Cystic hygroma of the neck - case report.

Cystic hygromas (CHs) are benign congenital malformations of the lymphatic system mainly diagnosed in small children aged less than two years old. They may give a multitude of local, sometimes severe complications. The most used method of treatment is surgical removal. In this paper, we present the case of a CH of a 13-year-old boy, localized in the right lateral region of the neck, diagnosed through magnetic resonance imaging (MRI), with excellent results of the surgical treatment.

Latest advances in chronic rhinosinusitis with nasal polyps endotyping and biomarkers, and their significance for daily practice.

The term chronic rhinosinusitis (CRS) comprises of an assortment of diseases that share a common feature: inflammation of the sinonasal mucosa. The phenotype classification of CRS, based on the presence of polyps, has failed to offer a curative treatment for the disease, particularly in refractory cases. Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging entity. Researchers have made efforts trying to characterize subtypes of the disease according to the endotypes, which are delineated by different immunological pathways, using biomarkers. Even if the inflammatory processes controlling CRSwNP are not fully understood, data suggested that the disease associated with a type 2 inflammatory mechanisms can be also linked to the type 1 or type 3 pathomechanism, being highly heterogeneous. Biomarkers for CRSwNP are proposed, such as: eosinophil count, cytokines, metalloproteinases, bitter and sweet taste receptors, and the nasal microbiome. For endotyping to be clinically applicable and simply determined, biomarkers referring to the intrinsic biomolecular mechanism still need to be found. Precision medicine is becoming the new standard of care, but innovative therapies such as biologics may be rather challenging for the clinicians in their daily practice. This new approach to CRSwNP implies patient selection and a simple algorithm for deciding the right treatment, easy to implement and adjust. Our review points out the ongoing new research on the pathophysiology of CRSwNP, biomarkers and treatment opportunities. It allows clinicians to keep abreast of current evidence-based knowledge and to individualize the management of CRSwNP, especially in refractory cases.

Clinical, ultrasound and histopathological correlation of clinically N0 neck nodes in patients with cancers of the pharynx and larynx.

BACKGROUND: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications. OBJECTIVES: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx. PATIENTS, MATERIALS AND METHODS: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection - "watchful waiting policy". All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L∕T); shape; lymph node area; central hypodensity; regular∕irregular margins; aspect (homogeneous or not). RESULTS: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group - patients treated with CO2 laser - detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases. CONCLUSIONS: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

The role of HPV infection in oropharyngeal cancer.

BACKGROUND: Human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has been recognized as a distinct disease entity associated with oral HPV infection with high-risk serotypes, mainly among white man at younger age. Lifetime number of oral sex partners of HPV-positive OPSCC patients is the strongest risk factor associated. HPV type 16 is now established as oncogenic and it is the main cause (over the 80%) of this type of OPSCC, followed by HPV 18 (3%). Nowadays, it is reported a dramatic rising of HPV-positive OPSCC, mainly in developed countries, including Australia, Canada, Denmark, Netherlands, Norway, Sweden, Poland, Slovakia, Switzerland, Estonia, France, Japan, United States (US) and United Kingdom. At present, the yearly number of new incidence OPSCC cases given to HPV worldwide has been estimated of 29 000 by the International Agency for Research on Cancer (IARC). If incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to overcome the annual number of cervical cancers by the year 2020, in the US. AIM: The aim of this paper is to review the recent data about several topics including risk factors of HPV-positive OPSCCs, guidelines in diagnostic evaluation, treatment, prognosis and prevention strategies, through prophylactic HPV vaccine on both sexes. Nowadays, HPV detection is a clinical standard of care for oropharyngeal malignancy by reporting tumors as HPV positive or p16 positive.

Sinonasal non-Hodgkin's malignant lymphoma - review of a clinical case.

Malignant lymphomas represent one of the most important problems of modern medicine, with a constant increase in the last decades, becoming the most frequent tumor among young people. Sinonasal localization is a particular site of malignant lymphomas, representing the second most frequent among ear, nose and throat (ENT) tumors. In this paper, authors present the clinical, diagnostic and therapeutic aspects of a malignant sinonasal lymphoma, which despite an aggressive histological subtype and important regional extension had a favorable clinical outcome. The patient presented to the ENT specialist with an important deformity of the nasal pyramid developed in the last two months. The anatomopathological exam and immunohistochemical analysis were conclusive for non-Hodgkin's lymphoma. The therapeutic course was cytostatic chemotherapy (in spite of the surgical approach) with beneficial oncological outcomes, which determined complete remission of the tumor. Computed tomography (CT) scan revealed a nasoethmoidal tumor with destruction of the nasal pyramid.

Malignant melanoma of the left nasal fossa - case report.

Mucosal malignant melanoma is an extremely rare tumor of the nose, with an aggressive character, low prognosis and frequent recurrences. The authors present a case of a 60-year-old male patient, diagnosed five years ago with adenoid cystic carcinoma, for which he had surgery and radiotherapy, who was admitted in our Clinic with unilateral epistaxis and obstruction of the nasal cavity. Clinical exam revealed an obstructive polypoidal bleeding mass of the left nasal cavity. Biopsy was performed and the histopathological exam showed malignant mucosal melanoma. Wide local endoscopic surgery was practiced for two times in the last two years, and for now, there is no recurrence. Malignant melanomas are tumors with high mortality rate, which necessitate an early diagnosis and immediate treatment.

Diagnostic and therapeutic aspects in malignant sinonasal lymphoma.

Among head and neck malignancies, lymphoma is the second most frequent cause. They can develop in the head and neck lymph nodes or as extranodal determinations. The onset of malignant lymphoma outside of lymph node registers increasingly frequent, currently over 30% of malignant lymphoma are diagnosed as taking place outside the lymph nodes. The aim of this paper is bringing in discussion and the presentation of current elements on the diagnosis and treatment in case of malignant sinonasal lymphoma, a pathological entity with a growing incidence. This study is a retrospective one, from January 2008 through December 2013, and included 31 patients admitted to "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT (Ear, Nose & Throat) Surgery, Bucharest, Romania, and diagnosed with malignant sinonasal lymphoma. Despite progress in terms of immunological techniques, cytogenetic and molecular histological outlining of malignant lymphomas, correct diagnosis and appropriate therapy of malignant sinonasal lymphoma is still a problem for the clinician and pathologist, as multidisciplinary collaboration of ENT-Hematology-Pathology-Radiotherapy being essential in this regard.

Morphological study of cephalothoracopagus deradelphus type conjoined twins. A case report.

Cephalopagus is a rare variety of conjoined twins. They are fused with their heads, thoracic and upper abdominal cavities. The exact mechanism for development of conjoined twins cannot be clearly explained. It appears that there is an alteration in the normal developmental process of monozygotic twins, which fail to separate from each other. We present the morphology of a cephalothoracopagus, revealed through anatomical dissection, emphasizing the arrangement of the viscera in the thoracic and abdominal cavities. They are fused with their heads, thoracic and upper abdominal cavities. The lower abdomen and pelvic cavities are free. Each twin has two upper and lower limbs, normally shaped. Each twin has a heart and two lungs. There is a single pharynx, esophagus and stomach, but normal lower abdominal systems. The genital and urinary systems are apparently normal. Due to the fusion of the heads and abnormal arrangement of the superior central nervous system, surgery is not attempted in these cases, the prognosis being very poor.

A rare case of concomitant tuberculosis of the nose, paranasal sinuses and larynx: clinical, histological and immunohistochemical aspects. A case report.

Extrapulmonary tuberculosis is a rare condition determined by Mycobacterium tuberculosis. It can affect any organ, and has a higher incidence with the increase of HIV infection, or in countries with high pulmonary tuberculosis. Diagnosis is difficult, mostly because of non-specific symptoms and a low rate of presentation for medical consult when symptoms do occur. Complete diagnosis is usually set by histological, immunohistochemical examinations, and also with Polymerase Chain Reaction (PCR) in selected cases. The authors present a case of concomitant tuberculosis of the nose, paranasal sinuses and subglottic larynx, without primary involvement of the lungs. The diagnosis was imposed by histological examination and immunostaining of probes obtained in surgery. The treatment was surgical debridement followed by specific antituberculosis medication.

Vagus nerve schwannoma in the parapharyngeal space: surgical, histological and immunohistochemical aspects. A case report.

Tumors of the parapharyngeal space are rare accounting approximately for 0.5% of all head and neck tumors. In the retrostyloid space, schwannomas are a more common finding, in contrast to other tumors. Usually, they present with a variety of slight symptoms until they grow in size and compress surrounding organs. Surgical treatment of parapharyngeal space tumors is difficult; due to the anatomical complex area, they develop in, and include several approaches, according to its size and relations. In this paper, we present a case of a 63-year-old female with a vagus nerve schwannoma in the parapharyngeal space. Beside the surgical difficulties, the resected tumor had a peculiar histopathological aspect (large areas of degeneration and atypia and little typical palisading) that compelled a thorough histological and immunohistochemical evaluation for positive and differential diagnosis.

A study on the type of lesions achieved by three electrosurgical methods and their way of healing.

The technical progress in the medical sector in the past decades has continuously driven the development of electrosurgical techniques. The controversies surrounding the superiority of a certain technique relative to another - electrocautery, laser and radiofrequency - have determined us to carry out a histopathological design with the aim of comparing the healing sort of the shallow wounds generated by the three types of electrosurgical devices. The experimental study has investigated the healing process inflicted by the electrosurgical devices mentioned beforehand on 12 Wistar albino rats. The wounds were inflicted under intravenous general anesthesia with Xylazine and Ketamine and were performed lateral to the spine region, using laser, radiofrequency and electric cautery. The histological samples harvested at one, three, five, and seven days were sent to pathological examination. We followed by comparison the evolution of the first two phases of the wound healing produced by the three electrosurgical methods analyzed. We described the histopathological changes occurred in the epidermis, dermis and hypodermis and also the subcutaneous soft tissues in all of the three types of lesions. Electrocautery remains the most frequently used electrosurgical device, even if it has unquestionable disadvantages as compared to other modern instruments. Laser-assisted surgery and radiofrequency are refine energy-based instrumentation, being utilized at a multidisciplinary surgical level.