Nontypeable Haemophilus influenzae Otitis Media: Mastoiditis and Meningitis Complicated with Central Venous Thrombosis in an Immunocompetent Child.

Implementation of the Haemophilus influenzae type B (Hib) conjugate vaccine brought about a reduction in the number of cases and morbidity from type B but an increase in nontypeable strain infections. Nontypeable Haemophilus influenzae (NTHi) commonly colonizes children's upper respiratory tract and causes otitis media, sinusitis, and bronchitis. Invasive NTHi diseases, such as meningitis and septicemia, have rarely been reported. Herein, we discuss a previously healthy, fully immunized 3-year-old girl presented with otitis media and mastoiditis leading to meningitis caused by NTHi complicated with central venous thrombosis. She was treated with antibiotics, mastoidectomy and ventilation tube insertion, and anticoagulation therapy and recovered uneventfully. Through this case, we wish to share our unique clinical experience that NTHi should be born in mind as a potential pathogen that can cause meningitis in previously healthy children, which may be helpful in future cases.

Ototoxicity associated with topical administration of diclofenac sodium as an otic drop: An experimental animal study.

OBJECTIVES: The aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration. METHODS: Twenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated. RESULTS: No significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups. CONCLUSION: Diclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.

Radiologic Evidence of Cochlear Implant Bone Bed Formation Following the Subperiosteal Temporal Pocket Technique.

OBJECTIVE: To compare the thicknesses of bone beneath the internal receiver stimulator (IRS) with the symmetric contralateral unimplanted side in postoperative temporal high-resolution computed tomography (CT) and/or cranial CT of the patients for whom cochlear implants were secured by the subperiosteal temporal pocket technique. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care hospital, cochlear implant referral center. SUBJECTS: Cochlear-implanted pediatric patients with postoperative temporal high-resolution CT and/or cranial CT were reviewed. The study group included 10 patients with Clarion devices (Advanced Bionics, Valencia, California). METHODS: Thicknesses of bone were recorded independently by 2 radiologists in the standardized coordinates of proximal, middle, and distal segments of both the IRS bed and the contralateral unimplanted side in each patient. Bone thickness differences in the proximal, middle, and distal segments of IRS were investigated. Any correlation between bone thickness differences and patient age at implantation or duration of implantation was also investigated. RESULTS: Mean values of bone thicknesses obtained from the IRS side and contralateral unimplanted side were, respectively, as follows: 2.40 ± 0.80 mm and 4.17 ± 1.10 mm in the proximal segment (P = .0001); 1.48 ± 0.33 mm and 3.02 ± 0.85 mm in the middle segment (P = .0001); and 2.13 ± 0.41 mm and 3.40 ± 0.61 mm in the distal segment (P = .006). Significant positive correlation was found between patient age at implantation and decrement values in the distal segments (r = 0.681, P = .03). CONCLUSION: The subperiosteally secured IRS eventually creates its own well on the skull vault. This new radiologic evidence shows that device migration risk decreases over time, and it supports the findings of other clinical series showing device stability using the subperiosteal pocket technique.

Temporal Bone Localized Chondroblastoma.

Chondroblastoma is a highly destructive tumor originating from immature cartilage cells. Although chondroblastoma is defined as a benign tumor, it may exhibit malign tumor behaviors such as invasion or metastasis on neighboring structures. Magnetic resonance (MR) image is a solid mass lesion, which included heterogeneous hypointense in T2A and heterogeneous minimal hyperintense in T1A with destructive expansile characteristics and millimetric calcifications. Temporal bone chondroblastomas may complicate the diagnosis because of their different histologic characteristics. Microscopically, chondroblastic cell nests and calcification of locally "chicken wire" type around the cells are observed. These tumors secrete s-100 and vimentin and are used for differential diagnosis. In this study, a temporal bone localized chondroblastoma case is presented.

[Importance of diffusion weighted magnetic resonance imaging at differentiation of cholesteatoma and granulation tissue in patients with chronic suppurative otitis media]. / Kronik süpüratif otitis mediali hastalarda kolesteatom ve granülasyon dokusu ayriminda difüzyon agirlikli manyetik rezonans görüntülemenin önemi.

OBJECTIVES: This study aims to report the significance of echo-planar diffusion-weighted imaging (EP-DWI) in preoperative magnetic resonance imaging of patients with surgically corrected cholesteatoma and granulation tissue according to DWI and apparent diffusion coefficient (ADC) values. PATIENTS AND METHODS: Ninety-one patients (52 males, 39 females; mean age 40.7±15.8 years; range 3 to 77 years) who admitted to radiology clinic of our hospital between December 2009 and May 2011 with a pre-diagnosis of chronic otitis media with primary acquired cholesteatoma and assessed preoperatively in our clinic by ear magnetic resonance imaging and DWI were included in the study. Diffusion-weighted imaging results were compared with operative findings and pathology results. Patients were retrospectively evaluated using picture archiving and communication system. Diffusion-weighted imaging and ADC images were examined qualitatively and quantitatively. RESULTS: Ninety-one patients suspected of cholesteatoma were operated. According to the results of operations, 50 patients had cholesteatoma and 41 patients had granulation tissue. The mean DWI values of patients with cholesteatoma were significantly higher than patients with granulation tissue (p<0.05). The mean ADC values of patients with cholesteatoma were significantly lower than patients with granulation tissue (p<0.05). The sensitivity and specificity of EP-DWI in detection of cholesteatoma were 97.6% and 92.0%, respectively. CONCLUSION: Echo-planar diffusion-weighted imaging by using ADC and DWI is a valuable tool with high sensitivity and specificity rates in detecting cholesteatoma particularly bigger than 5 mm and in differentiating them from other pathologies.

Nasal septal turbinate: cadaveric study.

BACKGROUND: Despite the importance of its location, the functional behavior of the nasal septal turbinate (NST) is still not completely understood. Basic histological knowledge is still lacking. The aim of this study was to describe the histological features of the NST and to compare its morphometric features to those of the adjacent nasal septum and the inferior and middle turbinates. METHODS: The study included 50 fresh cadavers. Excisional biopsy specimens of the NST with adjacent posterior septum were collected. In addition, mucosal and submucosal biopsy specimens were taken of the inferior and middle turbinates. Morphometric analysis was performed on five different tissue types: glandular elements, connective tissue stroma, arterial structures, and capillary or venous sinusoids. RESULTS: The mean proportion of venous sinusoids was statistically lower in the nasal septum and NST than in the inferior and middle turbinate. The mean proportion of glandular tissues was higher in the NST than in other regions of the nasal cavity. The mean proportion of arterial tissue was lower in the nasal septum and the NST. Significantly fewer capillary elements were found in the inferior and middle turbinates than in the nasal septum and NST. The mean proportion of connective tissues was lower in the NST than in other regions of the nasal cavity. CONCLUSION: The similar histopathological cell distribution in the middle and inferior turbinate supported a function as an erectile organ, but the findings for the NST pointed to different functional properties of this region.

The effects of corticosteroid on tissue lactoferrin in patients with nasal polyposis.

BACKGROUND: Although, lactoferrin (LF) is the second most important antimicrobial and anti-inflammatory peptide after lysozyme in upper respiratory tract, little is known about its role in chronic rhinosinusitis (CRS). Recent studies pronounced that LF levels were significantly reduced in CRS with nasal polyposis (NP) compared with other subgroups. However, effects of systemic corticosteroid (CS) treatment, which is currently the main NP treatment modality, and subsequent surgical intervention on LF levels are still not known. This study was designed to evaluate the effects of CS treatment and surgical intervention on LF levels in patients with NP. METHODS: Patients with inflammatory NP who were scheduled to undergo CS treatment and a control group were included in this study. LF levels were determined from mucosal samples taken from both groups, before and after CS treatment, and also 1 month after surgical intervention. RESULTS: Twenty-seven patients with NP and 14 patients who underwent septoplasty were included in the study. Tissue LF levels were significantly lower in the NP group compared with the control group (p = 0.014). Tissue LF levels did not change significantly in NP patients after CS treatment. However, a significant reduction in tissue LF was detected 1 month after endoscopic sinus surgery. CONCLUSION: Tissue LF concentrations significantly decreased in patients with NP. CS treatment had no effect on tissue LF levels, whereas postendoscopic sinus surgery, tissue LF levels were getting lower because there was also a reduction in inflammatory load (whether from reduction in mucosa surface area or resolution of disease).

The predictive value of dominant nodules and the management of indeterminate group in multinodular goiter.

The objectives of this study were to determine the predictive value of dominant nodules (DNs) in multinodular goiters (MNGs), and to stratify the risk of malignancy within the indeterminate category. The study design was retrospective study of patients with MNG. A total of 140 patients were reviewed. Fine needle aspiration biopsy (FNAB) findings for all DNs were categorized into four groups: (1) benign, (2) positive or suspicious for malignancy, (3) indeterminate, and (4) non-diagnostic. All FNAB specimens of the indeterminate group were also evaluated for the presence of Hurthle cell metaplasia and were categorized according to the presence of cytological atypia. Cytohistological comparison was then performed. Mean number and diameter of the DNs were 1.45 and 25.6 mm, respectively. Based on final histopathology, 22.14% of the patients had thyroid malignancy and 74.2% of thyroid carcinomas were located in DNs. The number of DNs was significantly larger in malignant thyroid glands than in benign ones. In total, 22.6% of the indeterminate FNABs were malignant. FNABs of the indeterminate group that included atypical cells had a statistically significant higher incidence of malignancy. The presence of Hurthle cells was not statistically different in malignant and benign nodules upon final histological diagnosis. In conclusion, FNAB of only DNs in MNG could determine thyroid malignancy in 75% of patients. The DN number might be required for the predictive value of malignancy. A subclassification of the indeterminate group, based on the presence or absence of cytological atypia, is necessary to better assess the risk of malignancy.

Determining the most suitable costal cartilage level for rhinoplasty: an experimental study.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of septal cartilage (SC) and costal cartilage (CC) grafts harvested from different ribs and to find at which level CC has characteristics closest to SC. STUDY DESIGN: Experimental cadaver study. SETTING: Istanbul Training and Research Hospital. MATERIAL AND METHOD: Cartilage grafts were harvested from the 6th, 7th, and 8th ribs and the SC of 10 fresh cadavers. Shaped cartilage grafts were subjected to a bending test. Results were measured, and the force-deflection curve was plotted. Flexural strength (σ(f)) and flexural modulus of elasticity (E(f)) were determined. Fractured surfaces were evaluated by scanning electron microscopy (SEM). RESULTS: According to F(max), it was determined that ribs 6, 7, and 8 have significantly more durability compared with the SC (Ps = .030, .004, and .001). With regard to deflection, there was no significant difference between the SC and the 6th and 7th ribs and between the 6th and 7th ribs (Ps = 1.000, .088, and .306), while a significant difference was found between the SC and the 8th rib (P = .001). According to σ(f), no differences were seen between the 6th and 7th rib (P = .782), while difference was detected between the 6th and 8th and the 7th and 8th ribs (p = .001). Similar trends were established in E(f) values as in σ(f.) These results were confirmed by SEM images. CONCLUSION: The 7th CC can be used as autograft because it shows similar properties to SC. However, the 6th CC is preferred if more flexibility is desired, and the 8th CC is preferred where more strength is needed.

Nasal septal packing: which one?

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3 h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.

Tensile characteristics of costal and septal cartilages used as graft materials.

OBJECTIVES: To determine the biomechanical characteristics of septal cartilage (SC) and costal cartilage (CC) taken from fresh cadavers using tensile testing and to establish CC graft material of a suitable thickness (ie, with tensile characteristics closest to those of SC). METHODS: Grafts of varying thickness were harvested from the central part of the seventh-rib CC and SC of 18 fresh cadavers. Tensile testing was performed with a 0.5-kilonewton load calibrated at 7 mm/min. The results were shown as a force-elongation curve. RESULTS: No significant difference according to tensile force was observed between the SC group and the 1.0-mm and 1.5-mm CC groups (P = .09 and P = .32, respectively). However, a significant difference was observed between the SC group and the 2.0-mm CC group (P = .04). Although the strength value of the CC group was 5.03 MPa, the modulus of elasticity was 1.33 MPa. In the SC group, the strength value was 12.42, but the modulus of elasticity was 1.39 MPa. The strength value of the SC group was higher than that of the CC group (P = .001), but the modulus of elasticity value of the CC group was higher than that of the SC group (P = .001). CONCLUSIONS: From the standpoint of tensile testing for preparing columellar struts, 1.0-mm and 1.5-mm CC have similar characteristics to SC and thus can be used instead of it. However, it is important to determine the thickness of CC by considering the expected characteristics of the established material and the forces that affect the area in the nose where the graft will be placed.

Myofibroma of the zygomatic bone in an older child: a case report.

Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.

Massive lymphoid hyperplasia presenting with obstructive sleep apnea secondary to lingual and palatine tonsil hyperplasia.

Lingual tonsil hyperplasia is a rare condition that may cause obstructive sleep apnea (OSA). In the management of OSA, the lingual tonsils should be evaluated during the otorhinolaryngologic examination. We report the case of a 66-year-old man with findings of upper airway obstruction secondary to excessive lingual and palatine tonsil hyperplasia and with MRI findings of bilateral cervical lymphadenopathy. We review the clinical, radiologic, and histopathologic aspects of this case, and we discuss the surgical options for treating massive reactive lymphoid hyperplasia in conjunction with OSA.

The effect of corticosteroid on metalloproteinase levels of nasal polyposis.

OBJECTIVES: The aim of this study was to investigate the effect of corticosteroid treatment on topical and systemic metalloproteinase levels of patients with nasal polyposis (NP). STUDY DESIGN: Prospective clinical trial. METHODS: The study included patients undergoing a paranasal sinus operation due to NP. Oral corticosteroid therapy was performed on all patients before endoscopic sinus surgery. Endoscopic and radiological evaluation were performed and nasal tissue specimens and venous blood samples were collected before (preop phase) and after corticosteroid treatment (periop phase) and also one month after surgery (postop phase). Endoscopic and computed tomography scan findings were scored adequately and all tissue and blood samples were examined cumulatively. RESULTS: The study included 27 patients with inflammatory NP. Preop tissue matrix metalloproteinase-2 (MMP-2) levels were found to be significantly lower than preop and postop concentrations. In contrast, periop serum MMP-2 levels were found to be significantly higher than preop and postop concentrations. Periop tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were also found to be significantly lower than preop and postop concentrations, similar to MMP-2 tissue concentrations. However, there was no statistical difference among tissue MMP-9 concentrations of the three phases. In addition, there was also no statistical difference among serum MMP-9 levels of the three phases. CONCLUSIONS: Oral corticosteroid treatment especially reduces tissue MMP-2, then TIMP-1. Severity of nasal polyposis primarily correlates with increasing tissue MMP-2/TIMP-1 ratio, then MMP-9/TIMP-1. These results suggest that selective inhibition for MMP-2 and activation for TIMP-1 might be a novel therapeutic strategy for patients with nasal polyposis.

Obesity and obstructive sleep apnea syndrome.

OBJECTIVES: to investigate the association of sleep apnea severity with insulin resistance, leptin, adipose-fatty acid binding protein (A-FABP) and visfatin levels and to evaluate the confounding role of obesity. STUDY DESIGN: prospective study. METHODS: the study included obese patients who were referred to the sleep laboratory. Patients were divided into two main groups according to their Apnea-Hypopnea Index (AHI). Measurements of body weight, height, blood pressure, waist circumference (WC), and neck circumference (NC) were taken on the night of the sleep study. Blood samples were taken after polysomnography. Insulin resistance was estimated with the homeostasis model assessment (HOMA) index. RESULTS: group A included 34 patients with obstructive sleep apnea syndrome (OSAS) and group B included 19 patients without OSAS. OSAS patients had significant higher visfatin levels; however, other parameters were similar. Leptin and A-FABP were significantly correlated with body mass index (BMI) in both groups. OSAS patients had significant higher NC and WC despite a BMI similar to that of group B, and strong correlations of these two variables were found with HOMA. Group A had higher visfatin levels than did group B. CONCLUSIONS: insulin resistance was not directly associated with BMI and/or AHI, but it was aggravated by nocturnal hypoxemia owing to apnea severity. NC was also a good predictor for insulin resistance and should not be ignored during the treatment selection for the patients with OSAS. Visfatin may have a potential role as a screening marker for OSAS.

Concha bullosa and septal deviation.

The aim of this study was to investigate the incidence of concha bullosa (CB) in cases with septal deviation (SD), correlation between the angle of deviation and degree of pneumatization and compare these correlations with qualitative and quantitative methods. We retrospectively searched our radiology database for all paranasal sinus computed tomography (CT) findings for 672 patients. All scans were grouped according to the presence and side of SD and/or CB. SD angles and pneumatization degree of the CB were measured with appropriate method. These findings were also classified according to the initial defined qualitative method. Generally, CB and SD incidences were 31.52 and 47.77%, respectively. CB ratio in SD patients was 45.34% whereas ratio in non-SD patients was 18.95%. Mean deviation angle of the isolated SD group (15.24 +/- 5.03) was found higher than both deviation angle of the unilateral CB + SD group (13.16 +/- 4.19) and bilateral CB + SD group (11.15 +/- 3.73) (P = 0.002, P = 0.0001 respectively). In conclusion, CB may tend to develop bilaterally in normal, non-deviated nose. However, the increasing incidence of unilateral CB, especially contralateral ones, in septal deviated patients suggested that SD may prevent the development of ipsilateral CB.

The role of matrix metalloproteinases in recurrent tonsillitis.

OBJECTIVE: The aim of this study was to investigate the status of matrix metalloproteinases (MMP-2, MMP-7, MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) due to dysregulated turnover of connective tissue matrices in children with recurrent tonsillitis (RT). METHODS: Forty-four patients with RT were enrolled in the study. All patients with RT were graded according to the hypertrophy degree of the tonsillar tissue from grade I to grade IV. Patients with grade I tonsillar hypertrophy and grade II tonsillar hypertrophy were accepted as group A, patients with grade III tonsillar hypertrophy and grade IV tonsillar hypertrophy were accepted as group B Tonsillectomy was performed via the usual dissection-snare method. Tonsillar specimens of superficial and core region were evaluated for MMP-2, MMP-7, MMP-9 and TIMP-1 analysis. RESULTS: There was no statistical significance according to the MMP-2, MMP-7, MMP-9 and TIMP-1 activity of superficial part and core regions in both groups individually, MMP-9 level of both the superficial and core regions in group B had statistical significant higher results than group A (p=0.026, p=0.06 respectively). MMP-7 level of the superficial part in group B patients also had statistical significant higher results than group A (p=0.025). However, there was no statistical difference found between superficial and core region MMP-2 and TIMP-1 levels of group A and group B. Related to this, balance between MMP-7-9 and TIMP-1 activities tended to slip MMP-7 and MMP-9 sides with increased tonsillar grade. CONCLUSIONS: Results from this study suggest that the presence of MMPs in tonsil tissue consolidates the involvement of degraded extracellular matrix proteins in the pathophysiology of chronic tonsillitis. MMPs activity showed diffuse dissemination in the tonsillar tissue and especially MMP-9 and MMP-7 are the main promoters of the extracellular matrix that responded to inflammatory changes in the tonsillar tissue. Further studies are needed concerning the possible efficiency of selective MMP inhibitors on tonsillar tissue.

Efficiency of corticosteroid treatment in resolution of bilateral abducens paralysis after head trauma.

A rare case of posttraumatic bilateral abducens palsy is presented. A 17-year-old male patient referred to our clinic because of complaints of diplopia, difficulty in opening his mouth, pain in the face, dyspnea, and chest pain after head trauma from a motor vehicle accident. The patient was not able to abduct eyes bilaterally, and diplopia occurred in the lateral gaze. All other extraocular movement was intact. He also had a mandibular fracture and bilateral pneumothorax. Computed tomography scan of the cranium showed no intracranial or extracranial hemorrhage, no mass effect, and no edema. No abnormalities were seen in the orbits, sinuses, skull base, and calvarium. For the treatment of sixth cranial nerve palsy, we applied corticosteroid therapy and waited for spontaneous recovery. During follow-up, at 3 months after discharge, he showed marked improvement in his ocular mobility and alignment without any residual limitation of abduction bilaterally. A bilateral sixth nerve palsy is rarely seen after a head trauma without cranial pathologic findings, and corticosteroid therapy may have beneficial effects during treatment besides spontaneous resolution.

A difficult case: sarcoidosis of the middle ear.

Sarcoidosis is a common multisystemic granulomatous disorder affecting several organs and tissues. However, the respiratory tract is the region commonly involved in more than 90% of patients, and the middle ear is a direct extension of it. In spite of this, direct middle ear and/or mastoid involvement of sarcoidosis is more rarely seen. Otological involvement may mimic a number of other diseases of the ear; sarcoidosis will probably not be considered prospectively. In addition, pulmonary symptoms of the patients often go unnoticed for some time. We report a patient presenting with hearing loss and tinnitus as the primary manifestation of sarcoidosis of the ear.

Head and neck hemangiopericytomas: diagnostic contradictions.

PURPOSE: To identify misdiagnostic points of hemangiopericytomas (HPs) of the head and neck. PATIENTS AND METHODS: We reviewed our clinical records from 2000 to 2007 retrospectively and identified 5 patients with HP of the head and neck. The records of each patient with head and neck HP were evaluated for age, sex, location of primary, clinical course, treatment, and tumor embolization (if performed). Pathologic slides of all patients were reviewed to identify histologic features and correlation with the clinical course and outcome for each lesion. RESULTS: Five patients with HP that arose from head and neck sites were identified. Five patients included 3 women and 2 men aged 9 to 52 years, with an average of 33.2 years. Each lesion of the patients derived from different parts of the head and neck. The most common complaints were painless mass (3 of 5) and nasal airway obstruction (3 of 5). Magnetic resonance imaging of the 3 patients reflected hyperintense on T2-weighted imaging and hypointense on T1-weighted imaging with diffuse enhancement after intravenous administration of gadolinium. Angiography was performed to all these 3 patients, and only 1 patient with cranial HP involvement did not show significant vascularity. Two patients had preoperative histopathologic results. All patients were operated on with appropriate approach. Pathologic slides of all patients were investigated and graded according to the tumor diameter, cellularity, mitotic rate, and necrosis. CONCLUSION: Differential diagnosis of clinical features and radiologic and pathologic aspects must be managed more carefully. Diagnostic way of these tumors has different pitfalls for the clinician.