“Parapharyngeal space” tumors: A cytopathological study of 24 cases on fine‐needle aspiration

Abstract

The parapharyngeal space (PPS) is a well-defined anatomic zone of loose connective tissue lying deep to the tonsil and lateral to the pharynx. Neoplasms arising within the PPS are rare. We retrospectively reviewed 24 PPS fine-needle aspirations (FNAs) performed at The Johns Hopkins Hospital over the past 16 years (1987-2002). Patients presented with neck pain, dysphagia, and/or intraoral swelling of varying duration. Radiographic imaging disclosed PPS masses, varying in size from 2.5 to 8 cm. The most common clinicoradiographic suspicion was a nerve sheath tumor. Six cases had FNA performed using a 23-gauge needle via a transoral approach in the outpatient suite whereas the remainder were aspirated via a 22-gauge Franseen needle under CT guidance. Six of 24 cases (25%) were nondiagnostic due to lack of adequate cellular material. Of the 18 cases considered diagnostic, there were nine (50%) pleomorphic adenomas (PAs); three (17%) squamous-cell carcinomas (SCC); and one each of oncocytoma, adenocarcinoma, not otherwise specified (NOS), adenoid cystic carcinoma, lipoma, neurofibroma, and non-Hodgkin lymphoma, together comprising the remaining 33%. Four of the six cases deemed nondiagnostic (consisting predominantly of blood) on subsequent tissue follow-up revealed paraganglioma (two cases), SCC (one case), and schwannoma (one case). PPS is an uncommon target of an FNA procedure. PPS masses represent a heterogeneous group of neoplasms of which PA appears most common, representing 50% of our diagnostic cases. The rate of nondiagnostic FNA samples is moderately high due to excessive bleeding encountered in this location and other technical problems relating to adequately targeting the lesion in close vicinity of major neck vessels.

Parapharyngeal space tumors without mandibulotomy: our experience

“…Approximately, 20% are malignant tumors [5]. Of all PPS tumors, pleomorphic adenoma is the most common [6].…”

Schwannoma parafaríngeo gigante: Diagnóstico diferencial y enfoque terapéutico

“…23 El estudio citohistológico mediante punción aspiración con aguja fina [PAAF] puede aportar datos significativos, 2,24 quedando reservado su uso para aquellas tumoraciones en las que tengamos certeza de su naturaleza sóli-da gracias al empleo de las ya citadas técnicas de imagen. Para su realización se propone la vía transoral, 24,25 como la más adecuada. En la reciente serie de 24 casos publicada por Oliai y cols.…”

“…En la reciente serie de 24 casos publicada por Oliai y cols. 24 no se describen complicaciones tras la realización de PAAF diagnósticos en masas parafaríngeas de naturaleza no vascular (un diagnóstico citológico de schwannoma). El empleo de biopsia prequirúr-gica está contraindicado en la mayoría de ocasiones, 2 por la complejidad anatómica del abordaje, por el riesgo de ruptura y hemorragia intratumoral y por la posibilidad de crear adherencias fibrosas entre la cápsula del tumor y la pared mucosa faríngea, lo que puede crear alguna dificultad en la posterior exére-sis tumoral.…”

Intraoral and Oropharyngeal Lesions: Role of Fine Needle Aspiration Cytology in the Diagnosis

“…These lesions have been traditionally treated on clinical basis and evaluated by surgical biopsy. Studies of transmucosal needle aspiration of oral cavity lesions are limited [1][2][3][4][5][6][7][8][9][10]. The oral cavity and oropharynx are readily accessible to fine needle aspiration (FNA) and it may be a useful technique for preliminary assessment.…”