Head and neck inflammatory pseudotumor: Case series and review of the literature

Abstract

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

Tumefactive fibroinflammatory lesion successfully treated with Rituximab

“…TFIL lacks significant numbers of IgG4 positive plasma cells and storiform pattern of fibrosis as seen in IgG4 related disease. TFIL lacks the ALK positivity and intranuclear eosinophilic inclusions as seen in IMT (7)(8)(9).…”

Laryngeal Inflammatory Pseudotumour Secondary to Mycobacterium kansasii

“…IPT associated with mycobacterial disease has been reported in skin [ 12 ], lymph nodes [ 13 ], lung [ 14 , 15 ], brain [ 16 ], and sinuses [ 17 ]. There have been cases of head and neck manifestations of IPT reported in lymph nodes, parotid, the para-pharyngeal space [ 18 ], and the tonsil [ 19 ]. IPT of the larynx are rare; in some cases there has been a history of intubation, previous surgery, or smoking [ 2 ].…”

“…In the more common setting of thoracic IPT of lungs and mediastinum complete surgical excision has been found to be effective [ 20 ]. Where surgery is not without considerable morbidity such as in orbital IPT, corticosteroids with or without radiotherapy have been found to show good disease control of 80%, however with high recurrence rates [ 18 , 20 ]. Surgery with or without steroids is generally the preferred modality of treatment especially when there are easily accessible sites as the larynx [ 5 ].…”

Laryngeal inflammatory pseudo-tumour secondary to mycobacterium kansasii

“…IPT associated with mycobacterial disease has been reported in skin [12], lymph nodes [13], lung [14,15], brain [16], and sinuses [17]. There have been cases of head and neck manifestations of IPT reported in lymph nodes, parotid, the para-pharyngeal space [18], and the tonsil [19]. IPT of the larynx are rare; in some cases there has been a history of intubation, previous surgery, or smoking [2].…”