles Warthin’s tumor; however, it does not demonstrate lymphoid elements. Given their rarity, its cytological features are not well described 4 , 5 , 8 . According to the World Health Organization histological classification of salivary gland tumors, OPC is a cystic lesion lined by oncocytic epithelium with occasional luminal papillary projections.…”

“…It mostly presents as a single cyst and rarely in a more diffuse pattern as multicysts 6 . In 2020, Hwang et al 8 reported a case of oncocytic cysts of bilateral tori tubarii. The patient presented with bilateral MEE caused by hypertrophied, irregular lobular changes to the submucosal, leading to the initial eustachian tube (ET) dysfunction.…”

“…Swelling only becomes noticeable upon compression toward its surrounding structures 5 . CECT imaging to determine the characteristics of the lesion may not be beneficial in smaller lesions, whereas magnetic resonance imaging (MRI) is more valuable in larger or multiple masses 8 , 9 . Imaging data available are inadequate to prove the best diagnostic choice in view of the lack of reported cases and extremely rare recurrence after excision.…”

“…Additionally, if the lesion was larger and the patient agreed for surgical excision, MRI can be performed to help delineate it apart from surrounding structures. In the presence of a vascular-looking mass or persistent epistaxis, CT angiography may be opted to map out the feeding vessels involved 1 , 8 .…”

“…A few cases reported were seen within the intraoral minor salivary glands and parotid glands, which all presented with a painless mass, whereas some cases were detected within the larynx, mainly at the supraglottic structures, and an increasing tumor size causes hoarseness, dysphonia, or rarely airway obstruction 7 . In 2020, Hwang et al 8 reported a case of oncocytic cysts of bilateral tori tubarii that presented with bilateral middle ear effusion (MEE). None of the cases reported had clinical presentation of bleeding tumor or epistaxis, like in our case.…”