Iceberg tumor leading to obstructive sleep apnea?

Introduction:

A 53 year old patient was referred to our outpatient department with a massive tumor at the right soft palate. Two months before CPAP-therapy was initiated due to a severe obstructive sleep apnea with significant daytime tiredness. Difficulties in fitting the CPAP-mask led to the ENT referral.

Findings:

Upon examination we found an indolent protrusion of the right soft palate. Further investigations revealed a massive tumor of the fossa pteryopalatina. As preoperative fine-needle aspiration cytology did not lead the way, we recommended surgery. Histopathological findings revealed a lymphoma of the marginal zone with no further need for therapy. After removal of a 8 × 7 cm tumor mass symptoms of daytime tiredness ceased – even without CPAP-therapy. However, a polygraphy three months after surgery verified the formerly diagnosed obstructive sleep apnea. Referral to a sleep laboratory lead to a newly fitted CPAP-therapy after verification of the diagnosis.

Conclusion:

This case report underlines the importance of an ENT-specialist in a newly diagnosed obstructive sleep apnea – without the lymphoma had not been diagnosed – as well as the obstructive sleep apnea as an independent diagnose with the need of therapy despite an important finding in the oropharynx.

Publication History

Publication Date:
18 April 2018 (online)