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Unknown primary nasopharyngeal melanoma presenting as severe recurrent epistaxis and hearing loss following treatment and remission of metastatic disease: A case report and literature review.

Azoury SC, Crompton JG, Straughan DM, Klemen ND, Reardon ES, Beresnev TH, Hughes MS - Int J Surg Case Rep (2015)

Bottom Line: Despite improved diagnostic capabilities, these lesions are often diagnosed at an advanced stage and associated prognosis is poor, partly due to high rates of recurrences and metastasis.Thorough clinical evaluations should be performed in such patients, and attention should be paid to recurrent and persistent symptoms, such as epistaxis and hearing loss.This may allow for earlier detection of primary disease.

View Article: PubMed Central - PubMed

Affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, USA. Electronic address: sazoury1@jhmi.edu.

No MeSH data available.


Related in: MedlinePlus

Computed-tomography demonstrating a 1.3 × 1 cm lesion in the right fossa of Rosenmuller involving the eustachian orifice and tympanomastoid effusion.
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fig0010: Computed-tomography demonstrating a 1.3 × 1 cm lesion in the right fossa of Rosenmuller involving the eustachian orifice and tympanomastoid effusion.

Mentions: In January 2013, the patient presented to an otolaryngology clinic for follow-up of chronic right-sided cerumen impaction and recurrent severe right-sided epistaxis. Following an unremarkable clinical exam, she was continued on a moisturization regimen with saline nasal spray, gel, and a humidifier. Symptoms persisted and the aforementioned regimen was modified to include other over-the-counter agents. She was later evaluated in April 2013 with similar complaints as well as diminished hearing. On exam, her physician noted right nasal turbinate swelling and septal ooze, as well as right ear cerumen impaction. Nasal packing was performed and the patient returned home, but bleeding persisted. The patient sought medical evaluation at a local hospital, and a limited nasal endoscopy was performed, revealing no bleeding source and a widely patent nasal cavity with no suspicious lesions. She subsequently returned to her original otolaryngology clinic and a more complete nasopharyngoscopy was performed, revealing a dark-nodular pigmented lesion in the right posterior nasopharynx with no evidence of satellite melanosis (Fig. 1). Imaging showed a 1.3 × 1 cm lesion in the right fossa of Rosenmuller obstructing the eustachian orifice and a right tympanomastoid effusion (Fig. 2). Staging PET scan demonstrated metabolic hyperactivity in this area extending into the ipsilateral torus tubarius and posteriorly into the eustachian tube orifice but without further evidence of local or metastatic disease. She underwent partial nasopharyngectomy, posterior septectomy, and resection of right torus in June 2013 via an endoscopic endonasal approach. Final pathology report demonstrated malignant mucosal melanoma (positive for S-100, HMB45, and Melan-A; BRAF and c-kit mutation-negative) and adjuvant radiation therapy (total of 70 Gy) was administered in September. She has since been doing remarkably well. In October 2013, several months following her surgery, examination of her right ear demonstrated a clear external auditory canal, with no evidence of effusion, retraction, or perforation. Surveillance imaging, clinical exams, and laboratory studies through November 2014 have been unremarkable for recurrent or metastatic disease, and she has had no further episodes of epistaxis.


Unknown primary nasopharyngeal melanoma presenting as severe recurrent epistaxis and hearing loss following treatment and remission of metastatic disease: A case report and literature review.

Azoury SC, Crompton JG, Straughan DM, Klemen ND, Reardon ES, Beresnev TH, Hughes MS - Int J Surg Case Rep (2015)

Computed-tomography demonstrating a 1.3 × 1 cm lesion in the right fossa of Rosenmuller involving the eustachian orifice and tympanomastoid effusion.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430121&req=5

fig0010: Computed-tomography demonstrating a 1.3 × 1 cm lesion in the right fossa of Rosenmuller involving the eustachian orifice and tympanomastoid effusion.
Mentions: In January 2013, the patient presented to an otolaryngology clinic for follow-up of chronic right-sided cerumen impaction and recurrent severe right-sided epistaxis. Following an unremarkable clinical exam, she was continued on a moisturization regimen with saline nasal spray, gel, and a humidifier. Symptoms persisted and the aforementioned regimen was modified to include other over-the-counter agents. She was later evaluated in April 2013 with similar complaints as well as diminished hearing. On exam, her physician noted right nasal turbinate swelling and septal ooze, as well as right ear cerumen impaction. Nasal packing was performed and the patient returned home, but bleeding persisted. The patient sought medical evaluation at a local hospital, and a limited nasal endoscopy was performed, revealing no bleeding source and a widely patent nasal cavity with no suspicious lesions. She subsequently returned to her original otolaryngology clinic and a more complete nasopharyngoscopy was performed, revealing a dark-nodular pigmented lesion in the right posterior nasopharynx with no evidence of satellite melanosis (Fig. 1). Imaging showed a 1.3 × 1 cm lesion in the right fossa of Rosenmuller obstructing the eustachian orifice and a right tympanomastoid effusion (Fig. 2). Staging PET scan demonstrated metabolic hyperactivity in this area extending into the ipsilateral torus tubarius and posteriorly into the eustachian tube orifice but without further evidence of local or metastatic disease. She underwent partial nasopharyngectomy, posterior septectomy, and resection of right torus in June 2013 via an endoscopic endonasal approach. Final pathology report demonstrated malignant mucosal melanoma (positive for S-100, HMB45, and Melan-A; BRAF and c-kit mutation-negative) and adjuvant radiation therapy (total of 70 Gy) was administered in September. She has since been doing remarkably well. In October 2013, several months following her surgery, examination of her right ear demonstrated a clear external auditory canal, with no evidence of effusion, retraction, or perforation. Surveillance imaging, clinical exams, and laboratory studies through November 2014 have been unremarkable for recurrent or metastatic disease, and she has had no further episodes of epistaxis.

Bottom Line: Despite improved diagnostic capabilities, these lesions are often diagnosed at an advanced stage and associated prognosis is poor, partly due to high rates of recurrences and metastasis.Thorough clinical evaluations should be performed in such patients, and attention should be paid to recurrent and persistent symptoms, such as epistaxis and hearing loss.This may allow for earlier detection of primary disease.

View Article: PubMed Central - PubMed

Affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, USA. Electronic address: sazoury1@jhmi.edu.

No MeSH data available.


Related in: MedlinePlus