More than Meets the Eye: Aspergillus-Related Orbital Apex Syndrome.

The patient is a 67-year-old Caucasian male with a past medical history of diabetes mellitus type 2, coronary artery disease (CAD) status post stent placement, renal cell carcinoma (RCC) status post left nephrectomy and bilateral adrenalectomy secondary to metastatic disease, and aspergillus pneumonia who was transferred from an outside hospital for evaluation of progressively worsening pulsating right temple and retrobulbar headache. Initial studies ruled out glaucoma, giant cell arteritis, and stroke, or aneurysmal pathology. The only positive finding was right sphenoid sinus disease on imaging that had caused bony destruction and infiltration of the right orbital apex. Broad-spectrum antibiotics were started for bacterial versus fungal sinusitis and the patient was admitted to the medical floor with consultations to Neurology, Otolaryngology (ENT), and Ophthalmology. ENT took the patient emergently to the OR. The final diagnosis was chronic aspergillus sinusitis and right-sided orbital apex syndrome (OAS). Antibiotics and antifungals were optimized by the infectious disease team. ENT also ordered steroid washouts post-operatively with budesonide and saline as well as sinus debridements every couple of weeks.

Human papillomavirus-induced oropharyngeal cancer in Hispanics in the United States.

OBJECTIVES/HYPOTHESIS: Determine disparities in survival outcome and clinical presentation between Hispanic and non-Hispanic white patients with human papillomavirus-positive oropharyngeal squamous cell carcinoma. STUDY DESIGN: Retrospective clinical research. METHODS: Clinical data on Hispanics and non-Hispanic white patients with diagnosis of human papillomavirus/p16-positive oropharyngeal squamous cell carcinoma were drawn from a tumor registry from the University of Miami Hospitals and Clinics from 2008 to 2014. Of 436 patients with oropharyngeal squamous cell carcinoma, 237 patents met inclusion criteria. Patient's age, gender, smoking history, alcohol history, race/ethnicity, tumor T stage, nodal N stage, and composite TNM stage were included in the analysis. Associations between race and other categorical variables were explored with χ2 test or Fisher exact test where appropriate. Survival curves were generated using the Kaplan-Meier method. RESULTS: Significant differences in clinical presentation was detected between Hispanic (N = 70) and non-Hispanic white (N = 167) patients. Hispanic human papillomavirus-positive oropharyngeal squamous cell carcinoma patients showed a higher proportion of women with disease, a higher proportion of patients presenting with tonsil rather than tongue base primary subsite cancer, and a higher proportion of patients who do not consume alcohol compared to non-Hispanic white human papillomavirus-positive oropharyngeal squamous cell carcinoma patients. A statistically significant survival difference between these two ethnic groups was not detected in the current dataset. CONCLUSIONS: Unique differences in clinical presentations between Hispanic patients and non-Hispanic whites with human papillomavirus-positive oropharyngeal squamous cell carcinoma were detected. This may be the first study to report novel clinical presentation in Hispanic human papillomavirus-positive patients with oropharyngeal squamous cell carcinoma living in the United States. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1097-1101, 2017.

Differentiation potential of individual olfactory c-Kit+ progenitors determined via multicolor lineage tracing.

Olfactory tissue undergoes lifelong renewal, due to the presence of basal neural stem cells. Multiple categories of globose basal stem cells have been identified, expressing markers such as Lgr5, Ascl1, GBC-2, and c-Kit. The differentiation potential of individual globose cells has remained unclear. Here, we utilized Cre/loxP lineage tracing with a multicolor reporter system to define c-Kit+ cell contributions at clonal resolution. We determined that reporter expression permitted identification of c-Kit derived progeny with fine cellular detail, and that clones were found to be comprised by neurons only, microvillar cells only, microvillar cells and neurons, or gland/duct cells. Quantification of reporter-labeled cells indicated that c-Kit+ cells behave as transit amplifying or immediate precursors, although we also found evidence for longer-term c-Kit+ cell contributions. Our results from the application of multicolor fate mapping delineate the clonal contributions of c-Kit+ cells to olfactory epithelial renewal, and provide novel insight into tissue maintenance of an adult neuroepithelium.

Dermoid cyst in the facial nerve--a unique diagnosis.

Facial nerve paralysis in children may occur as a complication of infections, trauma, or rarely from benign or malignant tumors of the facial nerve. We present the first reported case of a dermoid tumor in the facial nerve causing facial paralysis in a child. Case report at a tertiary Children's Hospital. A 9-month-old was referred to our institution for evaluation of persistent, complete right sided facial paralysis three months after receiving a diagnosis of Bell's palsy. A workup at our institution including MRI and CT revealed marked widening of the facial canal in the mastoid segment consistent with facial nerve schwannoma or hemangioma. Surgical exploration via mastoidectomy and facial nerve decompression revealed keratinous material containing hair that had fully eroded the facial nerve, disrupting it completely. The entire tumor was removed along with the involved segment of facial nerve, and the missing facial nerve segment was cable grafted. Histological examination of the tumor confirmed a ruptured dermoid cyst in the facial nerve. Facial nerve tumors are rare causes of facial paralysis in children, accounting for fewer than 10% of cases of facial paralysis in the pediatric population. Dermoid cyst can occur throughout the head and neck region in children, but a dermoid tumor in the facial nerve has not been described in the literature prior to this report. This represents a new and uncommon diagnostic entity in the evaluation of facial nerve paralysis in children. Appropriate imaging studies and pathology slides will be reviewed.