Indian Journal of Cancer Home 

LETTER TO THE EDITOR
[Download PDF]
Year : 2015  |  Volume : 52  |  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

Correspondence Address:
Farzan Siddiqui
Department of Radiation Oncology, Henry Ford Health Systems, Detroit, MI-48202
USA
Scott A McLean
Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI-48202
USA




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;52:668-669


How to cite this URL:
Siddiqui F, Bentley GA, McLean SA, Ryu S. Inflammatory pseudotumor of the pharynx: A rare entity. Indian J Cancer [serial online] 2015 [cited 2020 Aug 7 ];52:668-669
Available from: http://www.indianjcancer.com/text.asp?2015/52/4/668/178429


Full Text

Sir,

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.[1],[2] In the head and neck region, they have been noted in paranasal sinuses and larynx.[2],[3] Pharyngeal/parapharyngeal IPT is an extremely uncommon entity with only 4 cases reported in literature so far.[2]

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}

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.[4] An MRI performed 3 months after treatment showed a stable lesion.{Figure 2}

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.[3] 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.

References

1Coffin CM, Watterson J, Priest JR, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol 1995;19:859-72.
2Hytiroglou P, Brandwein MS, Strauchen JA, Mirante JP, Urken ML, Biller HF. Inflammatory pseudotumor of the parapharyngeal space: Case report and review of the literature. Head Neck 1992;14:230-4.
3Zitsch RP 3rd, Pollak N, Loy TS. Management of inflammatory pseudotumor of the larynx. Otolaryngol Head Neck Surg 2007;136:139-41.
4Siddiqui F, Patel M, Khan M, McLean S, Dragovic J, Jin JY, et al. Stereotactic body radiation therapy for primary, recurrent, and metastatic tumors in the head-and-neck region. Int J Radiat Oncol Biol Phys 2009;74:1047-53.