title: Leiomyosarcoma of the parapharyngeal space: a very rare entity.
abstract: Leiomyosarcoma of the head and neck is very rare, as only about 100 cases have been reported; of these, only 3 cases have been previously reported in the parapharyngeal space. We report the fourth such case, and we review the features of this entity. The patient was an 84-year-old woman who presented to the emergency department for treatment of an 18-month history of right-sided headache, a 6-month history of right-sided hearing loss and nasal obstruction, and a 2-month history of dysphagia. Physical examination revealed a bulge in the right side of the soft palate and the right lateral nasopharyngeal wall and complete obstruction of the right eustachian tube. Indirect laryngoscopy detected a bulge in the right lateral hypopharyngeal wall. Otoscopy revealed otitis media with effusion in the right ear. Imaging demonstrated a space-occupying lesion in the right parapharyngeal space that extended from the base of the skull to the level of the hypopharynx. Biopsy and histology identified the mass as a leiomyosarcoma. Metastasis to the brain was discovered shortly thereafter, and the patient died 10 months later. The unusual presentation of head and neck leiomyosarcoma requires a high index of suspicion and appropriate diagnostic imaging. Surgical excision is the recommended treatment when feasible; chemoradiotherapy does not appear to affect disease progression.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel. haim.ga@012.net.il.
authors.forename: Haim
authors.initials: H
authors.lastname: Gavriel
authors.forename: Eyal
authors.initials: E
authors.lastname: Yeheskeli
authors.forename: Gratiana
authors.initials: G
authors.lastname: Hermann
authors.forename: Ephraim
authors.initials: E
authors.lastname: Eviatar
mesh_terms: D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006261:Headache / Q000209:etiology; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications / Q000175:diagnosis*; D015508:Nasal Obstruction / Q000209:etiology; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000175:diagnosis*; D035583:Rare Diseases / Q000175:diagnosis*