Parapharyngeal angiolipoma causing obstructive sleep apnoea syndrome

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.

Cellular infiltrative angiolipoma of cheek in an infant

Lipomas represent about 1 to 5% of all neoplasms of the oral cavity most commonly presenting as painless, mobile, soft, round mass. Angiolipoma, spindle cell lipoma, mylelolipoma, chondrolipoma and myxolipoma are histological variants of lipoma arising from fat tissues. Although the angiolipoma is the most common tumour in the trunk and the extrimities of young people, it occurs infrequently in the head and neck region. In this article we present clinical, radiological and histological features of a cellular infiltrative angiolipoma exicised from the buccal mucosa of a 9 months old female child.

Mycosis fungoides as a cause of severe obstructive sleep apnea

We report the case of a 38-year-old woman, affected by a cutaneous form of mycosis fungoides (MF) who presented with a history of loud snoring associated with sleep apnea. A polysomnographic study confirmed the presence of severe obstructive sleep apnea syndrome (OSAS). Cranial and neck MRI revealed a neoplastic infiltration of the tongue base and the posterior pharynx wall. Upper airway neoplastic infiltration is rarely reported as a cause of OSAS and extra-cutaneous localizations of MF are uncommon. This is the first case in the literature of a patient with nocturnal polysomnogram documented OSAS caused by a mucosal involvement of MF.

Angiolipoma in head and neck: report of two cases and review of the literature

Angiolipomas are either encapsulated or non-encapsulated fatty tumours. They are distinguished from other lipomas by the excessive degree of vascular proliferation and because they are mixed with mature adipocytes. They commonly occur in the trunk and extremities and are rare in the maxillofacial area. Only 36 cases in the head and neck have been reported in the literature. The authors report the first non-infiltrating intramasseterine angiolipoma, and a case of non-infiltrating angiolipoma of the cheek. These tumours appear as homogenous low-density areas on CT with no contrast enhancement. MRI gives better tumour delineation and clear definition of the location and longitudinal extent of the mass. Histopathology demonstrates mature adipose tissue and the proliferation of numerous small branching blood vessels. Management of angiolipomas requires complete surgical excision.