|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 668-669
Inflammatory pseudotumor of the pharynx: A rare entity
Farzan Siddiqui1, Gail A Bentley2, Scott A McLean3, Samuel Ryu4
1 Department of Radiation Oncology, Henry Ford Health Systems, Detroit, MI-48202, USA
2 Department of Pathology, Wayne State University, School of Medicine, Detroit, MI-48201, USA
3 Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI-48202, USA
4 Department of Radiation Oncology, Henry Ford Health Systems, Detroit, MI-48202, USA, India
|Date of Web Publication||10-Mar-2016|
Department of Radiation Oncology, Henry Ford Health Systems, Detroit, MI-48202
Scott A McLean
Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI-48202
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Siddiqui F, Bentley GA, McLean SA, Ryu S. Inflammatory pseudotumor of the pharynx: A rare entity. Indian J Cancer 2015;52:668-9
Inflammatory pseudotumors (IPT) are rare, benign, space-occupying lesions of unknown etiology, composed of inflammatory cells, histiocytes, and fibroblasts mimicking malignant lesions on radiologic studies. They most commonly arise in the retro-orbital region; however, have been noted in various other sites including lungs, liver, pancreas, retroperitoneum, and mesentery., In the head and neck region, they have been noted in paranasal sinuses and larynx., Pharyngeal/parapharyngeal IPT is an extremely uncommon entity with only 4 cases reported in literature so far.
We present the fifth case of this kind ever reported and the first such case treated using stereotactic radiation therapy. This case is interesting for the long natural history of the disease and the challenges it presented for treatment.
In 1992, aged 47 years, our patient presented with complaints of snoring and difficulty in breathing, which woke her up from sleep. She was noted to have a mass in her right pharyngeal area. A biopsy from this lesion was reported as IPT [Figure 1]. She underwent an excision of this mass. Five years later, this mass recurred in the same site, and she underwent another resection. In 2003, she had another biopsy-proven recurrence. However, no further surgical resection was attempted for fear of causing excessive pharyngeal fibrosis and stenosis. She presented to our institute in 2004 with complaints of difficulty in breathing at night when she lay down. Physical examination showed scarring of lateral oropharyngeal wall with fullness along lateral wall extending to nasopharynx and down into hypopharynx. There was no palpable lymphadenopathy.
|Figure 1: Inflammatory pseudotumor. In areas the fibrous tissue has a diffuse infiltration of small lymphocytes, plasma cells, and rare eosinophils. No cellular atypia is identified. This lesion is composed of hyalinized fibrous tissue with scattered lymphoid follicles, many with reactive germinal centers. In other areas the fibrous tissue has a diffuse infiltration of small lymphocytes, plasma cells, and rare eosinophils. Cells with atypical morphology are not identified|
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A PET/CT scan revealed an abnormal soft tissue mass in the posterior right oropharynx measuring 33 mm × 23.5 mm in maximum axial cross-section from fossa of Rosenmueller to epiglottis.
In our multidisciplinary tumor board, it was decided to offer her treatment using fractionated stereotactic radiation therapy (FSRT). She was treated to a total dose of 36Gy in 6 fractions of 6Gy each on alternate days [Figure 2] based on our previous experience. An MRI performed 3 months after treatment showed a stable lesion.
|Figure 2: The right.sided oropharyngeal inflammatory pseudotumor was treated using fractionated stereotactic body radiation therapy. . (a) Axial section with the radiation treatment isodose lines encompassing the tumor and the coronal and sagittal reconstruction of the anatomy demonstrating the superior and inferior extent of the tumor. (b) Four month post.FSRT MRI showing slight reduction in the size of the mass. (c) Four year post.FSRT MRI showing further reduction but not complete disappearance of the mass|
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She has been following up since then with no significant complaints and near complete resolution of her symptoms 4 years after completion of FSRT. Examination of oral cavity and oropharynx shows minimal elevation of the right lateral pharyngeal wall. A recent MRI showed a marked reduction of lesion size with residual disease measuring 22 mm × 11 mm [Figure 2].
IPT presents a diagnostic and therapeutic challenge. Options for treatment include corticosteroid therapy, surgical excision, and radiotherapy. Our patient had multiple recurrences after surgical excisions. FSRT allowed us to deliver a high dose of radiation while restricting dose to normal mucosa, salivary glands, mandible, and spinal cord. There was no need to irradiate draining lymph nodes. This resulted in excellent control of the benign tumor while alleviating symptoms and maintaining her normal functional status. Our case indicates that radiotherapy may also have a role in achieving a long-term tumor response without progression.
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[Figure 1], [Figure 2]