Giant destructive sinonasal polyposis.

INTRODUCTION: Authors report their clinical experience in managing a 46-year-old male patient with long lasting nose breathing difficulties caused by nasal obstruction due to a large bilateral tumor masses in both nasal cavities. CASE OUTLINE: Physical examination, laboratory and biochemistry analyses, as well as computed tomography showed an inhomogeneous soft-tissue tumor mass completely filling both nasal cavities, maxillary, ethmoidal, sphenoidal, and frontal sinuses on both sides, accompanied by destruction of bony walls of all sinuses. Preoperative histopathology analysis showed a polyp with squamous metaplasia.The gigantic polypoid mass was removed by bicoronal approach to the frontal and ethmoidal sinuses and by direct approach to the maxillary sinuses and nasal cavity. Definite histopathology analysis confirmed the initial diagnosis, but the presence of fungal hyphae in allergic mucus was also observed. CONCLUSION: Polypoid growth in the nose rarely grow to such gigantic dimensions that it causes destruction of all walls of paranasal sinuses. Considering so far published reports from the literature, the presented case is among the biggest nasal polyps reported until now.

[T lymphocyte function in laryngectomized patients].

AIM: Malignant tumors of the larynx account for 2.3% of all malignancies, while their frequency among tumors of the head and neck ranges between 12% and 20%. Research on the general immune competence in patients with malignant diseases has provided useful insight in the relationship between immune disorders on one side and the clinical course on the other. Unfortunately, only few complete studies have been published so far with this regard in patients with malignant tumors of the larynx, and therefore our study was essentially aimed at establishing of general immunocompetence, presence and levels of the possible immune disorders and their association with the malignant tumors. MATERIAL AND METHOD: The study included forty two patients with primary squamocellular laryngeal cancer. All the patients underwent surgery, out of whom fifteen were treated postoperatively with radiotherapy. We tested the immune competence prior to the operation and in the postoperative period nine months later. In the venous blood we examined T lymphocyte function, monocyte levels and mononuclear phagocyte function. RESULTS: Preoperative evaluation of the presence and levels of general immune competence in patients with laryngeal cancer, showed a distinct decrease in the proliferative response to the PHA mitogen in vitro, with a tendency to normalize in patients who do not develop a relapse of the disease or distant metastasis during the follow-up period. During the whole study period, the number of monocytes and mononuclear phagocyte activity was above the normal level. CONCLUSION: The patients with operable laryngeal carcinoma had considerable immune disorders at various levels, primarily at the level of T lymphocytes. Of all the disorders, reduced mitotic activity of T lymphocytes in response to mitogens showed the highest dependance on the presence of malignant tissue in the organism.