Pseudotumor of the head and neck masquerading as neoplasia

Abstract

Four unusual cases of pseudotumor, which had clinical and radiographic findings suggesting neoplasia, are presented. One involved the maxillary sinus, destroying the lateral wall, and extending to the infratemporal fossa and the orbit. The second presented as an enlarging lacrimal gland tumor with ipsilateral parotid adenopathy, and the third as a large parapharyngeal mass that was diagnosed as a lymphoma on aspiration cytology. The fourth case documented the rare occurrence of a congenital pseudotumor, manifesting as proptosis in a neonate and thought to be a fibrosarcoma on frozen section study. Aggressive pseudotumors must be distinguished from malignancy to avoid unnecessary surgery or irradiation. Some cases can be distinguished from neoplasms by their dramatic response to oral steroid therapy, and others by characteristic features on CT or MRI. Due to the diverse cellular proliferation, aspiration cytology is infrequently helpful and diagnosis can be difficult on frozen section study. An approach to the diagnosis and management of pseudotumors is detailed.

Sinonasal inflammatory myofibroblastic pseudotumor (plasma cell granuloma)

“…[16] And it must also be distinguished from sinusitis, granulomatous inf lammation, collagen vascular diseases, sarcoidosis and neoplastic disorders. [17] Histologic transformation to an undifferentiated sarcomatous proliferation has not been reported in sinonasal IMPT. Unlike orbital localizations, sinonasal IMPT never transform into lymphoma or develop into systemic lymphoma.…”

Pseudotumor inflamatório de seios paranasais

“…They have no common identifiable cause, although some authors have assumed that any inflammatory stimulus may originate these pseudotumors. 7 The name is given because these lesions simulate neoplasms, both clinically and radiologically. 1,8 There are many synonyms, such as histiocytoma, xanthogranuloma, plasmocytic cell granuloma, and inflammatory myofibroblastic proliferation, due to its wide histological presentation spectrum.…”

“…5,6 Variation in symptoms, edema, erythema and fever may suggest an inflammatory etiology. 7 Systemic symptoms are usually not encountered. 6,8 All patients in our sample presented a typical clinical picture that included progressive nasal obstruction, repeated nasal bleeding episodes and a nasal tumor.…”

“…Some authors have preferred corticosteroid therapy, while others have chosen surgery as the treatment of choice. 6,7 High-dose corticosteroid therapy usually yields a favorable response; early lesions that include lymphoid follicles tend to be more responsive to corticosteroids, while mature lesions with a more fibrous content respond less. 7 Our first measure is to biopsy the lesion.…”

Tumoren der kleinen Speicheldrüsen des Gaumens: Diagnostik und Differentialdiagnose

“…2). Tumoren der Speicheldrüsen des wei chen Gaumens wachsen gern in die Fossa pterygopalatina ein [7], Da die Zunge im hinteren Drittel fixiert ist, kön nen Patienten mit Gaumentumoren, die eine retromandibuläre Ausbreitung aufweisen, oft lange symptomfrei sein, wie wir es bei einigen unserer Patienten sahen und wie es auch in der Literatur beschrieben ist [12][13][14], Unter monomorphen Adenomen werden zahlreiche benigne epitheliale Tumoren zusammengefasst, die etwa 15% der Speicheldrüsentumoren ausmachen, wobei Zystadenolymphome überwiegen (10%) und die übrigen Ade nome (Basalzelladenom, Talgdrüsenadenom, hellzellige Adenome. Onkozytome) mit 5% beteiligt sind.…”