A unique intraluminal growth of juvenile nasopharyngeal angiofibroma: A case report.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, hypervascular, benign tumor which is mainly seen among male adolescents. The tumor typically originates from the sphenopalatine fossa, but could spread through natural foramens and fissures. There are some reports of atypical growth of this tumor in literature but the intraluminal growth, which could be seen in paraganglioma and glomus tumors, has not reported yet in angiofibroma. In this article we present a case of extensive angiofoibroma with intraluminal involvement of the ophthalmic vein. Our patient was a 19-year-old boy with a complaint of nasal obstruction and occasional epistaxis since a year ago, without any visual or neurologic complaints. The patient underwent an endoscopic resection of the tumor after embolization via the nasal cavity. The intraoperative findings revealed the tumor extension to the orbit, intracranial space and cavernous sinus via inferior orbital fissure. The intracranial extension of the tumor was extradural and was successfully excised without CSF leakage. An interesting finding in this patient, was an intraluminal extension of the tumor in to the ophthalmic vein, which was completely excised endoscopically. (pre and post operation pictures are available in the full text). The definitive treatment of angiofibroma is surgical excision. Different surgical approaches are used but nowadays endoscopic resection with or without pre-operative embolization is the first choice of treatment. The intraluminal growth of the tumor was also excised as a pedunculated mass separately.

A Case of Fungus Ball-Type Pansinusitis Due to Fusarium proliferatum.

Incidence of fungal sinusitis due to the genus Fusarium has increased during the last two decades. We report a case of fungus ball sinusitis with multiple sinuses involvement in an Iranian 21-year-old woman. The patient was diagnosed as having a fungus ball-type sinusitis in computed tomography scan. The sinus biopsy revealed fungal structures on histopathological and direct microscopic examinations and a Fusarium species arose in culture. Partial sequencing of the translation elongation factor 1-alpha identified the isolate as F. proliferatum. Removal of all lesions by endoscopic surgery resulted in a favorable outcome. To the best of our knowledge, this is the first case of F. proliferatum-associated fungus ball which involved multi-sinus and highlights the efficiency of molecular methods for discrimination of fungal agents involved.

Histopathologic characteristics of inferior turbinate vs ethmoidal polypin chronic rhinosinusitis.

It seems apparently that the 2 separate anatomical areas (nasal cavity and paranasal sinus mucosa) are indeed one single unit with an identical behavior during inflammatory process. Similar histopathologic evidence in long-term condition could emphasize on the concept of rhinosinusitis in patients with inflammatory paranasal sinus disease. Prospective study was performed on 50 consecutive patients with polyposis in 2 different groups, one with and the other without asthma. Inferior turbine and polyp with ethmoid sinus origin were selected to compare the histopathologic findings of the surgical specimens from the 2 sites (affected sinus vs apparently unaffected nose). The general degree of inflammation, epithelial thickening, and inflammatory cell count were measured. The degree of inferior turbinate inflammation correlated with that of the ipsilateral polyp of ethmoid sinus in both groups. In addition, the total inflammatory cell count was comparable. There was no statistically significant difference in total polymorphonuclear, lymphocyte, and eosinophil count between the 2 sites in each group (P > .05). The ethmoid sinus inflammation in polypoid chronic sinusitis is accompanied by a proportionate inferior turbinate inflammation, not only in the patients with asthma but also in those with isolated sinonasal polyposis.

Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes.

The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nasopharyngeal angiofibroma (JNA) and to compare its related intra- and postoperative complications with findings from traditional approaches in the literatures. This study is a retrospective report of 47 cases of JNA that were treated with nasal endoscopic surgery between 1998 and 2005. According to the staging system by Radkowski et al (Arch Otolaryngol Head Neck Surg. 1996;122:122-129), the staging of the included patients were the following: 21 in stages IA to IIB, 22 in IIC, 3 in IIIA, and 1 in IIIB. Five patients were embolized before surgery. The mean blood hemorrhage in embolized patients was 770 mL, whereas in nonembolized patients, it was 1403.6 mL. In the follow-up period (mean, 2.5 years), the recurrence was found in 9 patients (19.1%), and mean time of recurrence was 17 months after surgery. The rupture of cavernous sinus occurred in 2 cases with no mortality. The mean hospital stay was 3.1 days in all cases and 1.8 days in embolized patients. The findings of this study demonstrate that endoscopic resection of JNA is a safe and effective technique because of decrease in blood loss, hospitalization, and recurrence rate, especially in tumors that are not extended through intracranial space. It is therefore strongly recommended that this modality is implemented as the first surgical step for tumors with stages I to IIIA of the Radkowski's staging system.

The comparison of histopathological characteristics of polyps in asthmatic and nonasthmatic patients.

INTRODUCTION: Considering the different clinical aspects of polyps in asthmatic and nonasthmatic patients, we aimed to explore their histopathological characteristics. MATERIAL AND METHODS: Twenty-five asthmatic patients and 25 nonasthmatic patients with polypoid chronic rhinosinusitis (29 male, 21 female; mean age 41.3 +/- 13.27; range 15-78 years) were enrolled in the study to be compared on the basis of histopathological characteristics. They were compared according to the following seven light microscopic findings: basement membrane thickness, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophilic infiltration, lymphocytic infiltration, and polymorphonuclear infiltration. RESULTS: Basement membrane thickening, goblet cell hyperplasia, and eosinophilic and lymphocytic infiltration were more prominent in the asthmatic compared with the nonasthmatic group (P < 0.05), whereas polymorphonuclear infiltration was more prominent in nonasthmatics (P < 0.05). No statistically significant differences were found between the two groups with regard to submucosal gland hyperplasia or subepithelial edema. CONCLUSION: Asthmatic patients present histopathological characteristics of a marked chronic inflammatory reaction, which might explain the negative effect on chronic rhinosinusitis outcome and the severity of the disease in this group.