Introduction: Warthin’s tumor (WT), also known as papillary cystadenoma lymphomatosum, is the second most common salivary gland tumor, accounting for approximately 15% of all salivary gland tumors (SGTs) and 24% of benign tumors. Rarely, WT may develop in extraparotid locations of the head and neck, including the minor salivary glands. Because of its histologic features, the diagnosis of Warthin’s tumor can sometimes be challenging, especially in extraparotid locations. We present a case of WT mimicking squamous cell carcinoma (SCC), with a second WT focus in the palatine tonsil, an unprecedented location. To our knowledge, this is the first such case described in the available literature. Aim: To present a case initially suspected to represent cervical carcinoma of unknown primary (cCUP), which was ultimately diagnosed as Warthin’s tumor of the parotid gland with a second focus in the palatine tonsil. Case report: A 73-year-old woman presented with a mass in the region of the left mandibular angle. Fine-needle aspiration biopsy suggested a lesion suspicious for malignancy, classified as category V according to the Milan classification. MRI of the head and neck revealed a complex mass with solid and cystic components located at the border of the inferior pole of the parotid gland and the posterior pole of the submandibular gland. The patient was scheduled for excision of the neck mass with lymph node dissection, as well as panendoscopy and bilateral tonsillectomy. Intraoperatively, a lesion of the inferior pole of the parotid gland was identified; therefore, the procedure was extended to include superficial parotidectomy with preservation of the facial nerve. Deep cervical lymph nodes of levels II and III on the left side were removed. Bilateral tonsillectomy was performed. No mucosal lesions of the upper aerodigestive tract were visualized on panendoscopy. Blind biopsies were taken from the nasopharynx and the base of the tongue. Final histopathological examination revealed a Warthin’s tumor in the left parotid gland and a 4-mm WT focus in the left palatine tonsil. Conclusions: Warthin’s tumors can mimic metastases of squamous cell carcinoma, exposing patients to high-risk procedures. Awareness of the possibility of papillary cystadenoma lymphomatosum occurring in various locations within the head and neck structures, including extra-salivary sites, may help pathologists and clinicians consider this diagnosis in the differential diagnosis of suspicious oncologic lesions.
IntroductionDrug-induced sleep endoscopy (DISE) of the upper airway is an important component of the diagnostic work-up of patients with obstructive sleep apnea (OSA), particularly in those being considered for surgical treatment. DISE enables dynamic assessment of the site and mechanism of upper airway collapse during pharmacologically induced sleep and facilitates individualized treatment planning.Aim:The aim of this paper is to present a practical protocol for performing DISE (“How I Do It”), including pre-procedural assessment and preparation, sedation, endoscopic assessment, and interpretation of the observed patterns of upper airway collapse.Method:A step-by-step description of our approach to DISE is provided, with particular emphasis on patient selection, monitoring of vital parameters, sedation management, and examination technique. The assessment of individual anatomical levels of the upper airway according to the VOTE classification is described, together with the role of additional diagnostic maneuvers, including the Esmarch maneuver and the use of an oral appliance. The most common patterns of upper airway obstruction and their implications for treatment planning are also discussed.Conclusions:DISE requires a standardized protocol and adequate experience of the team performing the procedure. When properly performed and evaluated, DISE provides important information about the mechanisms of upper airway obstruction and supports treatment decision-making in patients with OSA, particularly those being considered for surgical treatment.
Introduction:Benign positional paroxysmal vertigo is the most common cause of vertigo worldwide; a subclinical or subjective variant of that disease is defined as the presence of subjective vertigo without corresponding nystagmus; it accounts for 11.5% of all cases of Benign positional paroxysmal vertigo.Materials and methods:A prospective study of 32 patients presented with subjective Benign positional paroxysmal vertigo and had performed Alsarhan ( Rapid Bilateral Sitting Up) maneuver and followed up for a period of one month for any recurrence of the disease.Results:Alsarhan maneuver was useful in 84.4% of the cases; the usefulness rate was statistically significant.Conclusion:Alsarhan maneuver can be a promising method in treating this condition.
The EULAR accepted the OMERACT SGUS scoring system for major salivary glands as a useful tool for investigating Sjogren’s disease (SJD) and staging the severity of salivary gland disease. SGUS is suggested as an additional tool for investigation. MSGB, a major criterion for diagnosis, is not favored by many due to complications.Aim and Objective: To determine the role of SGUS to investigation, screen, diagnose and stage the severity of the Sjogren’s disease according to OMERACT gray scale guidelines. To correlate the SGUS findings to the clinical grade of disease and serological investigations used in criteria for diagnosisMaterials and Methods: A prospective study of patients with sicca symptoms. The patients with DED and dry mouth symptoms are investigated with ESSADAI scoring and subject to screening with schirmer’s test, corneal staining and SGUS. The findings correlated with the serological and clinical severity of the disease. The diagnosis of Sjogren’s disease is made by ACR guidelines with the use of SGUS along with Minor salivary gland Biopsy performed after consent for definitive diagnosis and in inconclusive diagnosis.Results: SGUS findings are present in all SJD cases. The grade of SGUS correlated to the levels of Anti-nuclear antibodies (grade 2 and grade 3 changes). ANA was detected in 92.9% and Anti-SS-A, Anti-Ro52 antibodies were present in 71.4%. Conclusion: SICCA symptoms are common but Schirmer’s test results do not correlate with the systemic manifestations of the disease. It is a useful investigation to screen for Sjogren’s disease. SGUS grade correlates with disease severity in SJD. SGUS changes have been found in patients where Anti- SSA antibodies and other criteria were normal. EULAR recommends initial evaluation of salivary gland involvement at screening for SJD and prior to starting treatment, and along with ophthalmic evaluation and serological studies SGUS can stage SJD in outpatient department.
Introduction: Cases of metastasis of malignant laryngeal tumours to the parotid gland are rarely described in the literature. The most common tumours metastasising to the parotid lymph nodes are skin tumours: squamous cell carcinoma and melanoma (approximately 70–80% of cases). Cases of the simultaneous occurrence of two tumours in the parotid gland are rarely described in the literature.Case report: In this paper, the authors present a case of co-occurrence of squamous cell carcinoma of the larynx metastasising to a salivary gland lymph node alongside a Warthin tumour in the parotid gland.Conclusions: The co-existence of benign and metastatic lesions within the parotid gland may impose diagnostic difficulties. In cases of extensive malignant tumours in the head and neck region, where enlarged lymph nodes and lesions in the parotid gland are found, the treatment of choice remains parotidectomy performed concurrently with lymphadenectomy. The extent of the parotid gland surgery depends on the size and type of lesions in the gland.
