Transcatheter arterial embolisation for paediatric inflammatory pseudotumour of the maxillary sinus.

BACKGROUND: Inflammatory pseudotumours are mostly seen in the lung, and occasionally in the head and neck region including the sinonasal area. Reported treatment modalities comprise corticosteroid treatment, surgical excision and radiotherapy. The latter option is required because wide surgical resection may be difficult for head and neck lesions, especially in children. However, clinicians should be aware of the risk of late-onset side effects of radiotherapy in children. CASE REPORT: We present a two-year-old girl with a massive inflammatory pseudotumour of the maxillary sinus. Transcatheter arterial embolisation was performed, and the lesion was successfully managed without additional therapy. There was no evidence of recurrence over the next five years. CONCLUSION: This is the first report presenting the utility of arterial embolisation for inflammatory pseudotumour.

Vascular supply with angio-CT for superselective intra-arterial chemotherapy in advanced maxillary sinus cancer.

Recently popularised, the combined angiography and CT (angio-CT) system is useful for correctly identifying the feeding arteries and their perfusion in various organs. We applied this system for advanced maxillary cancer to expose its feeding arteries and their supplying territories. In addition to the maxillary artery, extramaxillary feeding arteries were usually observed, including the ophthalmic, accessory meningeal, facial, transverse facial and ascending palatine arteries. These extramaxillary feeding arteries exhibited uniform tendencies, depending on the site of extramaxillary tumour extension.

Superselective intra-arterial chemotherapy for advanced maxillary sinus cancer: an evaluation of arterial perfusion with computed tomographic arteriography and of tumor response.

OBJECTIVE: The purpose of our study was to elucidate the relationship between arterial perfusion in advanced maxillary sinus cancer which was opacified by superselective intra-arterial computed tomographic arteriography (IA-CTA) and the tumor response to intra-arterial chemotherapy. METHODS: Superselective IA-CTA was performed to identify the feeding arteries and their perfusion in advanced maxillary sinus cancer in 10 patients. Cisplatin was selectively infused into these feeding arteries, except for the internal carotid artery. RESULTS: The results were assessed in 9 of the 10 patients, and a complete response was achieved in 5 patients in whom either the entire tumor, or most of the tumor, was perfused by the branches of the external carotid artery. In 4 patients with a partial response, the residual tumors were seen in the territory of the perfusion defect or in the perfusion territory of the internal carotid artery. CONCLUSION: Superselective IA-CTA is a useful technique to correctly identify the intratumoral perfusion and to predict tumor response to the intra-arterial chemotherapy of advanced maxillary sinus cancer.

[Expression of adhesive molecules, angiogenesis markers and protein products of suppressor genes in neoplasms of oral cavity and maxillary sinus]. / Ekspresja czastek adhezyjnych, wskazników angiogenezy i produktów bialkowych genów supresorowych w nowotworach jamy ustnej i zatok szczekowych.

INTRODUCTION: Adhesion molecules, angiogenesis markers and protein products of suppressor genes are potential prognostic indicators in different type of tumours. The purpose of this study was to analyze relations between expression of these markers and clinical as well as histological features of oral cavity and maxillary sinus tumours. MATERIAL AND METHODS: Measurements of expression of CD44, TP53, Nm23 oncoproteins and angiogenesis markers were performed. Forty-three patients treated in years 1985-2000 in the Department of Maxillofacial Surgery of the University Hospital in Wroclaw entered our study. Thirty-two of them were treated for oral cavity cancers. Remaining eleven patients were treated for maxillary sinus cancers. RESULTS: We have shown, there was a positive correlation between the number of the vessels and presence of the nodal metastases; between histological grading and VCAM expression; between CD44 expression and total surface area of the blood vessels. There was also correlation between total surface area of the blood vessels and patients' survival time.

VEGF and bFGF expression and microvessel density of maxillary sinus squamous cell carcinoma in relation to p53 status, spontaneous apoptosis and prognosis.

We have previously reported that p53 mutations, loss of bax expression or decreased spontaneous tumor apoptosis were associated with poorer prognoses in maxillary sinus squamous cell carcinoma (SCC)(Cancer 94: 1968-1980, 2002). In the present study, we analyzed tumor angiogenesis monitored by expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and tumor microvessel density, in correlation with p53 status, spontaneous apoptosis or disease prognosis in the same group of 70 maxillary sinus SCC patients. Tumor biopsy specimens obtained prior to initiation of treatment were examined for expression of VEGF and bFGF and tumor microvessel density using immunohistological methods. Average vessel density (AVD) (range: 3-75; median: 25) and maximum vessel density (MVD) (range: 4-125; median: 53) were assessed by the number of microvessels stained with anti-CD31 mAb in tumor lesions. VEGF was expressed in 35 (50%) of 70 patients and bFGF was in 43 (61%). Patients with VEGF expression showed significantly higher levels of MVD than those without VEGF expression (57 vs. 38; P=0.019). The VEGF expression was observed more frequently in patients with p53 overexpression and/or mutation than in those with normal p53 status (P=0.048). The MVD inversely correlated with the apoptotic index (AI) defined as the number of single stranded (ss)-DNA-positive cells per 1000 tumor cells (r= -0.23; P=0.022). Patients with neck lymph node and/or distant metastases after surgery showed significantly higher levels of MVD than patients without any metastasis (64 vs. 42; P=0.048). Low histological effectiveness of radiochemotherapy correlated with bFGF expression (P=0.0059). To clarify actual prognostic factors for maxillary sinus SCC, we selected 57 patients treated uniformly with preoperative radiochemotherapy followed by maxillectomy. Kaplan-Meier analysis showed that survival was significantly worse in patients with high MVD (> or =80) than in those with low MVD (<80) (P=0.042). These data suggest that the VEGF expression in association with the p53 overexpression and/or mutations may cause increased microvascularity, decreased spontaneous apoptosis or metastases, while the bFGF expression may be associated with resistance to radiochemotherapy, thereby resulting in poorer prognoses in maxillary sinus SCC. VEGF and bFGF expression and tumor microvessel density in tumor lesions were analyzed in 70 patients with maxillary sinus squamous cell carcinoma. The VEGF expression dependent of p53 overexpression and/or mutations was associated with angiogenesis, decreased spontaneous tumor apoptosis and metastases, while the bFGF expression was associated with resistance to radiochemotherapy, resulting in poor prognosis.

[Digital subtraction angiography and selective arterial embolization in the treatment of vascular tumors in nasopharynx and nasal sinuses].

The paper presents the treatment of vascular tumors in nasopharynx and nasal sinuses with digital subtraction angiography (DSA) and selective arterial embolization. By using preoperative embolization of blood supply arteries, the intraoperative bleeding was reduced significantly, the tumors were shrank and the tumor limits were clear. We recommend that DSA and selective arterial embolization should be used as a routine preoperative method adjunct to surgery for the treatment of vascular tumors of nasopharynx and nasal sinuses.

Juvenile angiofibroma of the maxillary sinus. A case report.

The clinicopathological features of a rare case of juvenile angiofibroma originating from the maxillary sinus of a 13-year-old boy are reported. This tumor was composed of angiomatous and fibrous structures. The analysis of nucleolar organizer regions (NOR) of the various components of this tumor indicated that the fundamental elements were the fibroblastic cells, rather than the vascular endothelial cells.

Real-time digital subtraction angiography for therapeutic neuroradiologic procedures.

Procedural control during therapeutic neuroradiologic procedures is generally based on repeated angiograms to assess the degree to which embolization has reduced abnormal blood flow. Due to the complex craniofacial skeletal anatomy that is superimposed over lesions in this area, subtraction studies are usually required to see the vessels and visualize a tumor stain satisfactorily. We have used a device incorporating continuous recursive digital video filtration, which allows the operator to view a subtracted fluoroscopic image of each control angiographic sequence in real time. The advantages of this technique for therapeutic procedures are described.