Mycobacterial tuberculosis superimposed on a Warthin tumor.

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Gold nanoparticles as high-resolution X-ray imaging contrast agents for the analysis of tumor-related micro-vasculature.

BACKGROUND: Angiogenesis is widely investigated in conjunction with cancer development, in particular because of the possibility of early stage detection and of new therapeutic strategies. However, such studies are negatively affected by the limitations of imaging techniques in the detection of microscopic blood vessels (diameter 3-5 µm) grown under angiogenic stress. We report that synchrotron-based X-ray imaging techniques with very high spatial resolution can overcome this obstacle, provided that suitable contrast agents are used. RESULTS: We tested different contrast agents based on gold nanoparticles (AuNPs) for the detection of cancer-related angiogenesis by synchrotron microradiology, microtomography and high resolution X-ray microscopy. Among them only bare-AuNPs in conjunction with heparin injection provided sufficient contrast to allow in vivo detection of small capillary species (the smallest measured lumen diameters were 3-5 µm). The detected vessel density was 3-7 times higher than with other nanoparticles. We also found that bare-AuNPs with heparin allows detecting symptoms of local extravascular nanoparticle diffusion in tumor areas where capillary leakage appeared. CONCLUSIONS: Although high-Z AuNPs are natural candidates as radiology contrast agents, their success is not guaranteed, in particular when targeting very small blood vessels in tumor-related angiography. We found that AuNPs injected with heparin produced the contrast level needed to reveal--for the first time by X-ray imaging--tumor microvessels with 3-5 µm diameter as well as extravascular diffusion due to basal membrane defenestration. These results open the interesting possibility of functional imaging of the tumor microvasculature, of its development and organization, as well as of the effects of anti-angiogenic drugs.

Subglottic cyst: the role of narrow-band imaging.

A subglottic cyst is a rare cause of neonatal upper airway obstruction, which may be misinterpreted as a subglottic hemangioma. With the advent of narrow-band imaging, the application of its unique features in analyzing the mucosa surface's vascular structures in pediatric subglottic lesions remains to be investigated. Here, we report the case of a preterm baby who developed two subglottic cysts when he was 3-months old. Both traditional endoscopic examination and narrow-band imaging were performed pre-operatively. Both the potential impact of this new technique and the diagnosis and management of this disease are discussed.

Brainstem hemorrhage presented as audiovestibular syndromes.

Brainstem hemorrhage usually presented with acute multiple neurologic dysfunction, and the prognosis was poor. Rarely, it can manifest with audiovestibular symptoms only. Here, we report a case of brainstem hemorrhage involving the right middle cerebellar peduncle and dorsal lateral pons presented with constant nonpulsatile tinnitus and rotatory vertigo. We believed that rotatory nystagmus should be regarded as a central sign until proven otherwise even if the neurologic signs are subtle.

Otomastoiditis with acute left facial nerve paralysis caused by Mycobacterium chelonae.

Mycobacterium chelonae usually causes soft-tissue and skin infection. It is a rare cause of otomastoiditis. The clinical presentation and operative findings are similar to those of other nontuberculous mycobacterial infections. We describe a case of left-sided otomastoiditis with acute facial nerve paralysis caused by this organism in a previously well middle-aged woman. Her facial palsy totally resolved after tympanomastoidectomy plus a 7-week regimen of clarithromycin and moxifloxacin. To our knowledge, a case of otomastoiditis with acute facial nerve paralysis caused by M chelonae has not been reported previously.

Voice and speech outcomes with radial forearm free flap-accompanied phonation tube after total pharyngolaryngectomy of hypopharyngeal cancer.

CONCLUSIONS: Radial forearm free flap (RFFF)-accompanied phonation tube (PT) for voice and speech restoration after pharyngolaryngectomy is promising, especially in phonation efficacy and intelligibility. It offers not only another safe surgical option but also a satisfactory result for such patients with advanced hypopharyngeal cancer. OBJECTIVES: We use RFFF with RFFF-accompanied PT for one-stage reconstruction both for tissue defect and voice reconstruction in patients undergoing total pharyngolaryngectomy. METHODS: Eight male patients with advanced hypopharyngeal cancer underwent total pharyngolaryngectomy. Voice restoration was done with RFFF-accompanied PT. Phonation outcomes and speech outcomes of the patients were evaluated and scored. RESULTS: The mean follow-up time was 13.7 months. All free flaps were successful without perioperative mortality. All the patients were able to produce sound. Phonation efficacy ranged from 70% to >90% postoperatively and 40% to >90% at the last follow-up. The speech intelligibility was graded as moderately good.

Cholesterol granuloma of the external ear canal: A rare presentation.

Almost all aural cholesterol granulomas develop in the mucosa of the middle ear. We describe the case of a 14-year-old girl who presented with an asymptomatic, nontender, dark-blue, cystic lesion in the posteroinferior portion of the left ear canal. The mass was excised via a postauricular approach. Postoperatively, the mass was identified as a cholesterol granuloma on pathologic examination. To the best of our knowledge, this is the first reported case of a human cholesterol granuloma limited to the external ear canal.