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Zuo W, Du Y, Chen JN. Nasopharyngeal amyloidoma: report of three cases and review of the literature. J Cancer Res Clin Oncol 2024; 150:337. [PMID: 38971938 PMCID: PMC11227456 DOI: 10.1007/s00432-024-05873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Nasopharyngeal amyloidoma is a rare, locally aggressive tumor that has been reported in the English literature in only 38 cases to date, most of which were in the form of case reports. The present study was aimed to summarize the characteristics of this rare tumor, with the goal of providing new insights for diagnosis and treatment. MATERIALS AND METHODS We report three cases of nasopharyngeal amyloidoma diagnosed in our hospital following comprehensive medical examination and review the current literature on all cases of nasopharyngeal amyloidoma from PubMed. The journey of nasopharyngeal amyloidoma, including presentation, diagnostics, surgeries, and follow-up was outlined. RESULTS None of the three patients had systemic amyloidosis. CT and nasal endoscopy showed irregular masses obstructing the nasopharyngeal cavity. Congo red staining confirmed the deposition of amyloid, and immunohistochemical analysis showed that the amyloid deposition was the AL light chain type. Through literature review, we found that nasopharyngeal amyloidoma most commonly occurred in individuals over the age of 40, patients usually had a good prognosis after complete tumor resection; however, there were still cases of recurrence, and unresected patients were at risk of progression to systemic amyloidosis. The efficacy of radiotherapy and chemotherapy was currently uncertain. CONCLUSION Early clinical and pathological diagnosis is crucial, and surgical intervention is the primary treatment option for this disease. Although patients usually have a favorable prognosis, long-term monitoring is necessary to detect potential relapses and initiate timely intervention.
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Affiliation(s)
- Wangsheng Zuo
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Yu Du
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Jian-Ning Chen
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.
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Schmid SE, Nesbitt NB, Snitchler AN, Verma PS, Grantham MD, Gallagher DJ. Localized Amyloidosis Involving Palatine Tonsils: A Case Report and Literature Review. Head Neck Pathol 2020; 14:1036-1040. [PMID: 32451875 PMCID: PMC7669982 DOI: 10.1007/s12105-020-01177-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/18/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
Amyloidosis is a localized or systemic process where extracellular insoluble plasma protein fibers are deposited into tissues. Localized amyloidosis is rare and curable by surgical resection. While the head and neck region represents 19% of localized amyloidosis cases, only one other case of bilateral involvement of the pharyngeal tonsils has been published in the international literature. We report a case of asymptomatic amyloidosis isolated to the bilateral palatine tonsils and a cervical lymph node in a 59-year-old male. Systemic amyloidosis was ruled out through multidisciplinary consultation, and resection of the masses was performed. This represents the second reported case of bilateral tonsillar amyloidosis.
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Affiliation(s)
- S E Schmid
- U.S. Army Medical Center of Excellence, San Antonio, TX, USA
| | - N B Nesbitt
- Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
| | - A N Snitchler
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - P S Verma
- Department of Hematology and Oncology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - M D Grantham
- Department of Pathology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - D J Gallagher
- Department of Otolaryngology - Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
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Vaxman I, Dispenzieri A, Muchtar E, Gertz M. New developments in diagnosis, risk assessment and management in systemic amyloidosis. Blood Rev 2019; 40:100636. [PMID: 31706583 DOI: 10.1016/j.blre.2019.100636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/19/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
Amyloidosis is a group of disorders characterized by a misfolded protein that deposits in organs and compromise their function. Clinician should have a high index of suspicion because in most cases, the clinical picture is non-specific. Typing of amyloid is of utmost importance and should be an integral part of accurately diagnosing a patient. AL amyloidosis is the most common systemic amyloidosis in the western world in which the misfolded proteins are immunoglobulin light chains secreted by clonal plasma cells. New data about prognostication of AL amyloidosis patients are accumulating. The treatment goal is to eradicate the amyloidogenic plasma cell clone, by using high dose melphalan and/or novel agents (proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies against CD38). Early diagnosis is important for effectively treating the patient as late diagnosis hampers chances for organ recovery. ATTR amyloidosis is less recognized but is increasingly seen due to better recognition and improved diagnostic tools. New data about treatment options (patisiran, inotersen and tafamidis) have recently been published and are discussed.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel; Israel Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Fuah KW, Lim CTS. Renal-limited AL amyloidosis - a diagnostic and management dilemma. BMC Nephrol 2018; 19:307. [PMID: 30400895 PMCID: PMC6219210 DOI: 10.1186/s12882-018-1118-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background Amyloidosis is a disorder caused by extracellular tissue deposition of insoluble fibrils which may result in a wide spectrum of symptoms depending upon their types, sites and amount of deposition. Amyloidosis can be divided into either systemic or localized disease. Case presentation We present a case of a middle-aged gentleman who presented with persistent nephrotic syndrome with worsening renal function. Repeated renal biopsies showed the presence of renal-limited AL amyloidosis. Systemic amyloidosis workup was unremarkable apart from a slightly raised band of IgG lambda level with no associated immunoparesis. The nephrotic syndrome and renal histology did not improve over a 3-year period despite being given two courses of chemotherapies. Conclusion We hope that early recognition of this unusual localised presentation of renal- limited AL Amyloidosis and its poor response to conventional treatment can alert the nephrologist to the potential existence of this rare condition.
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Affiliation(s)
- Kar Wah Fuah
- Department of Medicine, Hospital Tengku Ampuan Afzan, Kuantan, Malaysia
| | - Christopher Thiam Seong Lim
- Unit of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
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Amyloidosis of the Upper Aerodigestive Tract: Management of a Rare Disease and Review of the Literature. Dysphagia 2018; 34:179-191. [DOI: 10.1007/s00455-018-9956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023]
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Sakagiannis G, Giotakis E, Thompson LDR. Localized Nasopharyngeal Amyloidosis: A Clinicopathologic Series of 7 Cases with a Literature Review. Head Neck Pathol 2017; 12:542-547. [PMID: 29282670 PMCID: PMC6232197 DOI: 10.1007/s12105-017-0880-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/13/2017] [Indexed: 11/27/2022]
Abstract
Localized nasopharyngeal amyloidosis is an extremely rare entity with only 25 cases described in the English and German literature. We present a case series of seven patients with localized nasopharyngeal amyloidosis and combine the findings with a thorough review the literature.
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Affiliation(s)
- Georgios Sakagiannis
- Ear, Nose, Throat and Head and Neck Department, Attikon University Hospital, Athens, Greece
| | - Evangelos Giotakis
- Ear, Nose, Throat, Head and Neck Department, Hippokration University Hospital, Athens, Greece
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Ravindran A, Grogg KL, Domaas DA, Go RS. Polyclonal Localized Light Chain Amyloidosis—A Distinct Entity? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:588-592. [DOI: 10.1016/j.clml.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/13/2016] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
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8
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Intensity-modulated radiotherapy for localized nasopharyngeal amyloidosis. Strahlenther Onkol 2016; 192:944-950. [DOI: 10.1007/s00066-016-0996-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
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Kumar B, Pant B, Kumar V, Negi M. Sinonasal Globular Amyloidosis Simulating Malignancy: A Rare Presentation. Head Neck Pathol 2016; 10:379-83. [PMID: 26780770 PMCID: PMC4972754 DOI: 10.1007/s12105-016-0681-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/02/2016] [Indexed: 01/17/2023]
Abstract
Primary localized amyloidosis in the head and neck region is a rare entity. The most commonly involved organ is larynx. Primary amyloidosis localized to the sinonasal tract is extremely rare. We report one such case along with a brief review of the associated literature. The aim of reporting this case is to emphasize the fact that sometimes nasal amyloidosis can also present with signs and symptoms of nasal and nasopharyngeal malignancy. The definitive diagnosis in such cases depends upon histopathology and further confirmed by immunohistochemistry. A 55-year old male presented with recurrent episodes of nasal bleed, bilateral nasal obstruction, and bilateral hearing loss from last 7 years. On clinical examination a mass was found in the nasal cavity on both sides reaching up to the nasopharynx. Contrast enhanced CT scan revealed that the mass was extending up to the skull base and destroying bony landmarks of the nasal cavity and paranasal sinuses. Mass was proved to be amyloidosis after histopathological examination. It showed multiple blotches of globular submucosal deposit of amyloid, on staining with Congo red. Immunohistochemistry confirmed AL amyloidosis with expression of mixed kappa and lambda light chain immunoglobulin (κ > λ). No evidence of systemic amyloidosis was found after proper work up. It was managed by conservative surgery.
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Affiliation(s)
- Binay Kumar
- Department of Pathology, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Bhawna Pant
- Department of ENT, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Vikrant Kumar
- Department of ENT, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Meghna Negi
- Department of Pathology, Government Medical College, Haldwani-Nainital, Uttarakhand India
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Sánchez Legaza E, Cervera Oliver C, Guerrero Cauqui R. Amyloidosis of the Nasopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Amyloidosis of the nasopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:377-8. [PMID: 22698591 DOI: 10.1016/j.otorri.2012.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 02/08/2012] [Accepted: 02/13/2012] [Indexed: 11/20/2022]
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Durbec M, Ambrun A, Barnoud R, Poupart M, Pignat JC, Merrot O. Localized nasopharyngeal amyloidosis. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:160-2. [PMID: 22475977 DOI: 10.1016/j.anorl.2011.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 08/29/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To illustrate, via a case report, how a differential diagnosis of amyloidosis is to be suspected in case of a nasopharyngeal mass. CASE REPORT A 59-year-old woman presented with bilateral nasal obstruction with associated episodic tubal dysfunction. Physical examination found a mass occupying the entire nasopharynx, initially suggestive of tumor. DISCUSSION Amyloidosis was diagnosed on histopathologic study of the biopsy and surgical specimens. Exploration for systemic disease proved negative. The localized amyloidosis was managed conservatively. At 9 months' follow-up, there was no recurrence. CONCLUSION Localized amyloidosis, however rare, should be considered as differential diagnosis in any case of nasal obstruction with tubal dysfunction, even if bilateral. ENT physicians need to recognize and understand this pathology for adapted diagnostic and treatment planning.
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Affiliation(s)
- M Durbec
- Département d'otorhinolaryngologie et de chirurgie cervico-faciale, université Claude-Bernard Lyon I, hôpital de la Croix-Rousse, 93, Grande-rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France.
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Bhat A, Selmi C, Naguwa SM, Cheema GS, Gershwin ME. Currents concepts on the immunopathology of amyloidosis. Clin Rev Allergy Immunol 2010; 38:97-106. [PMID: 19626465 DOI: 10.1007/s12016-009-8163-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Amyloidosis is defined as the extracellular accumulation at systemic or organ-specific level of insoluble low molecular weight protein fibrils manifesting a beta pleated sheet configuration and a characteristic staining pattern. Several different types of proteins may lead to this phenomenon, and amyloidosis is defined by the biochemical nature of the protein in the deposits and further classified according to whether the deposits are localized or systemic, acquired or inherited, and by the resulting clinical phenotype. Amyloidosis includes subtypes such as light chain, associated with serum amyloid A protein, heritable and familial forms, dialysis-related disease, and organ-specific conditions. The pathogenesis and clinical features of these clinical and pathological entities will be critically discussed in this review article.
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Affiliation(s)
- Anupama Bhat
- Division of Rheumatology, Allergy and Clinical Immunology, Genome and Biomedical Sciences Facility, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, USA
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Abstract
AbstractObjective:We report the first case of nasal and nasopharyngeal amyloidosis secondary to multiple myeloma; this case also represents the fourth report of systemic nasal or nasopharyngeal amyloidosis.Method:Case report and review of the world literature concerning nasal and nasopharyngeal amyloidosis epidemiology, presentation and management.Results:Nasal and nasopharyngeal amyloidosis is rare. The presentation, clinical course and treatment are discussed for the presented patient. The amyloid tumour, which recurred in correlation with the progressive transformation of the multiple myeloma, was treated surgically. Subsequent localised radiotherapy decreased the size and growth rate of the tumour.Conclusion:Amyloid should be considered as a cause of resistant or recurrent epistaxis provided a mass lesion is seen on radiological imaging. Radiotherapy may be a treatment option in nasal and nasopharyngeal amyloidosis.
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Gilad R, Milillo P, Som PM. Severe diffuse systemic amyloidosis with involvement of the pharynx, larynx, and trachea: CT and MR findings. AJNR Am J Neuroradiol 2007; 28:1557-8. [PMID: 17846211 PMCID: PMC8134395 DOI: 10.3174/ajnr.a0604] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Amyloidosis is a term applied to a diverse group of disorders that share the deposition of amyloid protein in various extracellular tissues. Systemic amyloidosis may involve almost any organ system in the body including regions in the head and neck; however, pharyngeal involvement is rare, with only 12 cases having been previously reported. Ten of these cases were localized disease, and only 2 cases were systemic amyloidosis. We present the case of a patient with severe diffuse systemic amyloidosis with extensive involvement of the pharynx, larynx, trachea, lungs, eyelids, and breasts. We also review the imaging characteristics and pertinent literature.
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Affiliation(s)
- R Gilad
- Department of Neurosurgery, Mount Sinai School of Medicine of New York University, New York, USA
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Panda NK, Saravanan K, Purushotaman GP, Gurunathan RK, Mahesha V. Localized amyloidosis masquerading as nasopharyngeal tumor: a review. Am J Otolaryngol 2007; 28:208-11. [PMID: 17499143 DOI: 10.1016/j.amjoto.2006.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Accepted: 08/10/2006] [Indexed: 10/23/2022]
Abstract
Amyloidosis comprises a diverse collection of disease characterized by the presence of amorphous extracellular eosinophilic deposits of unique protein fibrils that gives apple green birefringence under polarized light after staining with Congo red. Head and neck region is the commonest site for localized form of amyloidosis. We report a case of a 43-year-old man with localized amyloidosis of nasopharynx with oropharyngeal extension and its management, along with a review of relevant literatures.
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Mesuro Domínguez N, Lacosta Nicolás JL. [Multifocal localized amyloidosis in a pediatric patient]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:471-3. [PMID: 17228648 DOI: 10.1016/s0001-6519(06)78751-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Amyloidosis of the upper airway is rare in the pediatric age group. We present a primary amyloidosis in the nasopharynx and nasal cavity in a 14-year-old girl. The symptoms were nasal obstruction and mucoid discharge. The diagnostic was revealed by histologycal analysis obtained from local surgical excision.
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Hayashi K, Ikai A, Sugisaki M, Tanabe H. Localised Amyloidosis of the Palate: Multislice Helical Computed Tomography and Magnetic Resonance Imaging Findings. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0915-6992(04)80041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
NPC represents 0.2% of malignant disease in the white population but is more common in southern China, among Chinese in East Asia and the United [figure: see text] States, and in North Africa, including Saudi Arabia. NPC in these ethnic groups tends to manifest at a younger age. Undifferentiated carcinoma is the most common histopathologic type and is associated with EBV. The tumor is optimally assessed with CT and MR imaging for staging; PET scanning provides optimal assessment of recurrent tumor or small lymph node metastases. The primary tumor in the nasopharynx may be small and infiltrating, causing no or only a small mass effect in the nasopharynx. In these cases, obliteration of fat planes and loss of muscle boundaries are important diagnostic findings, which are best evaluated with MR imaging including, Gd-DTPA with fat suppression. The size of the NPC varies from 1 to 2 cm to large tumors that extend to the oropharynx, PPS, nasal cavities, paranasal sinuses, and orbits. Skull base erosion is independent of the size of the nasopharyngeal tumor and ranges from slight erosion to extensive destruction. A concomitant finding is intracranial invasion, predominantly to the basal cisterns and cavernous sinuses associated with cranial nerve palsies. Intracranial invasion should be assessed with contrast MR imaging. Lymph node metastases in the neck are present in 90% of cases and are bilateral in 50% of cases. In a small percentage of cases, extension of lymph node metastases to the mediastinum and hilar areas are encountered. Distant metastases involve the lungs, skeleton, and liver, and occasionally the choroid. They are usually present at the initial presentation [figure: see text] and increase in frequency in advanced disease and in recurrent tumors. In addition, the metastatic lymph nodes in the neck reveal no specific imaging features that would allow differentiation from other lymph node metastases. They may be discrete, often multiple, and large and bulky displaying a variable degree of necrosis and enhancement following introduction of contrast material. Local recurrence manifests commonly within the first 2 to 3 years posttherapy and is optimally evaluated by MR imaging and PET scanning.
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Affiliation(s)
- Alfred L Weber
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Abstract
PURPOSE To discuss the presentation of localized amyloidosis affecting the nasopharynx and discuss the management options. Amyloidosis in the head and neck is a rare and benign condition that usually takes the form of localized amyloidosis. Because systemic amyloidosis markedly shortens life expectancy owing to its involvement with vital organs, rectal biopsy or fat aspiration of the anterior abdominal wall must be carried out to exclude systemic involvement. Localized amyloidosis in the head and neck can involve the orbit, sinuses, nasopharynx, oral cavity, salivary glands, and larynx. METHODS We present the case of a patient with conductive hearing loss and serous otitis media with effusion secondary to nasopharyngeal amyloidosis, as well as present a review of the literature. RESULTS Only a few cases of nasopharyngeal amyloidosis have thus far been reported. Patients with this disease can also present with recurrent epistaxis, postnasal drip, nasal obstruction, and eustachian tube dysfunction. Localized amyloidosis of the nasopharynx, which is slow growing, has proved difficult to treat because it can persist or recur despite surgical treatment. Furthermore, bleeding may be a major complication in treating patients with nasopharyngeal amyloidosis by transpalatal excision because the amyloid deposits cause vascular wall fragility. Finally, there is no evidence that surgical treatment of nasopharyngeal amyloidosis can prolong survival or that localized amyloidosis can progress to systemic amyloidosis. For these reasons, we elected to treat our patient with a tympanostomy tube and observation. CONCLUSION In the absence of systemic disease, localized amyloidosis of the nasopharynx may be treated conservatively.
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Affiliation(s)
- Alpen Patel
- Department of ENT and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
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Abstract
The localized form of amyloidosis affecting the head and neck region is rare. The characteristic features of localized amyloidosis appeared as multiple nodules on the tongue, lip, and cheek on computed tomography (CT) and magnetic resonance imaging (MRI). Contrast-enhanced CT scans represented this lesion as a marked nodular enhancement. MR features of this lesion appeared slightly low on T1-weighted images and slightly high on T2-weighted images compared with T1-T2 images of residual normal tongue. Time contrast intensity curves obtained from dynamic MRI rapidly increased to reach a plateau and gradually decreased during the late and delayed phases. MR findings suggest that such lesions might be comprised of fibrous tissue with abundant vessels. This report suggests that dynamic MRI might be helpful for diagnosing localized amyloidosis.
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Affiliation(s)
- J Asaumi
- Department of Oral Radiology, Okayama University Dental School, 2-5-1 Shikata-cho, Okayama 700-8525, Japan.
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Affiliation(s)
- A Pitkäranta
- Department of Otolaryngology, Helsinki University Hospital, Helsinki, Finland
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