Akio Yoshida

Meningioma of the parapharyngeal space: A unique extension of intracranial tumor

A 45‐year‐old woman with a meningioma growing in the parapharyngeal space is reported. Her initial symptom was a stuffy feeling in the right ear and swelling of the right parapharynx. The parapharyngcal mass was biopsied, and a frozen section diagnosis suggested a paraganglioma. On electron microscopy, however, the tumor cells failed to show secretory granules, and represented a prominent interdigitation of the cytoplasm with occasional desmosomal attachments. Based on these features the tumor was diagnosed as a meningioma. Thereafter a mass lesion in the temporal lobe of the brain was detected by computerized tomography of the brain. The extracranial extension of the meningioma may occur in some occasions, but such cases in which the infiltrative portion in the parapharyngeal space was initially discovered have been rarely reported.

Indication of tonsillectomy for recurrent tonsillitis.

The indication of tonsillectomy for recurrent tonsillitis was discussed from the standpoint of clinical immunology. Elevated serum IgG was observed in 29.8% of the patients under 8 years of age preoperatively. In contrast, in 25% of patients between 9-15 years of age, serum IgG was low preoperatively. In the patients over 16 years of age no abnormal serum IgG was found, and the elevated serum IgG returned to normal after tonsillectomy. The patients with normal serum IgG preoperatively retained normal values postoperatively. The low preoperative IgG level group still remained low postoperatively. As to postoperative improving symptoms, high and low grade fever improved most (100%), followed by cervical lymphadenopathy (93%), frequent absence from school (93%), sore throat (88%) and recurrence of bronchitis (85%). The patients with recurrent tonsillitis for 8 years showing high serum IgG had indications for tonsillectomy.

Follow up study of sudden deafness.

SummaryIt is significant to follow up patients with sudden deafness, because the change of hearing level after a long-term period and a differential diagnosis from Menières disease must be studied. We reported the follow-up study of 27 patients with sudden deafness who were admitted to the Department of Otolaryngology of the Second Tokyo National Hospital. The duration of follow-up ranged from 6–58 months, with a mean duration of 23.7 months. In the Complete Recovery Group there was little change of mean hearing loss during the follow-up period. We could demonstrate that the once recovered hearing level rarely deteriorated afterwards, but the not recovered hearing level would sometimes deteriorate.

Surgery in Elderly Patients With Head and Neck Cancer

A retrospective analysis of 19 patients aged 70 years or more with head and neck cancer, admitted between January 1982 and March 1983, was performed. Of these patients, radical surgical excision was performed on seven. At present recurrence has been observed in only one. Associated illness was found in 11 patients, hypertension and cardiac disease, in four cases each, being most frequent. Surgical operation should be performed even on elderly patients if the operation is indicated. However, careful and delicate management before, during and after the operation is essential.

MALIGNANT LYMPHOMA OF THE PAROTID GLAND WITH MONOCLONAL CYTOPLASMIC IMMUNOGLOBULIN

A 56‐year‐old Japanese man with a malignant lymphoma of the parotid gland was reported. The tumor was located in the superficial lobe of the parotid gland, and somewhat invaded the surrounding soft tissues, but the regional lymph nodes were not involved. Histologically, the tumor was composed of round cells with plasmacytoid configurations and small lymphocytes. The plasmacytoid cells showed eccentric nuclei with fairly marked irregularities and perinuclear halos. In a large number of tumor cells, a monoclonal cytoplasmic immunoglobulin (CIg), IgG‐Kappa type, was demonstrated by the PAP method. Ultrastructurally, some of the tumor cells showed welldeveloped endoplasmic reticulum. From these findings, this tumor was diagnosed as a diffuse B‐cell lymphoma, mainly composed of lymphoplasmacytoid cells. And this tumor may bear a similar nature to an extramedullary plasmacytoma of the classical terminology. Malignant lymphoma of the parotid gland is rare but a case with the demonstration of monoclonal CIg is considered very rare. ACT A PATHOL. JPN. 34: 1459–1467, 1984.

Tuberculosis in the Neck Region; Report of 3 Cases.

Although tuberculosis in the neck region is rare, the physician must keep it in mind and rule out malignant tumors in the differential diagnosis of any head and neck masses. We recently treated three patients with TB in the neck region. The diagnosis was confirmed by histological examination of the biopsy specimens. The treatment should be appropriate to the clinical stage. The recommended therapy for cervical scrofula is surgical excision, followed by antituberculous chemotherapy, which can shorten the period of treatment.

Surgery in elderly patients with head and neck cancer.

Nineteen patients over 70 years of age (13 men, 6 women) with head and neck cancer treated at the University of Occupational and Environmental Health were analyzed retrospectively. The primary site was in the larynx in 9 patients, in the paranasal sinuses in 4 patients, in the hypopharynx in 2 patients, and in the epipharynx, tongue, mouth floor and thyroid in 1 patient each. Seven of these patients underwent surgical resection: 3 total laryngectomies, 1 total maxillectomy, 1 hemiglossectomy with neck dissection, 1 Denkers operation and 1 pharyngolaryngoesophagectomy with neck dissection and reconstruction of the carotid artery. Eleven patients had associated illnesses. Hypertension and cardiac disease were most frequent. Postoperatively 1 patient developed cardiac failure and wound slough; he was discharged without any complications. The other patient who underwent pharyngolaryngoesophagectomy with reconstruction of the carotid artery died of cerebral herniation on the day following the operation. Even elderly patients should receive surgery, if it is indicated, but careful pre-, intra-, and postoperative management is always mandatory.