Unabsorbed dura patch removed eight years after pituitary surgery.

The Codman ETHISORB Dura Patch is a synthetic, absorbable material whose absorption is complete within approximately 90 days. We report the first case of an unabsorbed Codman Dura patch, in which a patient was presented with nasal obstruction and epistaxis 8 years after pituitary surgery for Cushing's disease.

Bilateral inferior turbinate osteoma.

Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma.A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively.To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches.

Air bag injury as a cause of inflammatory myofibroblastic pseudotumour of the subglottic larynx progressing to myositis ossificans.

Inflammatory myofibroblastic pseudotumour (IMFPT) is a rare condition. The clinical presentation can be indistinguishable from that of a malignant neoplasm. The most frequently affected organ is the lung; a much less common site is the larynx and subglottic involvement is particularly rare. Trauma is purportedly one potential aetiological factor, although there have been no previous reports of IMFPT occurring in the larynx secondary to external laryngeal trauma. We present a case of IMFPT of the subglottis which occurred subsequent to external trauma of the neck sustained during air bag inflation in a road traffic accident. This mechanism has not been previously reported. Furthermore, the lesion progressed uniquely to show myositis ossificans-like maturation over time. The patient was ultimately treated by means of complete local excision.

Simultaneous bilateral pleomorphic adenomas of the parotid glands with unilateral tyrosine rich crystalloids.

A case of simultaneous, bilateral pleomorphic adenoma of the parotid glands following irradiation to the head and neck for childhood Hodgkin's disease is presented. The tumour on the side given the highest radiation exposure contained so-called tyrosine rich crystalloids (TRCs). Simultaneous salivary gland neoplasms are rare; TRCs are also an unusual finding. Simultaneous pleomorphic adenomas with TRCs confined to one tumour have never been described, and any association between TRCs and irradiation has never been commented on. The precise nature of the TRCs remains obscure. Their unilateral distribution in this case supports the hypothesis that local factors are more important in their formation than systemic factors. In conjunction with other published work, this provides circumstantial evidence that irradiation may predispose to TRC deposition.

Isolated testicular vasculitis mimicking a testicular neoplasm.

A 19 year old man presented with unilateral testicular swelling and pain. An initial diagnosis of epididymo-orchitis was modified to a presumed testicular neoplasm following ultrasonography. The final diagnosis of isolated testicular vasculitis was established following histological examination of the orchidectomy specimen. Staining for antineutrophil cytoplasmic antibodies was negative. Despite immunosuppressive treatment, the patient developed further symptoms affecting the remaining testis one year later. He responded well to an increase in immunosuppressive therapy and has remained asymptomatic 18 months from diagnosis. Symptomatic vasculitis confined to the testis is extremely rare, but must be considered in the differential diagnosis of testicular swelling and may be the presenting feature of a systemic vasculitis such as polyarteritis nodosa. The risk of progression to systemic disease in such cases is unknown. Immunosuppressive therapy must be considered carefully and long term follow up is important.

Management of laryngeal amyloidosis.

Amyloidosis of the upper aerodigestive tract is rare. However, the larynx is the commonest site within the upper airways to be affected. Three cases of uncomplicated primary amyloidosis of the larynx and one case of laryngeal amyloidosis with more generalized dissemination throughout the head and neck are presented. In this article the different presentations of laryngeal amyloidosis and principles of management of this condition at that site are highlighted.

Role of repeat fine needle aspiration cytology in head and neck lesions: preliminary study.

In this preliminary prospective study the value of repeating fine needle aspiration cytology (FNAC) in patients with head and neck lesions was investigated. Few reports exist on the significance of repeating the procedure in head and neck patients. Fifty-seven patients have been sampled twice for the first and second (repeat) FNAC. The second aspirate was performed in the operating theatre under general anaesthesia prior to a surgical procedure. The cytological results were compared with the histology of the 57 resected lesions. It was found that the overall diagnostic results improved after repeating the FNAC. It can be concluded that repeating FNAC is useful and should be considered under some circumstances, especially in the case of non-diagnostic cervical lymph node aspirates.

Gastrointestinal stromal tumour of the pharynx.

This documents the case of a 55-year-old female presenting with a solitary polypoidal tumour of the pharynx. Histological examination revealed features consistent with a gastrointestinal stromal tumour. Although well described elsewhere in the gastrointestinal tract, from our literature search, this is the first reported case of such a tumour occurring in the pharynx

Invasive candidiasis of the tonsil.

A patient with unilateral tonsillar enlargement secondary to locally invasive candidal infection is presented. This was not associated with any history of immunosuppression or prolonged use of broad-spectrum antibiotics. Invasive candidal infection of the tonsil has not previously been reported.

Haemangiopericytoma of the submental region.

Haemangiopericytoma refers to an uncommon vascular/perivascular neoplasm of which a minority of cases arise in the head and neck. It comprises a group of lesions with marked clinical and pathological heterogeneity and a lack of positive criteria by which to make a definitive diagnosis. We describe an unusual case of such a tumour in the submental region, review its pathological features and discuss issues in management and prognosis.

Primary malignant melanoma of the pharynx.

A case of primary malignant melanoma of the pharynx is presented. Mucosal melanomas of the upper respiratory tract are rare. They tend to present late and therefore the prognosis is generally poor. The initial mainstay of treatment is adequate surgical resection. Prognostic factors are less well documented than in cutaneous melanoma.

Solitary fibrous tumour of the thyroid gland.

Solitary fibrous tumours of the thyroid gland are rare; only five cases have been reported in the literature. Clinically, they present as a long-standing firm mass in the thyroid. Histologically, they show a range of appearances including so-called 'patternless growth pattern', spindle-cell morphology, alternating hypo- and hyper-cellular areas, keloid-like hyalinization and a prominent haemangiopericytoma - like architecture. The behaviour of extrathoracic solitary fibrous tumours is unpredictable and requires careful, long-term follow-up.

Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus--an under-recognised association.

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an 'empty swallow'. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric 'inlet patch'. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.

Securin induces genetic instability in colorectal cancer by inhibiting double-stranded DNA repair activity.

Genetic instability (GI) is a hallmark feature of tumor development. Securin, also known as pituitary tumor transforming gene (PTTG), is a mitotic checkpoint protein which is highly expressed in numerous cancers, is associated with tumor invasiveness, and induces GI in thyroid cells. We used fluorescence inter-simple sequence repeat PCR to assess GI caused primarily by DNA breakage events in 19 colorectal tumors. GI values ranged significantly, with Dukes' stage C&D colorectal tumors exhibiting greater GI and higher securin expression than Dukes' stage A&B tumors. Consistent with these findings, we observed a dose-dependent increase in GI in HCT116 cells in response to securin overexpression, as well as in non-transformed human fibroblasts. As securin has been implicated in a novel DNA repair pathway in fission yeast, we investigated its potential role in chemotoxic DNA damage response pathways in mammalian cells, using host cell reactivation assays. Securin overexpression in HCT116 cells inhibited etoposide-induced double-stranded DNA damage repair activity, and repressed Ku heterodimer function. Additionally, we observed that securin and Ku70 showed a reciprocal cytosol-nuclear translocation in response to etoposide-induced dsDNA damage. Our data suggest that, by repressing Ku70 activity and inhibiting the non-homologous end-joining dsDNA repair pathway, securin may be a critical gene in the development of GI in colorectal cancer.

Myoinositol and phosphatidylinositol metabolism in synaptosomes from galactose-fed rats.

The effects of experimental galactose toxicity on inositol and phosphatidylinositol (PtdIns) metabolism in synaptosomes from 0- to 30-day-old rats were investigated. Galactose toxicity was induced by feeding mothers a 40% galactose diet from the 12th day of pregnancy until 19 days postpartum when the offspring were weaned onto the maternal diet. There was no decrease in myoinositol concentrations and only a small decrease in PtdIns in synaptosomes from galactose-fed rats relative to glucose-fed controls. Synaptosomes from rats on the two diets converted equivalent amounts of [U-14C]glucose to inositol and PtdIns. Acetylcholine stimulated [2-3H]inositol incorporation into PtdIns while producing a net decrease in PtdIns concentration in synaptosomes from 22- to 30-day-old rats. However, the phospholipid response to acetylcholine in synaptosomes from galactose-fed rats was impaired. Thus, the acetylcholine-stimulated labeling of PtdIns was 40--50% lower in these synaptosomes while the effect on PtdIns concentration was reduced by a maximum of 55%. The data suggest that galactose-fed rats may have either a deficiency in the number of acetylcholine receptors or a defect in some step between receptor-neurotransmitter interaction and PtdIns breakdown.

Undifferentiated columnar cells in colorectal adenomas and familial adenomatous polyposis.

We have observed and defined morphometrically and histochemically groups of undifferentiated columnar cells within the surface epithelium in colorectal mucosa. They were present within both non-polypoid and polypoid mucosa in familial adenomatous polyposis, and within non-hereditary adenomatous polyps of the colon and rectum. The cells show some evidence of proliferative activity and appear similar to cells previously described in the stomach which were proposed as precursors to type 3 sulphomucin-secreting intestinal metaplasia in atrophic gastritis. To our knowledge, these observations have not been previously described. It is possible that the cells represent the cellular basis of the shift in the proliferative zone from the normal site at the crypt base to the colorectal mucosal surface, which is known to precede adenomatous polyp formation. The cells may therefore be involved in the early stages of colorectal adenoma formation.

Metastatic ureteral tumour.

We report a case of renal carcinoma which presented initially with lymphatic spread. Five years later, a contralateral ureteric tumour was excised, with to date, 2 years of disease-free survival. Isolated ureteric metastases are very uncommon.

Tumour heterogeneity: a problem in biopsy assessment of the proliferation index of oesophageal adenocarcinomas.

Tumour heterogeneity may pose a problem when biopsy specimens are taken to measure proliferation (for example, in assessing response to therapy). Two "biopsy specimens" were taken from the centre and two from the edge of the luminal surface of 20 resected oesophageal adenocarcinomas. The proliferation index for each "biopsy specimen" was measured by counting Ki67 labelled nuclei in histological sections. The proliferation index was not associated with tumour differentiation or stage. There was site specific heterogeneity with a significant difference in proliferation index between the central (mean (SD) 36.4 (9.7)) and edge "biopsy specimens" (39.3 (9.9)). There was, however, a wide range of differences between pairs of "biopsy specimens" from both sites. In conclusion, if a tumour is to be sampled for measurement of the proliferation index before and after treatment, then the sequential biopsy specimens (preferably duplicated on each occasion) should be taken consistently from a leading edge of the lesion.