Horner Syndrome from a Pediatric Otolaryngology Perspective

2019 ◽  
Vol 129 (2) ◽  
pp. 191-194 ◽  
Author(s):  
Kyra N. Folkert ◽  
Heather de Beaufort ◽  
Nancy M. Bauman
Keyword(s):  
Pediatric Patients ◽  
Excisional Biopsy ◽  
Neck Mass ◽  
Neural Pathways ◽  
Horner Syndrome ◽  
Pediatric Otolaryngology ◽  
Level Ii ◽  
Potentially Malignant ◽  
Poorly Differentiated ◽  
Clinical Triad

Introduction: Horner syndrome is described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital or acquired from neoplastic, infectious or traumatic conditions, including birth trauma. Most cases of pediatric Horner syndrome present first to a pediatric ophthalmologist however since the neural pathways involve the cervical sympathetic chain otolaryngologists should understand the pathophysiology to avoid delay in management of potentially malignant cases. Objectives: To aid otolaryngologists in recognizing and managing pediatric Horner syndrome by describing 3 unique cases from malignant, traumatic and/or congenital causes. Methods: Case report of 3 pediatric patients with Horner syndrome presenting to our pediatric otolaryngology department. Results: Case #1 is 5-month-old female with ptosis and a left level II 1.5 cm neck mass. Magnetic resonance imaging showed the mass displacing the common carotid artery and excisional biopsy revealed a poorly differentiated neuroblastoma. Case #2 is a 9-year-old female with anisocoria appearing after suffering a severe playground injury. Case #3 is a 3-year-old-male who developed ptosis and anisocoria following re-excision of a recurrent cervical lymphatic malformation. Conclusion: Pediatric Horner syndrome may be a benign finding that is easily overlooked but may reflect a serious underlying condition. Otolaryngologists should be aware of the pathophysiology and differential diagnosis, including malignant causes, to appropriately manage patients.

scholarly journals Head and neck inflammatory pseudotumor: Case series and review of the literature

2016 ◽  
Vol 29 (6) ◽  
pp. 440-446 ◽  
Author(s):  
Sagar Kansara ◽  
Diana Bell ◽  
Jason Johnson ◽  
Mark Zafereo
Keyword(s):  
Head And Neck ◽  
Inflammatory Pseudotumor ◽  
Case Series ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Disease Recurrence ◽  
Neck Mass ◽  
Level Ii ◽  
Oral Corticosteroids ◽  
Inflammatory Pseudotumors

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

scholarly journals Cutaneous squamous cell carcinoma arising in hidradenitis suppurativa: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984735 ◽  
Author(s):  
Catherine F Roy ◽  
Simon F Roy ◽  
Feras M Ghazawi ◽  
Erica Patocskai ◽  
Annie Bélisle ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Hidradenitis Suppurativa ◽  
Rare Complication ◽  
Excisional Biopsy ◽  
Necrosis Factor Alpha ◽  
Spindle Cells ◽  
Poorly Differentiated ◽  
Well Differentiated

We present a case of a 64-year-old man who presented with a rapidly growing tumor in the left buttock and intergluteal cleft area, which was affected by hidradenitis suppurativa. The patient was on tumor necrosis factor-alpha inhibitors for hidradenitis suppurativa for 2 years prior to the development of the mass. Initial biopsy of the mass showed a well-differentiated squamous cell carcinoma with spindle cells and positive epithelial immunomarkers. Subsequent excisional biopsy of the tumor showed an infiltrating poorly differentiated squamous cell carcinoma composed of islands of atypical sarcomatoid spindle cells. Squamous cell carcinoma arising in hidradenitis suppurativa is a rare complication which may occur secondary to chronic inflammation and epidermal hyperproliferation in hidradenitis suppurativa–affected areas.

scholarly journals Incidence of Horner syndrome associated with neuroblastic disease

2020 ◽  
Author(s):  
Katarzyna Kuchalska ◽  
Monika Barełkowska ◽  
Katarzyna Derwich ◽  
Katarzyna Jończyk-Potoczna ◽  
Anna Gotz-Więckowska
Keyword(s):  
Adrenal Gland ◽  
Retrospective Analysis ◽  
Surgical Procedures ◽  
Pediatric Oncology ◽  
Surgical Procedure ◽  
Pediatric Patients ◽  
Study Group ◽  
Horner Syndrome ◽  
Neuroblastic Tumor ◽  
Frequent Localization

Abstract Purpose Horner syndrome (HS) manifests in unilateral ptosis, miosis, enophthalmos, and anhedonia. It is most commonly caused by trauma or surgical procedures, but can also occur in pediatric patients as a result of tumors, especially neuroblastoma (NBL). The objective of this study was to analyze the incidence of HS in patients diagnosed with NBL. Methods A retrospective analysis of data collected at the Department of Pediatric Oncology, Hematology, and Transplantology from 2004 to 2019 was performed. The study group included 119 patients younger than 18 years old, with 62 girls and 57 boys. All of them were diagnosed with a neuroblastic tumor. Results Among the 119 patients, eight children (6.72%) were diagnosed with HS associated with NBL. Three of these patients presented to the clinic with HS, whereas HS developed after the surgical procedure to remove the tumor in four patients. The adrenal gland was the most frequent localization of the tumor. However, HS occurred more frequently in patients with mediastinum tumors. As a presenting symptom, HS occurred in 2 of 11 cases (18.18%) with mediastinum localization. All of the patients with HS were younger than 2 years old. Conclusion Investigation of the cause of isolated HS is crucial because it can be the first symptom of NBL. However, the surgical procedure itself increases the risk of HS as a complication of NBL treatment.

scholarly journals Horner syndrome as a manifestation of thyroid carcinoma: a rare association

2013 ◽  
Vol 57 (6) ◽  
pp. 483-485 ◽  
Author(s):  
Bernardo Pereira ◽  
Tiago Silva ◽  
Henrique Luiz ◽  
Isabel Manita ◽  
Luísa Raimundo ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Thyroid Neoplasms ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Imaging Data ◽  
Horner Syndrome ◽  
Thyroid Mass ◽  
Poorly Differentiated ◽  
Thyroid Malignancies ◽  
Neck Vessels

An 82-year-old patient presented a progressively growing hard thyroid nodule, and left ptosis. Additionally, ophthalmologic evaluation revealed ipsilateral miosis, diagnostic findings of Horner syndrome. Computerized tomography revealed a 7.5-cm thyroid mass infiltrating the main neck vessels. Although clinical and imaging data were suggestive of poorly differentiated thyroid carcinoma, fine-needle aspiration led to the diagnosis of papillary carcinoma. Paliative care was proposed to the patient due to the advanced stage of the neoplasm and to significant comorbidities. Horner syndrome is an infrequent manifestation of thyroid disorders and benign etiologies are more often implied. Malignant thyroid neoplasms represent a rare cause of Horner syndrome. However, an appropriate and prompt diagnosis is paramount for timely treatment of rare thyroid malignancies.

scholarly journals The foreign bodies in lower respiratory tract in pediatric patients treated in referral academic department of pediatric otolaryngology

New Medicine ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Irina Drogobytska ◽  
Maciej Pilch ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Foreign Body ◽  
Respiratory Tract ◽  
Physical Examination ◽  
Lower Respiratory Tract ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Academic Department ◽  
Diagnostic Process ◽  
X Ray ◽  
Pediatric Otolaryngology

Introduction. Foreign bodies in lower respiratory tract for many years are big challenge for otolaryngologists. These objects could present variability of clinical symptoms. Increase of infection and mortality due to delay of accurate diagnosis. Interview is the most important part of examination of patient with suspected foreign body in airways. Any suspicion of aspiration is qualification to diagnostic bronchoscopy. Aim. This paper refers occurrence assessment, clinical course, diagnostic process and treatment of the pediatric patients with suspected foreign body in lower respiratory tract hospitalized in referral Academic Department of Pediatric Otolaryngology. Material and methods. Retrospective analysis of 74 patients with suspected foreign body in lower respiratory tract, who were hospitalized in Clinical Department of Pediatric Otolaryngology in Warsaw Medical University in 2016-2018. Analysis includes demographic data, occurrence frequency, localization and the type of foreign body, diagnostic process and treatment. Results. This study includes 42 boys (57%) and 32 girls (43%) in age of 8 months to 16-year-old. The episode of choking occurs in interview in 71 patients (96%). Foreign bodies in lower respiratory tract were confirmed and evacuated in bronchoscopy procedure in 44 cases (59.5%). In 30 cases (40.5%) there were any foreign body in airways. The most common group of patients admitted to Clinic with suspected foreign body in airways was children in age between 1 to 3-year-old, which accounted for 22 cases (50%). Coughing was the most commonly reported symptom (54.5%), wheezing (27.5%) and dyspnea (15.9%). Twenty-three patients were presenting wheezing and whirring in physical examination. Air trap found in thorax x-ray were in 22 patients (45%). The right main bronchus was the most common place of foreign body retention – 22 patients (50%). The organic foreign bodies were in 32 cases (72.7%) and non-organic in 12 (27.3%). The nuts were the most common foreign body aspirated to airways. Conclusions. Foreign body aspiration should be suspected in every patient, not only those with choking episode but also with patients who presents ambiguous change in physical examination and x-ray scan. In pediatric patient with suspected foreign body in lower respiratory tract, in every time the bronchoscopy is needed to be done, even in patients with no abnormalities in physical examination and x-ray scan.

scholarly journals Early detection and treatment of Speckled leukoplakia

2016 ◽  
Vol 49 (1) ◽  
pp. 54
Author(s):  
Selviana Tampoma ◽  
Iwan Hernawan
Keyword(s):  
Early Detection ◽  
Healing Process ◽  
Excisional Biopsy ◽  
Heavy Smoker ◽  
Transformation Rate ◽  
Rare Type ◽  
Worldwide Population ◽  
Potentially Malignant Disorders ◽  
Potentially Malignant ◽  
History Of

Background: Leukoplakia is one of potentially malignant disorders that can be found on oral mucosa. Speckled leukoplakia is a rare type of leukoplakia with a very high risk of premalignant growth. Approximately 3 % of worldwide population has suffered from leukoplakia, 5-25% of which tend to be malignant leukoplakia. Purpose: This case report was aimed to discuss about early detection of speckled leukoplakia as one of potentially malignant disorders. Case: A 62 year old male patient came with chief complaint of bald and painful tongue since one month ago. The patient has a history of allergic reaction, hypertension, uric acid, and hepatitis B. He had been a heavy smoker since young until 10 years ago. Intra oral examination showed a firm, rough, non scrapable white plaque lesion with a size of 1 x 1.5 cm, surrounded by painful erosion with diffuse boundary. Case Management: Based on cytology examination, the patient was reffered to oncologist to get an excisional biopsy. Next, the patient succesfully underwent the excisional biopsy and came for control. The results showed the healing process of the lesion with a minimal complaint of bald tongue, especially when eating spicy or hot meal. To improve healing process, the patient then was given an antibacterial mouth rinse containing zinc and mulvitamin. Conclusion: Speckled leukoplakia could show high malignant transformation rate, therefore, early detection and treatment are necessary.

Cervical ganglioneuroma mimicking a carotid body tumour

2020 ◽  
Vol 13 (12) ◽  
pp. e238469
Author(s):  
Alexandra G Britten ◽  
Payam Entezami ◽  
Brent A Chang
Keyword(s):  
Carotid Body ◽  
Surgical Excision ◽  
Neck Mass ◽  
Care Physician ◽  
External Carotid ◽  
Carotid Body Tumour ◽  
Intravenous Contrast ◽  
Level Ii ◽  
History Of ◽  
The Right

A 30-year-old woman was referred to the ear, nose and throat clinic by her primary care physician for a 10-year history of an asymptomatic, large, right-sided neck mass. On examination, the patient had a palpable, non-tender, five-by-four centimetre, mobile, right-sided level II neck mass. CT scan with intravenous contrast showed an enhancing mass with multiple fluid cavities, splaying the external carotid and internal carotid arteries, concerning for a carotid body tumour. Patient was then referred to interventional radiology for angiography and embolisation prior to definitive surgical excision. However, when the mass was then excised surgically, final pathology identified the mass as a ganglioneuroma. Patient recovered well postoperatively with some ptosis of the right eye and symptoms consistent with first bite syndrome, treated with conservative measures.

scholarly journals Laryngeal Langerhans Cell Histiocytosis Presenting with Neck Mass in an Adult Woman

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Hesam Jahandideh ◽  
Yasser Nasoori ◽  
Sara Rostami ◽  
Mahdi Safdarian
Keyword(s):  
Head And Neck ◽  
Langerhans Cell Histiocytosis ◽  
Pediatric Patients ◽  
Neck Region ◽  
Rare Condition ◽  
Neck Mass ◽  
Langerhans Cell ◽  
Adult Woman ◽  
Head And Neck Region ◽  
Laryngeal Involvement

Langerhans cell histiocytosis (LCH) is a very rare condition that commonly affects the head and neck region. There are very few cases of isolated laryngeal involvement by LCH, mostly reported in pediatric patients. Here, we report a case of laryngeal LCH in a 62-year-old woman presenting with a neck mass several weeks ago. The clinical and histopathological findings are reported with a brief discussion about the disease.

Ectopic Cervical Thymus: A Common, yet Rarely Symptomatic Pediatric Neck Mass

2020 ◽  
Vol 16 ◽  
Author(s):  
Lee Rousslang ◽  
Jaren Meldrum ◽  
Rooks Veronica ◽  
Augustah Poutre ◽  
Timothy Biega
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Incidental Finding ◽  
Case Series ◽  
Surgical Excision ◽  
Neck Mass ◽  
Thymic Tissue ◽  
Ectopic Thymus ◽  
Unusual Finding

Abstract:: Ectopic thymic tissue is an unusual finding that is generally asymptomatic. We present a case series of five pediatric patients with cervical ectopic thymuses. In two patients, the ectopic thymic tissue was symptomatic, and in three patients it was an incidental finding. We highlight the need to include this anomaly on the differential diagnosis for a pediatric neck mass. We also propose observation, rather than surgical excision, as the treatment of choice for asymptomatic cervical ectopic thymus.

scholarly journals Pediatric Abdominal Tuberculosis in Singapore: A 10-Year Retrospective Series

2020 ◽  
Vol 7 ◽  
pp. 2333794X2090395
Author(s):  
Sarah Ailyne Wong ◽  
Dawn Lee Meijuan ◽  
Sin Wee Loh ◽  
Koh Cheng Thoon ◽  
Natalie Woon Hui Tan ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Severe Disease ◽  
Abdominal Tuberculosis ◽  
Excisional Biopsy ◽  
Pulmonary Involvement ◽  
Abdominal Imaging ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Presenting Symptoms ◽  
Abdominal Symptoms

Background. Tuberculosis (TB) remains a major cause of mortality and morbidity globally. Pediatric patients are more likely to develop severe disease. Abdominal TB is a rare manifestation of pediatric TB and can present with chronic and nonspecific abdominal symptoms. This study examines the clinical profile of pediatric patients with abdominal TB and treatment outcomes. Method. A retrospective study of patients admitted to a tertiary pediatric hospital in Singapore over 10 years. Clinical characteristics and outcomes were examined. Results. There were 3 male and 3 female patients with mean age of 11.3 years. Household contacts were traced in 3 cases. The most common presenting symptoms were fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Inflammatory markers were raised with mean C-reactive protein (CRP) and erythrocyte sedimentation (ESR) rate at 70.9 mg/L and 90 mm/h respectively. Abdominal imaging showed abnormalities such as splenic foci and thickened bowel wall with significant intraabdominal lymphadenopathy. Mycobacterium tuberculosis was isolated from stool, rectal swabs and intra-adominal specimens. Two patients underwent excisional biopsy of lymph node to obtain diagnosis. Two patients required emergency laparotomy and 1 patient received esophagogastroduodenoscopy and colonoscopy. Four out of the 6 patients had pulmonary involvement. Conclusion. Abdominal TB should be a differential diagnosis in children with chronic abdominal symptoms for at least 8 weeks with anemia, raised ESR and CRP. The gold standard for diagnosis still remains as positive microbiological culture. However, abdominal imaging studies are also vital in obtaining further supportive evidence for chronic infection.

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