Chițac, Celesta Drăgulescu, B.
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Petrescu, Alexandru Ciucă, M. Vasilca, A. We present the case of mild papilloma definition year-old female patient, accusing oral mild papilloma definition and mild dysphagia. Clinical examination, flexible fibroscopy and imaging pointed to a diagnosis of a haemangioma of the right hypopharynx.
A microscopic laryngoscopy procedure was carried out, with intratumoral monopolar electrocauterization which led to a complete retraction of the tumour. The postoperative evolution was favourable, with no postoperative complications or recurrence up to 1-year check-up.
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Keywords haemangioma, angiography, monopolar electrocauterization Rezumat Autorii prezintă cazul unei paciente în vârstă de 31 de ani care se internează în clinica miros gura paraziti pentru sângerare exteriorizată oral mild papilloma definition disfagie uşoară.
Pe baza examenului clinic, fibroscopic şi a investigaţiilor imagistice, se pune diagnosticul de formaţiune tumorală vasculară hipofaringiană mild papilloma definition. Se practică prin abord microlaringoscopic electrocauterizarea intratumorală cu ac monopolar, cu retracţia până la dispariţie a hemangiomului faringian.
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Evoluţia postoperatorie a fost bună, lipsită de complicaţii hemoragice sau dispnee. Nu s-a constatat recidivă mild papilloma definition la ultimul control efectuat la un an postoperator. Cuvinte cheie hemangiom angiografie cauterizare monopolară Case report Haemangiomas are benign tumours originating in the vascular endothelium.
They represent a type of tumour rarely encountered in clinical practice, especially in the pharynx, with a small number of cases mild papilloma definition in literature.
The treatment represents a challenge, as there is no agreed-upon standard, due to the rarity of the disease, the variable clinical mild papilloma definition, and the location of the tumour.
A year-old woman consulted our clinic, accusing two episodes of oral haemorrhage, in moderate quantity, which ceased spontaneously, and mild dysphagia, all occurring in the last month. She had no record of other significant illness of herself or her family. She is a smoker and works as a clinical mild papilloma definition. The physical examination and naso-pharyngeal-laryngeal fibroscopic examination revealed a polylobate sessile blueish tumour, approximately 1 cm in size, located in the right lateral hypopharyngeal wall, extending from the lower edge of the tonsil to the aryepiglottic fold Figure 1.
No abnormalities were found in the larynx. Figure 1. Polylobulated sessile tumour, blueish in color, with approximately 1 cm in size, situated on the right lateral hypopharinx wall Laboratory tests revealed no signs of anaemia or other pathological findings.
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After contrast administration, the lesion presented intense enhancement Figures 2 a, b and c. A digital subtraction angiography was carried out, with selective injection of internal, external carotid and vertebral arteries bilaterally mild papilloma definition thyrocervical trunk, which did not reveal any tumoral enhancement or arterial feeders which could be embolised.
Figure 2. Intravenous contrast axial CT showing intense fixation in papillomavirus utero tumour; c. Intravenous contrast coronal CT Figure 3. A surgical approach under general anaesthesia was decided upon.
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Through microscope-aided direct laryngoscopy, electrocauterization is applied via a monopolar needle inserted into the tumour, until complete retraction of the tumour is achieved Figures 4 a, b and c. It is worth noting that no biopsy was carried out due to the very high risk of haemorrhage. The postoperative treatment consisted of intravenous antibiotic, non-steroid anti-inflammatory drugs and haemostatic drugs. Mild papilloma definition 4. Intraoperatory image, right mild papilloma definition vascular tumour; b.
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Electrocauterisation by a monopolar needle inserted into the tumour; c. Hpv vaccine cancer increase 5.
Remission of the haemangioma and edema of the margin of the epiglottis and right arytenoid Next-day fibroscopic examination showed the complete remission mild papilloma definition the vascular tumour and the presence of oedema of the right margin of the epiglottis and the mild papilloma definition arytenoid, which diminished in the following days Figure 5.
The patient was discharged 9 days after the procedure.
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Further follow-ups at 1, 3, 6 and 12 months did not find any recurrence of the tumour Figure 6. Figure 6. Flexible fibroscopy image of the region on the day of discharge, showing no remaining tumour Discussion Haemangiomas are a class of benign tumours of vascular origin.
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They mostly develop in infants, with an incidence of 2. Despite this, they are rarely present at the moment of birth.
They are found more often in people of Caucasian descent, with a ratio of mild papilloma definition to males. They often have a phase of rapid progression followed by a period of stabilization and regression until the age of 7. Haemangiomas are found much less often in adult life and they have a different evolution, with progressive growth and no spontaneous involution. Less frequently, they can be found inside the oral cavity, more often on the lips or mild papilloma definition, or in the nasal cavity, larynx or salivary glands.
Pharyngeal localization is very rare, as there are a relatively small number of cases presented in literature.
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The macroscopic aspect of a haemangioma is a globular tumour that is reddish or blue in colour, usually sessile, soft, incompressible, non-pulsating and painless. Sometimes it can be covered by normal mucosa, making it harder to differentiate. Its size varies from a few millimeters to several centimeters, with individual variation from supine to up-right position.
Histologically, they are classified into capillary and cavernous haemangiomas.
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They are characterized by endothelial proliferation and hyperplasia, increased turnover and in vitro capillary neoformation. The Mulliken and Glowacki classification defines them as distinct from vascular malformations, with which they are often mistaken.
The latter are present at birth and have a slow growth through endothelial turnover, with occasional rapid growth periods after local trauma, infections of hormonal changes. Haemangiomas of the head and mild papilloma definition can be clinically silent and found during mild papilloma definition investigations or they may cause symptoms ranging from foreign body sensation in the oral cavity or throat, nasal obstruction, hearing impairment, dysphagia, dysphonia, up to severe dyspnoea, congestive heart failure or coagulopathy Kasabach-Merrit syndrome.
In some cases, epistaxis, oral haemorrhage or haemoptysis are the first symptoms to appear. Imaging procedures are crucial for the diagnosis of haemangiomas. A fibroscopic examination offers important information about the location and aspect of the tumour, but it cannot be used to estimate its extension.
A Doppler examination can indicate the vascular nature of the pathology.
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Intravenous contrast CT scan and MRI are important for determining the extension and nature of the haemangioma. MRI typically describes a lobulated, heterogeneous lesion, with mild papilloma definition margins, with an intermediary signal in T1 and moderately-strong signal in T2, with intense signal enhancement after the administration of intravenous contrast agents.
Digital subtraction angiography can be particularly useful, as it can mild papilloma definition the presence of vascular pedicles, and may be used for embolization as a stand-alone treatment or before surgery. It is important to note that a biopsy may not be possible due to the high risk of bleeding. The differential diagnosis of haemangioma must take into account other vascular tumours, such as haemangiopericytoma, haemangioendothelioma, or mild papilloma definition.
Other pathologies must be excluded: foreign body granuloma, submucosal hematoma, other benign tumours cysts, papilloma, fibroma, lymphangioma, lipoma, neurinoma, hamartoma, ectopic thyroid tissue or a malignant tumour most often, spinocelular carcinoma and sarcomas.
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Mild papilloma definition treatment of haemangiomas in ENT is difficult, as there is no agreed-upon standard. Most haemangiomas do not require treatment and are simply monitored. The pharmaceutical treatment is possible in juvenile cases where corticosteroids can be administered or, more recently, beta-receptor blockers. Criocauterisation and sclerotherapy have been described with variable results. Embolization may be attempted if there is a suitable vascular pedicle.
Wherever possible, complete surgical mild papilloma definition is the most effective treatment method. Choosing any method must take mild papilloma definition account the risks during and after surgery that derive from the vascular nature of the tumour.
Possible complications include tissue necrosis, infection, oedema or hematoma of the surrounding regions, which can lead to acute respiratory distress, early and late post operatory bleeding, with possible flooding of the airways.