A Case of Pleomorphic Adenoma of the Nasopharynx Extracted Orally with a Coblator^®

Abstract

We report a case of pleomorphic adenoma of the nasopharynx that was extracted orally using Coblator^®.

A 63-year-old woman with ovarian malignancy was identified by CT, during a systematic examination of the whole body, as having a mass in the nasopharynx. There were no subjective symptoms pertaining to the otorhinolaryngological system. A vasodilated tumor with a smooth surface was seen in the mid-portion of the nasopharynx, towards the left side. A biopsy was performed to confirm the association of this tumor with the ovarian malignancy, and the findings were consistent with the diagnosis of pleomorphic adenoma. CT revealed mild, but uniform contrast enhancement of the entire tumor. MRI showed a contrast-enhancing mass measuring 21×22×22 mm in size in the posterior wall of the nasopharynx, visualized as a hypointensity in T1-weighted images and as a hyperintensity in T2-weighted images. As neither CT nor MRI showed any evidence of tumor infiltration of the surrounding tissues, resection of the tumor was planned. As the patient had telemetastasis to malignant ovarian tumor, the endoscopic transoropharyngeal approach was adopted for the surgery, to minimize the risk of postoperative dysfunction. Coblator^®, which is excellent for low-temprature resection, hemostatic coagulation and suction, was selected as the device for the tumor removal. The tumor could be successfully removed en bloc, with almost no bleeding. The patient was not particularly troubled by the hypernasality or tubal dysfunction. Although CT and MRI examinations conducted five months after the surgery showed no evidence of disease relapse, the patient unfortunately died of Trousseau syndrome caused by the ovarian cancer. Since the treatment was successful in this patient, we consider that it is important to choose a flexible treatment strategy according to individual cases.