Solitary Fibrous tumor of Nasal cavity: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Solitary fibrous tumors (SFTs) involving the nasal cavity are extremely rare with few cases reported in the literature. CASE PRESENTATION: We present a case of SFT in a 90 year-old male complaining of a slow-growing mass prolapsing through left nostril. Nasal endoscopy and imaging exams revealed a mass occupying the entire left nasal cavity, pushing the nasal septum to the opposite side and extending up to the nasopharynx. Biopsy specimen examination reported sarcoma. The patient underwent complete surgical resection of the mass through left para-latero-nasal approach. Immuno-histochemical analyses confirmed the diagnosis of SFT. The patient has remained free of tumor 2 years after surgery. CLINICAL DISCUSSION: Clinical and imaging features of SFTs of nasal cavity are not specific. A broad of differential diagnosis is associated with histopathologic features of SFTs. Therefore, immuno-histochemical analyses are crucial to confirm the diagnosis. Complete resection of the mass with clear margins is mandatory to minimize local recurrence. CONCLUSION: SFTs of nasal cavity are very rare neoplasms which continue to pose challenges to practitioner. Pathological examination and mainly immunohistochemical studies are important to establish the diagnosis. Complete resection of the tumor is the key for good outcome.

Management of Isolated sphenoidal aspergillosis: Case report and review of literature.

INTRODUCTION AND IMPORTANCE: Sphenoidal aspergillosis is an uncommon serious condition that could lead to a fatal outcome. There is dilemma in its management. Published data concerning this pathology are limited so we find interesting in adding our experience to the literature mass. In fact, this work focused on the description of the clinical features of this entity as well as its management by presenting a case report and reviewing literature. CASE PRESENTATION: We report a case of 53 years old male who presented to the outpatient department of our university teaching Hospital with isolated chronic headache complaint that evolving through two years. His physical examination revealed no abnormalities. CT scan of facial bone and MRI showed an aspect in favor of sphenoidal aspergillosis. He underwent an endoscopic sphenoidotomy. Microscopic examination was consistent with the diagnosis of sphenoidal aspergillosis. There were no needs to associate an antifungal treatment since we estimate the surgery excision was complete. The patient remained free of disease after surgery for a follow-up of 4 years. CLINICAL DISCUSSION: Aspergillosis is ubiquitous in nature, currently causing severe disease in both immunocompetent and immunocompromised patients. Its frequency has increased over the past few years due to the widespread use of antibiotics, corticosteroids, and improved diagnostic methods. Surgery is the primary form of treatment, however if signs of invasion are present, it should be supplemented with an anti-fungal treatment. CONCLUSION: Sphenoidal aspergillosis is a rare condition whose diagnosis is not always obvious. The clinician should always bear this diagnosis in mind in patients with chronic sinusitis avoiding invasive and fulminant forms which could be life-threatening.

A rare case of primary sinonasal meningioma: A case report.

INTRODUCTION AND IMPORTANCE: Extra cranial primary meningioma of sinonasal tract is a rare entity. It is often misdiagnosed as nasal polyp. CASE PRESENTATION: Here we report a case of a primary ethmoid sinus meningioma with extension into the nasal cavity in a 41-year-old man. The tumor was completely excised via endoscopic endonasalapproach and the histologic diagnosis of meningioma was established. The patient was regularly follow up for 12 months without recurrence of the tumor. CLINICAL DISCUSSION: The final diagnosis of primary sinonasal meningioma is based on histopathology and immunohistochemistry analyses results. The importance of complete surgical resection is undoubted and also is a goodindicator prognosis. CONCLUSION: The otolaryngologists should be aware of the diagnosis of primary meningioma; despite of its rarity it is considered as a possible cause of nasal obstruction.

Second branchial cleft cyst: about 34 cases.

BACKGROUND: the amygdaloid cyst is a rare laterocervical cystic tumor arising from the second branchial cleft. It accounts for 2% of laterocervical tumors. AIM: analyze the anatomo-clinical characteristics and discuss the management and therapeutic indications of second branchial cleft cysts. METHODS: we report a 14-year retrospective study (2000-2013) concerning 34 cases of amygdaloid cysts diagnosted and treated at ENT department of Farhat Hached hospital of Sousse. RESULTS: The average age of our patients was 27 years with a sex ratio 0.8. Physical examination found a cervical mass in all the cases: jugulo-carotid in 26 cases (77%), supraclavicular in two cases (6%). The location was not specified in 6 cases (17%). Cervical ultrasound was performed in 30 patients, and showed a cystic mass in 17 cases. Complement by CT was performed in 5 patients suggesting the diagnosis of second branchial cleft cysts in two cases. One patient had an MRI for a large supraclavicular mass. A fine needle aspiration biopsy was performed in 13 patients. All patients underwent surgery with complete excision of the cyst. Histopathological examination confirmed the diagnosis of second branchial cleft cysts, with 2 cases of malignant degeneration. One case of recurrence was noted. CONCLUSIONS: Second branchial cleft cysts are relatively rare malformations. Their diagnosis is confirmed by pathological examination. The treatment is surgical.

Laryngeal synovial sarcoma: Report of 2 cases.

Synovial sarcoma is a malignant mesenchymal tumor. It most commonly occurs in the lower extremities of young adults. The head and neck are rare sites, accounting for less than 10%. The larynx is an extremely rare site. We report two cases of 27 and 18 year-old men who developed a synovial sarcoma of the larynx. They presented with hoarseness of voice and hemoptysis. Endoscopy detected a mass in the supraglottic region. The biopsy concluded a synovial sarcoma. Immunohistochemistry conveyed diagnostic certainty. They had been treated with total laryngectomy and post-operative radiotherapy. The 2 patients are seen for regular follow-ups in our department and they remained recurrence-free for 10 years and 24 months, respectively. Synovial sarcoma is a very rare tumor of the larynx. A multidisciplinary therapeutic approach is essential for the management of this malignancy. Long-term follow-up is required to monitor for recurrence and improve disease-free survival.

Rosai-Dorfman disease of the nasal cavities: A CO(2) laser excision.

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare nonneoplastic histiocytic proliferative disorder characterized by painless massive lymphadenopathy. Extranodal manifestations frequently occur in the head and neck area. METHODS: We report the clinical and histological features of nasal cavities and cervical lymph node RDD in a 72-year-old woman, who complained of major nasal obstruction and hyposmia. RESULTS: Nasal endoscopy revealed polypoid masses arising from the turbinates; the septum was intact. Immunohistochemical analysis revealed staining for S-100 protein, CD68, and alpha-1 antitrypsin. The presence of the Epstein-Barr virus was revealed by serology and also by in situ hybridization. The general examination and systemic evaluation did not find other extranodal localization. CONCLUSION: Because the disease is known for not responding to local or systemic steroids, CO(2) laser excision was used to clear the nasal obstruction with a satisfactory result. This is, to the best of our knowledge, the first description of the use of laser excision for nasal cavities RDD.