Nasal Glial Hamartoma: A New Type of Sinonasal Hamartomas.

Hamartomas are rare, tumour-forming, benign lesions that have been reported throughout the body that can resemble other malignant entities. Hamartoma subtypes can be distinguished based on their histological features. Sinonasal hamartomas may have presenting symptoms and radiological features that mimic other nasal neoplastic lesions. Therefore, it is essential to diagnose it accurately, as the treatment approaches can range from radical surgeries in malignant cases to a simple excision in hamartoma. In this paper, we report a novel case of sinonasal hamartoma, which demonstrates an unprecedented histological feature of glial tissue with astrocyte-like cells. Furthermore, we present the unconventional presenting symptoms and radiological features seen in this case that mimic the behaviours of nasal inverted papilloma (IP) lesions, thereby highlighting the need for careful investigation of such patients in order to distinguish both glial hamartoma and IP lesions. Concluding that identification of glial hamartoma as a new subtype of sinonasal hamartoma is crucial, as mistaking it for other lesions may subject patients to overly aggressive treatment and potential unnecessary harm.

Glandular Fever Testing in Patients Presenting With Tonsillitis: A Retrospective Study.

BACKGROUND: Tonsillitis, the inflammation of the palatine tonsils, typically arises from infections and predominantly affects children of primary school age. Most cases stem from viral or bacterial infections. Glandular fever, a subtype, is primarily caused by the Epstein-Barr virus (EBV). This specific type of tonsillitis can lead to severe complications, including splenic rupture, encephalitis, chronic fatigue, and acute acalculous cholecystitis. As a result, early identification is vital to establish proper safety measures and prevent the onset of these potentially dangerous complications in patients. OBJECTIVES: This study aims to determine the number of missed glandular fever cases diagnosed as simple tonsillitis and raises considerations in managing these patients. METHODS: A 12-month retrospective single-centre cohort study was carried out in Lincoln County Hospital, Lincoln, England. A total of 185 patients diagnosed with tonsillitis were included, along with their presenting symptoms and investigations, including liver blood tests and glandular fever screening. RESULTS: Among the 185 patients, averaging 26 years old, 112 were screened for EBV infection, revealing 35 positive cases (31.3%). Notably, 74% of these positive cases (26 out of 35) displayed abnormal liver function test results. CONCLUSION: Applying the percentage of EBV-positive cases to the 73 unscreened patients results in a likelihood of 23 missed cases of EBV infection. These form 12% of the study group, indicating a significant potential missed number of cases. Given the associated risks and complications with EBV, we note the importance of screening to identify cases and apply relevant considerations in their management.

Intracranial germ cell tumors: a single-institution experience.

BACKGROUND AND OBJECTIVES: Intracranial germ cell tumors (GCTs) are not a common disease. We reviewed the experience of a single institution to determine the variables that affect treatment outcome. DESIGN AND SETTING: A retrospective review of patients with the diagnosis of intracranial germ cell tumors treated in a single institution (KFSHRC) during the period from March 1985 to December 2007. PATIENTS AND METHODS: Fifty-seven patients with the diagnosis of intracranial GCT were recorded in the KFSHRC Tumor Registry during the period from 1985 to 2007. Seven patients with a pineal region tumor treated as germinomas in the earlier years without a tissue diagnosis were excluded. This retrospective study was restricted to the remaining 50 patients with a tissue or marker diagnosis: 31 germinomas and 19 non-germinomatous germ cell tumors (NGGCTs). RESULTS: The 10-year overall survival (OS), event-free survival (EFS) and relapse-free survival (RFS) were 87%, 88% and 96% for patients with germinoma, with a median follow-up of 4.5 (range 2-17) years, compared with 26%, 29% and 46% for patients with NGGCT with a median follow-up of 3 (range 1.5-13) years. For NGGCT, variables favorably influencing OS were younger age (< 16 y vs ≥16 y, P=.01), higher radiation dose (>50 Gy vs ≤50 Gy; P=.03) and later year of diagnosis (>1990 vs <1990 P=.002). CONCLUSIONS: Tissue diagnosis of GCTs is mandatory prior to treatment except for patients with elevated markers. In germinoma, localized radiotherapy (RT) for M0 patients may be adequate. Long-term follow-up is needed to define the benefit of adding chemotherapy. For NGGCT, the use of combined modality treatment and RT dose ;gt;50 Gy are important factors that influence the outcome. Second-look surgery and resection of residual/ refractory tumors is always recommended.

Rhabdomyosarcoma in childhood: a retrospective analysis of 190 patients treated at a single institution.

OBJECTIVES: The study goal was to retrospectively review the treatment results of childhood rhabdomyosarcoma and identify prognostic factors that affect treatment outcome. PATIENTS AND METHODS: The records of 190 patients with childhood rhabdomyosarcoma treated between January 1991 and December 1999 were reviewed. The data were analyzed for clinico-epidemiological factors and the impact of potential prognostic factors on failure-free survival. Factors evaluated were age, gender, histology type, primary site, tumor size, Intergroup Rhabdomyosarcoma Study (IRS) group, surgical procedure, and the use of radiation treatment. RESULTS: The 5-year actuarial FFS and OS were 40% and 50%, respectively. The only significant prognostic factors as estimated by univariate analysis were histology type (p=0.01), primary site (p=0.002), tumor size (p=0.049), IRS-group (p=0.003), surgical procedure (p=0.002), and radiation treatment (p=0.001). Multivariate analysis showed that histology type (p=0.02), primary site, and IRS-group (p=0.02) were the only independent prognostic factors. CONCLUSIONS: This analysis demonstrates that failure-free survival for rhabdomyosarcoma is dependent on several factors at the time of initial diagnosis, including histologic subtype, primary site and disease group. Our treatment results were inferior compared to IRS-studies as the patients during this period were treated on individual bases and not standardized protocol.

A randomized study of accelerated fractionation radiotherapy with and without mitomycin C in the treatment of locally advanced head and neck cancer.

OBJECTIVES: This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in the treatment of locally advanced head and neck cancer. PATIENTS AND METHODS: Between May 1998 and October 2001, sixty patients with locally advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (1) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). RESULTS: The 2-year overall survival (OS) of the whole group was 21%. The OS according to treatment arm was 23%, 20%, and 28% in CF, AF, and AF+MMC arms respectively (p<0.19). The 2-year loco-regional control (LC) rate was 22% for the whole group of patients. The LC was 10%, 25%, and 30% for the CF, AF, and AF+MMC respectively (p=0.27). The only significant parameters for OS and LC were performance status and pre-treatment hemoglobin level. Mucositis grades 3 & 4 occurred in 70% and 90% of the patients in the AF and AF+MMC arm respectively compared to 55% of patients in the CF arm (p=0.04). However the addition of MMC did not significantly increase the incidence or severity of mucositis between AF and AF+MMC (p=0.13). Hematological toxicity grades 3 & 4 were significantly higher after MMC (occurred in 40% of patients versus 10% and 5% in CF and AF arms respectively, p=0.04). There was no statistically significant difference in the incidence of grade 3 dryness of mouth (p=0.06), fibrosis (p=0.6), or lymphoedema (p=0.39) among the three arms. CONCLUSION: There was a trend for improvement of LC and OS rates with the use of AF and the addition of MMC to AF compared to CF radiotherapy, although the difference was not statistically significant. The small number of the patients in each treatment arm and the inclusion of multiple tumor sites may contribute to these statistically insignificant results. Accordingly we advise 85 to continue the trial with inclusion of a larger number of patients and restrict tumor sites to one major site.