US in preoperative evaluation of parotid gland neoplasms.

Salivary gland neoplasms account for only 3% of all tumors of the head and neck area, but as they represent a wide variety of histological types, they are a big diagnostic challenge. The cornerstone of salivary gland neoplasm treatment, both for the benign and malignant lesions, is surgery. The main goal of the therapy is not only to achieve complete surgical tumor resection, but also to preserve adjacent structures (facial nerve, parapharyngeal space structures). Ultrasonography is an examination commonly used in the preoperative diagnosis of the lesions localized within salivary glands. Very often it is the only diagnostic imaging method used in these cases. The aim of the study was to establish diagnostic value of US examination and its parameters for the assessment of parotid gland tumors. A prospective study was performed on a group of 51 patients with parotid gland neoplasms, who over a period of 3 years underwent surgery in Otolaryngology and Laryngological Oncology Department with Craniomaxillofacial Surgery Department of Central Clinical Hospital of Ministry of Defence in Warsaw. All the included patients underwent US examination in the preoperative period. The parameters selected for the assessment were: ill-defined tumor margins, tumor vascularity and the presence of enlarged regional lymph nodes. The results of imaging examination were compared to the final diagnosis based on pathological examination of the surgical specimen. The parameters of the US examination such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the evaluation of parotid gland tumors were established based on the examination results. An analysis was performed and ill-defined parotid tumor margins turned out to be a US parameter with higher diagnostic value for differentiating benign and malignant lesions than increased tumor vascularity. The presence of enlarged regional lymph nodes with blurred echostructure on the US examination had little value for differentiating lesions. The sensitivity of the US examination in terms of detecting malignant parotid gland neoplasms increased significantly in the setting of simultaneous assessment of several parameters.

[Bleeding as an initial symptom of tonsillar carcinoma]. / Krwawienie pierwszym objawem raka migdalka podniebiennego.

The authors present the case of the patient suffering from recurrent bleeding from the palatine tonsil. A visual and tactile examination did not reveal any alteration to the tonsil. Following three recurrent bleeding episodes, we conducted an examination of the vessels (through MRI including vessel option) and consequently ruled out any possible presence of vessel alterations in the tonsil and in the adjacent tissues. Subsequently tonsillectomy was carried out. The histopathological examination revealed the presence of carcinoma in the tonsil's flesh, whereas the mucosa of the tonsil remained unaltered. Over the period of six months the patient had repeatedly been examined by experienced head and neck surgeons, none of whom found any abnormalities in the tonsil. No other symptoms of the tonsil carcinoma were detected in the patient. The authors underscore the rare occurence of the abovementioned symptoms in carcinoma of the tonsil. They note, however, that certain number of patients with the branchiogenic cyst exhibit the abovementioned symptoms of the tonsil carcinoma.

[Sudden sensorineural hearing loss as the first symptom of multiple sclerosis. Review of literature and case report]. / Nagla gluchota czuciowo-nerwowa jako pierwszy objaw stwardnienia rozsianego. Przeglad pismiennictwa i opis przypadku.

Sudden sensorineural hearing loss is rarely the first manifestation of multiple sclerosis (MS). In the presented case of a 31-year-old woman, sudden hearing loss in the left ear was the first monosymptomatic manifestation of the disease. Based on clinical evaluation and MRI, we diagnosed the relapsing-remitting variant of MS. The several-month long observation of the patient included noting the fluctuations in the patient's hearing capability in correlation with the continuously abnormal auditory brainstem responses.