Locally advanced oncocytic carcinoma of the nasal cavity treated with surgery and intensity-modulated radiotherapy.

Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.

Cross-cultural application of the "Sniffin' Sticks" odor identification test.

BACKGROUND: Odor identification tasks are an important tool for the clinical assessment of olfactory function. However, cultural differences prevent odor identification tests from being used in different countries, because odor identification is strongly dependent on familiarity with these odors. The "Sniffin' Sticks" olfactory test has been developed in Europe and is used for assessment of olfactory function in many European countries. The aim of this study was to investigate the applicability of the "Sniffin' Sticks" odor identification test in an area with a different culture compared with its place of origin. METHODS: The 16 odors in the ''Sniffin' Stick'' odor identification test were kept the same but some descriptors were changed compared with the original version. One odor was presented for 3 seconds. Then, subjects chose an item from a list of four descriptors. Two hundred two subjectively normosmic subjects were tested. Forty-two subjects were retested 1 week after the first test. RESULTS: Mean odor identification scores of age groups 18-35 years, 36-55 years, and >55 years were 14.8, 14.7, and 13.3, respectively. The score at the 10th percentile was 13.0 in the youngest group of subjects. Age-related decrease of odor identification scores was clearly established. The decrease of the odor identification score was most obvious in subjects aged 63-67 years. The coefficient of correlation between test and retest was 0.76. CONCLUSION: After revision of the descriptors, the ''Sniffin' Sticks'' odor identification test appears to be suited for assessment of olfactory identification function in an Asian region.

Toward a better understanding of sinonasal mucosal melanoma: clinical review of 23 cases.

BACKGROUND: Primary sinonasal mucosal melanoma is a rare disease, occurring far less often than cutaneous lesions. The objective of this study was to review the records of patients diagnosed with primary sinonasal mucosal melanoma. METHODS: We performed a retrospective review of the medical records of 23 patients with sinonasal mucosal melanoma who were treated at Taipei Veterans General Hospital between 1982 and 2002. RESULTS: Sixteen of the 23 patients were male and 7 were female; their mean age was 68.2 years (range, 39-87 years). At diagnosis, the melanoma was limited to lesions located in the sinonasal area in 20 patients, and had spread in 3 patients. Local recurrence developed in 9 patients, neck metastasis in 5, and distant metastasis in 19. The 5-year disease-specific survival and local control rates were 22.26% and 52.30%, respectively. CONCLUSION: In our experience, primary sinonasal mucosa melanoma is prone to spread from the site of origin. The major obstacle in improving overall survival is achieving systemic control.

The role of ostiomeatal complex obstruction in maxillary fungus ball.

OBJECTIVE: The aim of this study was to clarify the role of ostiomeatal complex obstruction in maxillary fungus ball. STUDY DESIGN AND SETTING: Comparative study in a hospital setting of the mean Lund-Mackay scores for the anterior ethmoid and frontal sinuses of 54 versus 48 patients with maxillary fungus ball versus chronic unilateral rhinosinusitis, respectively. RESULTS: In cases with partial opacification in the maxillary sinus, the anterior ethmoid and frontal sinuses were diseased in the chronic unilateral rhinosinusitis group but not in the maxillary fungus ball group. In cases with total opacification in the maxillary sinuses, all anterior ethmoid and frontal sinuses in both groups were diseased, but the disease condition of the frontal sinuses was significantly less severe in the maxillary fungus ball group (P < 0.001). CONCLUSION AND SIGNIFICANCE: In this era of evidence-based medicine, we provide statistical data supporting the principle that maxillary fungus ball is not associated with osteomeatal complex obstruction and that another as-yet-unexplained mechanism must be responsible. EBM RATING: B-3b.

Localized amyloid deposition in the nasopharynx and neck, mimicking nasopharyngeal carcinoma with neck metastasis.

Amyloidosis results from the deposition of amyloid proteins in organs and tissues. Clinically, it can be classified into systemic and localized forms. Here, we report a case of localized amyloidosis of the nasopharynx and neck. The initial presentation was a nasopharyngeal mass, and bilateral neck masses, mimicking nasopharyngeal carcinoma with neck metastasis. Computed tomographic scans of the neck revealed asymmetry between the bilateral nasopharyngeal walls, and multiple radio-opaque masses in both sides of the neck. A nasopharyngeal biopsy was performed and confirmed amyloid deposition. Subsequent neck-mass excision biopsies confirmed that the neck masses were also amyloid deposits. Further laboratory examinations revealed no systemic involvement. There was no disease progression after local excision. Localized amyloidosis in the head and neck is rare, but can have various manifestations that may sometimes mimic neoplasms.

Oncocytic Schneiderian papilloma.

Oncocytic Schneiderian papilloma, fungiform papilloma, and inverted papilloma are 3 morphologically separate tumors arising from the Schneiderian membrane. Oncocytic Schneiderian papillomas comprise about 3 approximately 5% of this entity. Old-aged group predominates. No sex predilection is noted. Multi-layered eosinophilic epithelium characterizes this kind of tumor. Exophytic and inverted growth pattern is found microscopically. It is often confused with sinonasal adenocarcinomas which contain only single-layered epithelium. Clinically, its behavior parallels inverted papillomas due to local recurrence and coexistence of malignancy. We reported a case of oncocytic Schneiderian papilloma arising from the anterior ethmoid sinus and extending to maxillary sinus antrum. Although destruction of the lamina papyracea was noted preoperatively, no malignancy was found microscopically. We adopted endoscopic approach and removed the tumor thoroughly. External approach was necessary if tumor extent was not feasible to endoscopic approach. The etiology of oncocytic Schneiderian papillomas remains unknown. However, it should be considered in the differential diagnosis of unilateral nasal polypoid lesions clinically.

Tuberculosis of the parotid gland: sonographic manifestations and sonographically guided aspiration.

OBJECTIVE: Involvement of the parotid gland by tuberculosis (TB) is rare. If treated properly, the prognosis of TB of the parotid gland is good. In this retrospective study, we report our experience with sonography and sonographically guided aspiration in the diagnosis of parotid TB. METHODS: Over 12 years, 9 adults (mean age, 48 years) with parotid gland TB had been examined with high-resolution sonography and color Doppler sonography for their clinical problems of swelling on the mandibular angle. Sonographically guided fine-needle aspiration was done for cytologic study, stains for acid-fast bacilli, and cultures for mycobacterium. RESULTS: The sonographic patterns were classified as chiefly the parenchymal type (4 patients) and chiefly the periparotid type (5 patients). The parenchymal type appeared as a diffusely enlarged, comparatively hypoechoic gland (compared with the contralateral asymptomatic gland), with or without focal intraparotid nearly anechoic zones, which might have a cavity or cavities within it. The periparotid type appeared as hypoechoic nodules located in the peripheral zone of the hyperechoic parotid gland, consistent with enlarged periglandular lymph nodes. The diagnosis of parotid TB was made in 8 of 9 patients on the basis of sonographically guided aspiration for acid-fast bacilli stains, cytologic study, and cultures for mycobacterium. CONCLUSIONS: Sonographic examination contributes substantially in the diagnosis of parotid TB infection. In the presence of diffuse parotid echo pattern changes with periparotid lymphadenopathy, and with or without focal hypoechoic zones, TB infection should be differentiated. Sonographically guided fine-needle aspiration may provide further diagnostic information by means of stains, cultures, and cytologic study.

Parosteal osteosarcoma of the mastoid bone following radiotherapy for nasopharyngeal carcinoma.

Radiation-induced tumors subsequent to nasopharyngeal carcinoma are very rare. To date, no post-irradiation parosteal osteosarcoma of the craniofacial bone has been reported in the English literature. In October 2000, a 57-year-old Chinese woman presented 5 years after radiotherapy for nasopharyngeal carcinoma with a 6-month history of a gradually enlarging left postauricular mass. CT scans revealed a densely calcified mass with radiating bony spicules, applied to left mastoid tip. The lesion was excised en-bloc through a postauricular incision. The histologic diagnosis was a parosteal osteosarcoma. Because of inadequate safe margins and the patient refusal of another surgery, 6600 cGy of radiation was subsequently administered to the temporal bone. Post-operative follow-up in 3 years was negative for any evidence of tumor recurrence and post-irradiation complications.

Malignant fibrous histiocytoma of the maxillary sinus presenting as toothache.

Malignant fibrous histiocytoma (MFH) is a high-grade and aggressive sarcoma. It is relatively rare in the head and neck region. Its diagnosis is based on immunohistochemical stains. Wide excision followed by postoperative radiotherapy is believed to be the treatment of choice for MFH. In October 2001, a case of MFH in the maxillary sinus, which presented as a toothache at the beginning, was successfully diagnosed and treated. Using the external approach, the tumor mass was completely removed, and postoperative radiotherapy was subsequently performed. Seventeen months after the surgery, the patient was clinically well without any evidence of local recurrence or distant metastasis.

Madelung's disease.

Madelung's disease is a rare disease of undetermined cause characterized by symmetric deposits of painless, diffuse, subcutaneous adipose tissue on the suboccipital area, the cheeks, the neck, the shoulders and the upper trunk. It is commonest in countries bordering the Mediterranean. The patients are usually middle-aged male alcoholics. Although lesions can initially mimic a head and neck malignancy, management is essentially symptomatic, with conservative removals done as indicated clinically or for cosmesis. Oriental reports about Madelung's disease are very rare. Here a case of Madelung's disease in a 59-year-old male is described. We describe his clinical course and review the literature.

Pilomatricoma of the head and neck: a retrospective review of 179 cases.

OBJECTIVE: To describe the clinical presentations and management of pilomatricoma, formerly known as pilomatrixoma, of the head and neck. DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: The study included 179 patients with a diagnosis of pilomatricoma of the head and neck. INTERVENTION: All patients underwent surgical excision for pilomatricoma of the head and neck between 1991 and 2002. RESULTS: Pilomatricoma occurred at any age (mean age, 29.8 years); 45.3% of the cases occurred in patients younger than 18 years. The female-male ratio was 0.97:1. The average size of the lesion was 1 cm. The most common sites of occurrence were the neck (30.2%), cheeks (16.8%), scalp (16.2%), and brow and periorbital area (14.0%). Multiple occurrence was found in 1 case. Two of 179 tumors recurred after surgical excision. CONCLUSIONS: Because preoperative diagnosis of pilomatricoma is usually incorrect, careful clinical examination and a high index of suspicion would result in a more accurate diagnosis. Complete surgical excision is the treatment of choice. Otolaryngologists should consider pilomatricoma in the differential diagnosis of neck masses.

A huge osteoma of paranasal sinuses with intraorbital extension presenting as diplopia.

Osteoma of the paranasal sinuses is a benign, well-defined and slow-growing tumor arising most commonly from the frontal sinus. The ethmoid and maxillary sinuses are less frequently involved. Very seldom, it may involve the orbit, usually by direct extension from the adjacent paranasal sinuses. We report a case of a huge osteoma in right ethmoid and maxillary sinuses with orbital extension that was accompanied by diplopia in a 20-year-old, previously healthy man. An external approach to the involved sinuses was utilized to remove the tumor completely after a successful maxilloethmoidectomy. The pathologic report confirmed the clinical diagnosis of osteoma. The patient fared well after surgery and his diplopia resolved without any definite cosmetic complications. No residual tumor was found during post-operative follow-up.

Nasopharyngeal lymphoid hyperplasia of an HIV carrier, mimicking nasopharyngeal cancer.

Lymphoid hyperplasia of cervical lymph nodes is a common head and neck presentation of human immunodeficiency virus (HIV) infection. Lymphoid hyperplasia of HIV carrier presenting as nasopharyngeal tumor and neck mass is rarely discussed. We reported a 30-year-old male patient who had left side neck mass for 3 months. Nasopharyngeal cancer with neck metastasis was impressed due to huge nasopharyngeal tumor and neck mass. The patient was then transferred to our clinic for further evaluation. Physical examination revealed a 30 x 30 mm mass over left jugulodigastric area and a 20 x 20 mm mass over left posterior triangle of neck. Telescopic examination revealed a 20 x 20 mm bulging mass over nasopharynx. Nasopharyngeal biopsy was done and histopathologic examination revealed lymphoid hyperplasia. Laboratory survey showed seropositive of HIV infection for both enzyme-linked immunosorbent assay (ELISA) and western blot tests.

Choanal atresia: an unusual serious complication of complementary and alternative medical treatment.

The use of complementary and alternative medicine (CAM) is common among patients with chronic, long-standing nasal disease. Complications resulting from inappropriate CAM practices are sometimes reported, but serious complications such as choanal atresia and stenosis are rare. We report a case of choanal atresia and stenosis due to herbal drug (ie, chemical) cauterization of the nasal cavity in a 39-year-old man. We reviewed the literature on why patients previously given conventional treatment seek alternative therapies. The patient underwent surgical intervention to relieve choanal atresia and stenosis. The postoperative course was unremarkable, and follow-up for 1 year revealed no evidence of restenosis. Choanal atresia and stenosis resulting from CAM treatment are rare. Otolaryngologists should be aware of possible complications occurring in patients receiving such treatments.

Fibrous dysplasia of the ethmoid sinus.

Although craniofacial bone is the second common site of fibrous dysplasia involvement, it is rarely found in the paranasal sinus. Among fibrous dysplasia of the head and neck, the maxilla and mandible are the most frequent sites to be involved. Fibrous dysplasia becomes dormant in adolescence and early adult life and is more common in female. It is one of the fibrous osseous lesions and should be differentiated from osteoma and ossifying fibroma. Radiographically, fibrous dysplasia showed "groundglass" bone appearance on CT scans with bone window. Histopathologically, it presents woven-type bone embedded in a cellular fibrous stroma without osteoblastic rimming. We presented a case of 25-year-old female with fibrous dysplasia in her right side ethmoid sinus. She visited to us with the chief complaint of right side headache since adolescence. The lesion was removed by endoscopic sinus surgery and pathology proved fibrous dysplasia. The patient was free of headache after operation. The advance of endoscopic sinus surgical technique, makes it an optimal method for the pathological diagnosis and treatment to avoid the cosmetic problems caused by external approach in limited paranasal sinus fibrous osseous lesions.

Juvenile xanthogranuloma of the nasal cavity.

Juvenile xanthogranuloma (JXG) is the most common non-Langerhans histiocytosis, but it rarely occurs extracutaneously. It sometimes presents with associated neurofibromatosis and Juvenile chronic myalogenous leukemia. We present a case of nasal JXG and discuss the histological characteristics, the classification, and the management.