Vol.97 No.6 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No. 6 June 2004
Inflammatory Pseudotumor of the Parapharyngeal Space
Shigetaka Moriai
(Nikko Kinen Hospital, Asahikawa Medical College)
Takashi Osaki
(Nikko Kinen Hospital)
Yasuaki Harabuchi
(Asahikawa Medical College)
We report a case of inflammatory pseudotumor (IPT) of the parapharyngeal space, clinically mimicking a neoplastic process. A 68-year-old man was admitted to our hospital because of swelling of his left face and difficulty in opening the mouth. We found an ulcer with fur on his buccal mucosa, surrounded by granulation, and a palpable lymph node on his left submandibular region.
CT and MRI findings revealed the left parapharyngeal mass had invaded the left maxillary sinus with destruction of the posterior bony wall. A PET revealed that administered FDG was accumulated on the left parapharyngeal space, which subsequently appeared to the left buccal mucosa, and also on the right upper lobe of the lung.
The first biopsy of the abnormal buccal mucosa showed no malignancy. We performed an open biopsy of the parapharyngeal mass via the left maxillary sinus under general anesthesia. The pathologic findings were fibrotic tissue and inflamed granulation tissue.
Prednisolone at 20 mg/day was instituted and decreased gradually, and totaled 555 mg after 30 weeks; the tumorous findings in the left parapharyngeal space and lungs were extinguished.
IPT is a benign disease with no specific inflammatory findings pathologically, but with demonstrated bone destruction, which simulates malignant disease clinically. Our case was successfully treated with steroid therapy, without wide surgical excision.
IPT of the parapharyngeal space is an extremely rare lesion, compared with that of the paranasal sinus.
Key words : inflammatory pseudotumor, parapharyngeal space, difficulty in opening the mouth, steroid therapy, paranasal sinus