Rhinology

Aggressive inflammatory pseudotumor of the maxillary sinus and orbit

March 18, 2014     Sheldon Chong, MBBS, MS(ORL-HNS); Carren S.L. Teh, MBBS, MS(ORL-HNS); Shashinder Singh, MBBS, FRACS; Mun Kein Seong, MBBS, MPath; Subrayan Viswaraja, MBBS, FRCS(Edin), FRCOphth(UK)
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Abstract

Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. It is uncommon in the head and neck region, particularly in the paranasal sinuses. We present an unusual case of IPT of the maxillary sinus and orbit in a 27-year-old woman who presented with cheek swelling, right orbital swelling, double vision, and associated fever and trismus. Computed tomography identified a mass with radiologic features suggestive of a malignancy of the maxillary sinus and orbit; the mass extended into the infratemporal fossa, parapharyngeal space, anterior antral wall, and surrounding soft tissue. A diagnosis of IPT was established on the basis of histologic and immunohistochemical analysis, which identified a proliferation of bland spindle cells and a mixed inflammatory cell infiltrate. Despite its aggressive appearance, IPT is associated with a good prognosis. Our patient was treated successfully with a combination of surgery, steroid therapy, and methotrexate. Chemotherapeutic agents are generally reserved for recalcitrant cases.

Early detection of nasopharyngeal carcinoma using IgA anti-EBNA1 + VCA-p18 serology assay

March 18, 2014     Achmad C. Romdhoni, MD, PhD; Nurul Wiqoyah, MS; Widodo Ario Kentjono, MD, PhD
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Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in Indonesia. Overall, it ranks fourth in males and sixth in females as the most prevalent type of cancer in that country. The data show that in the year 2011, NPC incidence was considered to be intermediate (6.2/100,000 population per year). Through histopathologic examination, about 70 to 80% of these cases were found to be type III according to the WHO classificaton. NPC carries an excellent prognosis if treated early, but most patients presented with stage III to IV disease, which negatively affected the cure rate and increased the mortality rate. Epstein-Barr virus (EBV) IgA serology has been established as an effective marker for NPC. Therefore, biologic markers, DNA, and/or antibody-based diagnosis is needed to decrease NPC cases. A screening program needs to be developed that will identify people at high risk of NPC and those who are in the early stage of the disease. In this study, 20 samples were collected from posttherapy patients. An otolaryngologic examination, histopathology of nasopharyngeal tissue, and blood testing for serologic markers were performed. IgA anti-EBNA1 + VCA-p18 enzyme-linked immunosorbent assay showed positive impact as a tool for confirming the diagnosis of NPC, but it still has to be combined with other specific diagnostic tools for post-therapy monitoring and for determining prognosis.

Endoscopic modified Lothrop approach for the excision of bilateral frontal sinus tumors

March 18, 2014     Jiun Fong Thong, MRCS; Deyali Chatterjee, MD; Siew Yoong Hwang, FRCS
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Abstract

We describe the use of an endoscopic modified Lothrop approach for clearance of an extensive sinonasal-type hemangiopericytoma of the nasal cavity and paranasal sinuses with bilateral frontal sinus involvement in a 44-year-old woman. The modified Lothrop approach is conventionally used to treat sinusitis, but with some slight modifications to the technique, it can also be used for tumor excision.

Endoscopic view of an inferior meatal polyp

March 18, 2014     Jae Hoon Lee, MD
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Most polyps in the nasal cavity develop from the mucosa of the anterior ethmoid sinus, the contact areas of the uncinate process, and the middle turbinate so that they are observed in the middle meatus.

Schwannoma of the nasal septum: An unusual finding

March 18, 2014     Shruti Dhingra, MS, DNB; Jaimanti Bakshi, MS, DNB; Satyawati Mohindra, MS, DNB
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Abstract

Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

The significance of magnetic resonance imaging and computed tomography findings in sphenoid sinus agenesis

February 12, 2014     Lokman Uzun, MD; Omer Faik Sagun, MD; Bulent Seferoglu, MD; Omer Etlik, MD; and Kamran Mahmutyazicioglu, MD
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Abstract

Agenesis of the sphenoid sinuses is a very rarely encountered anatomic variation. Findings on magnetic resonance imaging can mislead the radiologist and clinician. Therefore, the gold standard for diagnosis is computed tomography (CT) of the paranasal sinuses. We present the case of a 28-year-old man who was admitted to our hospital with a 3-month history of headache. CT of the paranasal sinuses revealed isolated bilateral sphenoid sinus agenesis.

Endoscopic view of sphenoid sinus illumination and transillumination

February 12, 2014     Ken Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; and Eiji Yanagisawa, MD, FACS
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The sphenoid sinus has been considered a more challenging sinus to view with the lighted guide wire; unlike the other three paranasal sinuses, the sphenoid sinus is “hidden” from view because of its more posterior location.

Unusual presentations of choanal polyps: Report of 3 cases

February 12, 2014     Ali Ozdek, MD; Halil Erdem Ozel, MD
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Abstract

Most choanal polyps arise from the maxillary sinus, and they are called antrochoanal polyps. Their typical endoscopic and radiologic appearance makes them easy to diagnose. However, some choanal polyps originate in unusual sites in the paranasal sinuses and nose, such as the sphenoid sinus and the lateral wall of the nose. These polyps usually present unilaterally, although bilateral presentations are possible. We describe 3 cases of atypical choanal polyps: a sphenochoanal polyp, bilateral antrochoanal polyps, and a giant antrochoanal polyp. In each case, nasal endoscopy and computed tomography clinched the diagnosis, and endoscopic surgery was performed to successfully remove the polyp. We discuss the clinical characteristics of these 3 cases.

Osteochondroma of the nasal dorsum presenting as a nasal hump

February 12, 2014     Hakan Tutar, MD; Aykut Erdem Dinc, MD; Omer Uluoglu, MD; and Metin Yilmaz, MD
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Abstract

We describe the case of a 24-year-old man who underwent open septorhinoplasty for the treatment of progressive nasal disfigurement caused by a nasal hump. Postoperative histopathology of the resected hump revealed that it was an osteochondroma. The patient showed no evidence of recurrence during 2 years of follow-up. To the best of our knowledge, this is the first case of an osteochondroma involving the nasal dorsum to be reported in the English-language literature.

Organized hematoma of the maxillary sinus: A clinicopathologic study of 5 cases

February 12, 2014     Hidenori Yokoi, MD, PhD; Atsushi Arakawa, MD, PhD; Fumihiko Matsumoto, MD, PhD; Naoko Yokoi, MD, PhD; Katsuhisa Ikeda, MD, PhD; and Naoyuki Kohno, MD, PhD
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Abstract

Organized hematoma of the maxillary sinus is rare. Its pathogenesis is still not clear, and it appears to have multiple causes. We report the clinical, clinicopathologic, and immunohistochemical findings in 5 patients-3 men and 2 women, aged 19 to 68 years (mean: 40.2)-with pathologically proven organized hematoma of the maxillary sinus. In all 5 cases, we were able to successfully perform curative treatment via endoscopic sinus surgery. Our findings suggest that most organized hematomas are angiomatous. Immunohistochemical analysis identified the presence of proliferative activity.

Recurrent chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity in a child

January 21, 2014     Kazuhiro Nomura, MD, PhD; Takeshi Oshima, MD, PhD; Atsuko Maki, MD, PhD; Takahiro Suzuki, MD, PhD; Kenjiro Higashi, MD; Mika Watanabe, MD, PhD; Toshimitsu Kobayashi, MD, PhD
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Abstract

Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare type of hamartoma. To the best of our knowledge, only 1 case has been previously reported. A 7-year-old girl presented with a case of COREAH of the bilateral nasal cavities. Polypous masses in both nasal cavities were resected endoscopically, and they were histologically diagnosed as COREAH. A large polypous mass recurred 1 year postsurgically on the right side only. A second endoscopic surgery was performed, and the lesion was confirmed to be recurrent COREAH. Hamartoma of the nasal cavity is rare and is generally considered to be self-limiting. This case suggests that nasal hamartomas may have neoplastic characteristics, and therefore require complete resection.

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area

January 21, 2014     Marco Fusetti, MD; Alberto Eibenstein, MD; Ettore Lupi, MD; Enzo Iacomino, MD; Tiziana Pieramici, MD; Alessandra Fioretti, MD, PhD
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Abstract

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

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