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1.
Rom J Morphol Embryol ; 63(2): 413-419, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36374146

RESUMO

Currently, allergic rhinitis (AR) is the most common allergic disease worldwide. AR is defined as immunoglobulin E (IgE)-mediated chronic inflammatory disease of the upper airways. It characterizes by symptoms like nasal obstruction, rhinorrhea, nasal itching, and sneezing. The immune system and genetic susceptibility in the interaction with the environment lead to the development of AR. Many cytokines, chemokines and cells maintain allergic inflammation. Studies show that 10% to 30% of the adult population are affected, and that prevalence rates are increasing world widely. AR, nasal polyps (NP), as well as chronic rhinosinusitis (CRS) are all associated with eosinophilic infiltration and large quantities of mast cells (MCs) within the mucosa. The diagnosis and management of chronic sinonasal diseases involves the analysis of eosinophilic infiltration, MCs, and their markers eosinophilic cationic protein (ECP) and tryptase. Regarding nasal cancer, nasal allergies were found to exhibit a dual function: immune surveillance may help in the defense against malignant cells, but an opposite effect is observed in tissues with chronic stimulation and inflammation. In the present paper, we studied a group of 70 patients diagnosed with AR and NP, rhinosinusitis or nasal cancer, admitted to the Ear, Nose & Throat (ENT) Clinic of the Emergency City Hospital, Timisoara, Romania, between January 2016 and December 2020, and we identified 37 (53%) patients diagnosed with AR and NP, 25 (36%) patients diagnosed with AR and rhinosinusitis, and eight (11%) patients diagnosed with AR and nasal cancer. The average age of the patients was 53 years old. Every patient included in the study was histopathologically and immunohistochemically diagnosed.


Assuntos
Pólipos Nasais , Neoplasias Nasais , Rinite Alérgica , Sinusite , Humanos , Adulto , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/patologia , Neoplasias Nasais/patologia , Sinusite/complicações , Sinusite/patologia , Rinite Alérgica/complicações , Rinite Alérgica/metabolismo , Doença Crônica , Inflamação/patologia , Mucosa Nasal/patologia
2.
Indian J Pathol Microbiol ; 65(4): 750-754, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36308175

RESUMO

Aim: The aim of our study is to analyze the staining models for VEGF, p16, and p53, as well as to understand the biology of inverted papilloma caused by smoking. Materials and Methods: Thirty-one cases, diagnosed with sinonasal inverted papilloma between 2015 and 2019, were included. Demographic data such as age and gender, admission symptoms of the patients, and anatomical location, stage, surgical technique, and recurrence information were obtained from clinical follow-up files. Immunohistochemical staining for p16, VEGF, and p53 were performed on patient materials. Results: In our study, the female to male ratio was 9.33 with an average age of 53.137 ± 13.96 years. Of the patients, 17 were nonsmokers and 14 were smokers. No significant relationship was found between smoking status and relapse and dysplasia. In contrast, a significant relationship between the Krouse stage and dysplasia (P = 0.005) was observed. A similar significant relationship was observed between p16 immunohistochemical expression and dysplasia (P = 0.030). On the other hand, VEGF and p53 immunohistochemical expressions were not significantly related with dysplasia and recurrence. Conclusions: Inverted papillomas are benign tumors that clinically give symptoms similar to nasal polyps. However, recurrence and malignant transformation potential exist and the factors causing this risk are not clearly identified. In our study, no malignant transformation was observed in patients who were admitted to our hospital.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Papiloma Invertido/patologia , Proteína Supressora de Tumor p53 , Fator A de Crescimento do Endotélio Vascular , Prognóstico , Recidiva Local de Neoplasia , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/patologia , Transformação Celular Neoplásica , Fumar/efeitos adversos , Estudos Retrospectivos
3.
Indian J Pathol Microbiol ; 65(4): 911-913, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36308205

RESUMO

A 3-month-old boy presented with an intranasal polypoidal mass protruding out of the nostril which was present since birth and growing slowly. The mass was non-pulsatile and soft to firm in consistency. It did not increase in size on coughing, crying, or compression of the jugular vein. Magnetic resonance imaging and contrast-enhanced computed tomography (CT) revealed a lobulated well-circumscribed soft tissue mass in the left nasal cavity with no intracranial communication. Complete surgical excision of the mass was carried out via an intranasal endoscopic approach. Histopathological examination confirmed the diagnosis of intranasal glioma.


Assuntos
Coristoma , Glioma , Pólipos Nasais , Neoplasias Nasais , Masculino , Recém-Nascido , Humanos , Lactente , Pólipos Nasais/patologia , Nariz/patologia , Coristoma/patologia , Glioma/diagnóstico , Glioma/cirurgia , Glioma/patologia , Cavidade Nasal/patologia , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/cirurgia , Neoplasias Nasais/patologia
4.
Ann Ital Chir ; 112022 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-36259423

RESUMO

AIM: To show a rare case of inverted papilloma with bilateral origin treated with endoscopic approach MATERIAL OF STUDY: The authors reported the unusual case of a 71-year-old male patient with a growing mass occupying both nasal cavities. The patient complained bilateral nasal obstruction associated with thick nasal secretions, anterior and posterior nasal drip, snoring and diffuse nasal pain. The biopsy revealed inverted papilloma. RESULTS: CT Scan and RMI of paranasal sinuses showed a bilateral origin of the tumor with a triple involvement on the left side: middle turbinate axilla, frontal recess posterior wall and ethmoidal sinus roof. Nasal endoscopic surgery approach was performed and the tumoral mass was removed completely. DISCUSSION: Inverted papilloma is an uncommon primary nasal tumor that presents three typical characteristics: a high rate of recurrence, local aggressive behaviour and association with malignancy. Although bilaterality is very rare, in this case the neoplasia occupied both nasal cavities with extension to left frontal, sphenoid and ethmoid sinuses. CONCLUSION: The authors, in line with the literature, showed that endoscopic approach represents once again a safe and efficient technique, even for larger tumors. KEY WORDS: Bilateral origin, Inverted papilloma, Paranasal sinuses.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Neoplasias dos Seios Paranasais , Masculino , Humanos , Idoso , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/cirurgia , Neoplasias Nasais/patologia , Endoscopia , Nariz
5.
Comput Biol Med ; 149: 105976, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36067631

RESUMO

BACKGROUND: Inverted papilloma (IP) is a common sinus neoplasm with a probability of malignant transformation. Nasal polyps (NP) are the most frequent masses in the sinus. The classification of IP and NP using computed tomography (CT) is highly significant for preoperative recognition, treatment, and clinical examination. Few visible differences exist between IP and NP in CT, making it a challenge for otolaryngologists to distinguish between them. This study intended to classify IP and NP using a neural network and analyze its ability to discriminate the differences. METHODS: IP and NP in CT were classified using a deep convolutional neural network (CNN) with an attention mechanism, which combines a densely connected convolutional network (DenseNet) and squeeze-and-excitation network (SENet). Using SENet's channel attention, the specific channel weights in the feature maps are improved, which can enhance feature discriminativeness. To discuss the interpretability of SE-DenseNet, we analyzed the heatmap of the final convolutional layer. RESULTS: We evaluated the classification performance of SE-DenseNet on a clinical dataset containing 3382 slices for 136 patients. The experimental results and a heatmap show that SE-DenseNet can effectively locate sinonasal lesions in patients and distinguish IP from NP with an average Acc of 88.4% and AUC of 0.87. CONCLUSION: Otolaryngologists can use the proposed model to diagnose IP and NP in CT because of its accuracy and efficiency. Moreover, the visualized heatmaps produced by the convolutional layers show that the method is reliable.


Assuntos
Pólipos Nasais , Neoplasias Nasais , Papiloma Invertido , Neoplasias dos Seios Paranasais , Humanos , Pólipos Nasais/diagnóstico por imagem , Redes Neurais de Computação , Neoplasias Nasais/patologia , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/cirurgia
7.
Am J Otolaryngol ; 43(6): 103614, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36113312

RESUMO

PURPOSE: Although sinonasal inverted papilloma malignant transformation has not been entirely understood, some studies have suggested that human papillomavirus acts as a potential oncogenic agent in the progression of sinonasal inverted papilloma to squamous cell carcinoma. The purpose of this study was to assess the association between human papillomavirus infection and sinonasal inverted papilloma transformation, taking also into account human papillomavirus types and their distribution in different geographic areas. MATERIALS AND METHODS: The literature from the last 25 years was examined. The systematic review and meta-analysis were performed according to the PRISMA guidelines. RESULTS: A total of 163 malignant sinonasal inverted papilloma and 961 non-malignant sinonasal inverted papilloma were included in the overall analysis. From this sample it was possible to recognize a statistically significant increase in risk of malignancy of sinonasal inverted papilloma for human papillomavirus infection (OR = 2.43, 95 % CI: 1.45-4.08, I2 = 14.0 %). A positive association for patients with high-risk human papillomavirus types was noted (OR = 10.20, 95 % CI: 3.66-28.42, I2 = 15.9 %). In all the 3 geographical areas analyzed the presence of high-risk human papillomavirus significantly increased the probability of malignant transformation. CONCLUSIONS: High-risk human papillomavirus infection plays a key role in the malignant transformation of sinonasal inverted papilloma and its research during histological examination can be of paramount importance. More prospective studies are needed to help further tease out this association.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Infecções por Papillomavirus , Neoplasias dos Seios Paranasais , Neoplasias do Sistema Respiratório , Humanos , Neoplasias dos Seios Paranasais/patologia , Neoplasias Nasais/patologia , Papillomaviridae , Transformação Celular Neoplásica
8.
J Neurol Sci ; 442: 120406, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36081302

RESUMO

PURPOSE: Esthesioneuroblastoma (ENB) is a rare malignant neoplasm of the olfactory epithelium with an estimated incidence of 0.4/million. It can directly extend along the cribriform plate in order to metastasize to the central nervous system. However, non-contiguous intracranial involvement without recurrence at the primary site is extremely uncommon. In this report, the authors review the literature and present a case of non-contiguous intracranial metastasis of ENB without recurrence at the primary site. To the best of our knowledge, this case presents the longest disease-free interval reported in the literature. METHODS: A systematic review of literature was conducted in accordance with the PRISMA guidelines. Additionally, the presentation, surgical management, and post-operative outcomes of an 82-year-old female with non-contiguous intracranial metastasis of ENB after 19 years of remission are described. RESULTS: A total of 137 deduplicated works were identified after the search. Of these, 6 papers satisfied our inclusion criteria for our systematic review. Average age at presentation was 50.8 years (range: 26-66) and 52.6% of patients were female. A majority of cases achieved gross-total resection and received adjuvant radiotherapy for initial treatment. The median interval to intracranial metastasis was 6 years from the time of primary tumor presentation. The median overall survival from ENB recurrence with non-contiguous intracranial metastasis was 11.5 months. CONCLUSIONS: ENB is a highly recurrent tumor and harbors the potential to involve the intracranial space even years after remission. Intracranial involvement entails poor overall survival. Lifetime radiographic follow-up should be considered in all patients with ENB.


Assuntos
Estesioneuroblastoma Olfatório , Neoplasias Nasais , Humanos , Feminino , Idoso de 80 Anos ou mais , Masculino , Estesioneuroblastoma Olfatório/patologia , Estesioneuroblastoma Olfatório/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Intervalo Livre de Doença
9.
Rev Col Bras Cir ; 49: e20223034, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36074390

RESUMO

INTRODUCTION: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. METHODS: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). RESULTS: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. CONCLUSIONS: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.


Assuntos
Neoplasias Nasais , Neoplasias Cutâneas , Brasil , Estudos Transversais , Testa/patologia , Testa/cirurgia , Humanos , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
10.
Am J Rhinol Allergy ; 36(6): 827-834, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35915990

RESUMO

OBJECTIVES: To examine the epidemiology, subtypes, trends over time, and predictive factors for recurrence and malignant transformation of sinonasal papillomas. METHODS: A retrospective chart review of 118 patients with sinonasal papillomas from 2009 to 2019 was conducted at the University of California, Los Angeles. This study is a follow-up to a previously published study from 2000 to 2009 at the same academic center. RESULTS: The mean age was at presentation was 58.5 years, with a 2:1 male to female ratio, and average follow-up of 30.1 months. The rate of recurrence after complete resection was 19% with an average of 32.6 months to recurrence. The time to recurrence followed a bimodal distribution with 57% of cases recurring within 24 months (mean = 10) and 43% from 40 to 103 months (mean = 61). The proportion of the inverted papillomas rose from 38% in 2000-2004 to 89.6% in 2015-2019. Patients presenting at a younger age had a higher chance of recurrence (mean age 52 with recurrence vs. 61 without recurrence). Age did not correlate with histopathologic transformation in surgical pathology. Furthermore, histopathological transformation did not raise the chance of recurrence. Smoking, alcohol use, chronic rhinosinusitis, and allergic rhinitis were not associated with any of the outcome measures in this study. The most significant factor predicting recurrence, beside age at presentation, was the history of two or more prior sinus surgeries for papillomas or other reasons (OR = 3.52 and 5.81). CONCLUSION: This study explored the features of sinonasal papillomas as well as the risk factors for recurrence and transformation. Younger age at presentation and two or more prior surgeries for papillomas were associated with recurrence. Time to recurrence followed a bimodal distribution, with late recurrences happenning from 40 to 103 months after surgery, emphasizing the importance of long-term follow-up for timely resection of tumors and prevention of malignancy.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Neoplasias dos Seios Paranasais , Transformação Celular Neoplásica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Nasais/epidemiologia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Papiloma Invertido/epidemiologia , Papiloma Invertido/patologia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/epidemiologia , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Estudos Retrospectivos
11.
Artigo em Chinês | MEDLINE | ID: mdl-35959585

RESUMO

In this article we reported 13 cases of the substantial nasal mass in children. Among 13 these patients, 3 cases were septal hemangioma, 2 cases were maxillary hemangioma, 1 case was nasal infantile fibromatosis, 1 case was osteoblastoma of the nasal cavity and sinuses, 2 cases were lymphoma of nasopharynx, 1 case was maxillary lymphoma, 1 case was rhabdomyosarcoma of nasopharynx, 1 case was maxillary squamous-cell carcinoma, 1 case was squamous-cell carcinoma of nasopharynx.All 13 cases were treated with surgery, 1 case with nasal infantile fibromatosis, 2 cases with lymphoma of nasopharynx, 1 case with rhabdomyosarcoma of nasopharynx, 1 case with nasopharyngeal carcinoma and 1 case with maxillary carcinoma were taken postoperative radiotherapy and chemotherapy. The most common substantial nasal mass in children was hemangioma. This study included 2 cases with nasal invasive benign tumors, 1 case with nasal infantile fibromatosis and 1 case with osteoblastoma of the nasal cavity and sinuses. The functional nasal endoscopic surgery of mass resection was the main method for the treatment of mass in this area and had achieved satisfied effect. Lymphoma and rhabdomyosarcoma were the most common nasal malignant tumor in children. Nasopharyngeal carcinoma and maxillary carcinoma were not uncommon.


Assuntos
Neoplasias Ósseas , Carcinoma de Células Escamosas , Fibroma , Hemangioma , Linfoma , Neoplasias Nasofaríngeas , Neoplasias Nasais , Osteoblastoma , Rabdomiossarcoma , Carcinoma de Células Escamosas/patologia , Criança , Fibroma/patologia , Humanos , Cavidade Nasal/patologia , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasais/patologia , Neoplasias Nasais/terapia , Osteoblastoma/patologia
12.
Am J Surg Pathol ; 46(11): 1507-1513, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35993580

RESUMO

Sinonasal papillomas are a diverse group of benign epithelial neoplasms of the sinonasal tract. Inverted papilloma, in particular, must be distinguished from other lesions with no malignant potential. The aim of this study was to distinguish sinonasal papillomas from morphologically similar lesions using CD163 immunostaining. Cases from a 19-year period were identified. These included 49 inverted, 10 exophytic, and 12 oncocytic papillomas, 21 chronic sinusitides with squamous metaplasia, 27 inflammatory polyps, 5 verrucae vulgares, 5 respiratory epithelial adenomatoid hamartomas, and 6 DEK::AFF2 carcinomas of the sinonasal tract. A subset of biopsy cases (8 inverted papillomas, 5 inflammatory polyps) was separately analyzed. CD163 immunohistochemistry (IHC) was performed. A unique "circle" staining pattern was identified in the surface epithelium. After locating a hotspot, circles were quantified in 10 consecutive high-power fields. Circles were present in 66/71 (93%) cases of sinonasal papilloma, with a mean of 35 circles/10 HPF (range: 0 to 160/10 HPF) and a median of 19 circles/10 HPF. Circles were present in 20/58 (34%) non-neoplastic cases, with a mean of 2 circles/10 HPF (range: 0 to 27/10 HPF) and a median of 0. Considering all resection and biopsy cases, performance for distinguishing papillomas from non-neoplastic lesions was best at a cutoff of 10 circles/10 HPF (2-tailed P <0.0001) with sensitivity, specificity, positive predictive value, and negative predictive value of 66.2%, 93.1%, 92.1%, and 69.2%, respectively. The results were similar in the biopsy subset. One other neoplastic entity, the DEK::AFF2 carcinomas, also showed prominent CD163 circle staining. In summary, sinonasal papillomas demonstrate extensive CD163 "circle" staining in the epithelium compared with the non-neoplastic lesions studied. As such, the "circle sign" on CD163 IHC may be helpful in distinguishing between diagnoses, particularly on small biopsies or equivocal specimens.


Assuntos
Carcinoma , Neoplasias Nasofaríngeas , Neoplasias Nasais , Papiloma Invertido , Neoplasias dos Seios Paranasais , Antígenos CD , Antígenos de Diferenciação Mielomonocítica , Proteínas Cromossômicas não Histona , Humanos , Neoplasias Nasais/patologia , Proteínas Oncogênicas , Papiloma Invertido/diagnóstico , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/diagnóstico , Neoplasias dos Seios Paranasais/patologia , Proteínas de Ligação a Poli-ADP-Ribose , Receptores de Superfície Celular , Coloração e Rotulagem
13.
Am J Otolaryngol ; 43(5): 103493, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35715292

RESUMO

BACKGROUND: The study was designed with the purpose of showing the potential advantages of the VITOM-3D assisted paramedian forehead flap for nasal reconstruction. METHODS: A 72 years-old female patient presented to our department with a wide left nasal defect. On her clinical history she referred a basal cell carcinoma of the left nasal skin treated with multiple excision in another center without reconstruction. On clinical examination, we observed the absence of the left nasal tip, columella, upper lateral and lower lateral cartilage. In our experience the paramedian forehead flap based on supratrochlear artery is a feasible reconstruction (Shokri, T., et al). The first surgeon (Dr. Placentino) along with the head and neck team decided to reconstruct the nasal defect assisted by the 3D 4 K exoscope (VITOM®; Karl Storz, Tuttlingen, Germany). RESULTS: The goal of reconstruction is to carefully evaluate the nasal defects and rebuild the nose as close as possible to its original shape with the multilayer technique, creating the internal lining, the intermediate bony-cartilage structure and external skin. (Kim, I.A., et al). The exoscope allowed us to reconstruct the inner layer with the mucoperiostal septal flap, middle layer with auricular cartilage and the external skin through the elevation of the paramedian forehead flap. The flap is elevated from cranio-caudal direction including skin, subcutaneous tissue, frontalis muscle and associated fascia or periosteum. Donor site was primarily closed with the exception of a small defect. Post-operative period was uneventful, and after a period of 4 weeks when vascularization was complete, the patient underwent pedicle excision. At the recent 6 months follow-up, the flap had healed completely with the shape of nose restored with good symmetry. CONCLUSION: High-definition (4 K), three-dimensional (3D) exoscope are being used to perform a growing number of head and neck surgeries (Bartkowiak, E., et al). However, the use of the 3D exoscope in the nasal reconstruction has not been previously described. In our opinion the potential advantages of this technique are, firstly, to achieve a better magnification and to improve the vision of anatomical structure that leads to a better functional and aesthetic result, secondly, to reduce surgical times. High-definition allowed us to highlight the scar tissue and preserve as much healthy tissue as possible. In addition, we underline the use of the exoscope for a better remodeling of cartilage.


Assuntos
Carcinoma Basocelular , Neoplasias Nasais , Rinoplastia , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/cirurgia , Cartilagem da Orelha/cirurgia , Feminino , Testa/patologia , Testa/cirurgia , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia
14.
Pediatr Dev Pathol ; 25(5): 562-567, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35732187

RESUMO

Teratocarcinosarcoma is an extremely rare malignancy of the nasal cavity and paranasal sinuses. It exhibits both sarcomatous and carcinomatous components. Less than 100 cases are reported. It presents in adults with only two reported cases in infancy. Here we present a case of 3-week-old female with antenatally detected ocular mass. MRI revealed an exophytic right ocular mass (10 × 7.0 × 7.0 cm) with intracranial extension. The tumor consisted of malignant glands and mesenchymal elements of undifferentiated blastema-like cells and immature neuroepithelium. After an initial diagnosis and treatment for a Wilms tumor protocol, the mass showed no response. A second opinion rendered a diagnosis of sinonasal teratocarcinosarcoma. The patient underwent surgical resection and seven cycles of CNS ICE chemotherapy. A second debulking surgery revealed a very scant viable tumor with post-treatment changes. The patient is alive at 43 months on weekly vincristine maintenance. Molecular testing revealed a somatic CTNNB1 gene mutation. In conclusion, this is a rare and aggressive tumor which showed disease free survival beyond that reported in the literature with the appropriate use of multimodality therapy.


Assuntos
Carcinossarcoma , Neoplasias Nasais , Adulto , Carcinossarcoma/diagnóstico , Carcinossarcoma/genética , Carcinossarcoma/terapia , Feminino , Humanos , Mutação , Cavidade Nasal/patologia , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Vincristina/uso terapêutico , beta Catenina/genética
15.
J Plast Reconstr Aesthet Surg ; 75(8): 2757-2774, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35643599

RESUMO

BACKGROUND: While bilobed and trilobed transposition flaps are established workhorses for nasal reconstruction, their utility is often limited to defects less than 1.5 cm, subjecting patients to more involved multistage or cosmetically less favorable repairs. We highlight the use of bilobed and trilobed transposition flaps for intermediate (≥ 1.5 cm) and large (≥ 2.0 cm) nasal defects. METHODS: Patients reconstructed with multilobed transposition flaps 2017-2020 were identified at two institutions. Validated scar scale (SCAR) and patient component of the patient and observer scar assessment survey (POSAS) were used to assess patient outcomes at a minimum 5-week follow-up. Statistical analyses were performed. RESULTS: Thirty-four patients were identified with mean defect size 1.8 cm diameter. There were no major postoperative events. Scar revision was performed in 9 patients. The mean provider SCAR score was 3.06 (best possible 0, worst possible 13). The mean patient arm of the SCAR scale and POSAS were 0.07 (best possible 0, worst possible 2) and 10.93 (best possible 6, worst possible 60), respectively. CONCLUSION: Bilobed and trilobed flaps have excellent outcomes for intermediate and large nasal defects.


Assuntos
Neoplasias Nasais , Procedimentos Cirúrgicos Reconstrutivos , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Humanos , Cirurgia de Mohs , Nariz/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia
16.
J Cutan Med Surg ; 26(5): 465-472, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35588084

RESUMO

BACKGROUND AND OBJECTIVES: After local flaps, it may be necessary to reconstruct the contour of the nasal ala. This is possible with a single-stage all-layer shaping suture. In the present study, the functional and aesthetic results after single-stage reconstruction of the nasal ala were prospectively evaluated. PATIENTS AND METHODS: Patients who underwent surgery for skin tumors of the nose between 06/2019 and 06/2020 who required reconstruction of the nasal ala as part of the defect closure and had an all-layer suture used were prospectively included in the study. A standardized evaluation of aesthetic and functional outcome was conducted by the patient and a physician at discharge as well as 4 weeks later. Patients additionally underwent a follow-up survey 6 months later. RESULTS: Thirty-seven patients were included in the study. Four weeks postoperatively, all flaps were found to be fully healed and vital. Aesthetic outcome at 4 weeks was rated as very good or good by physicians in 73% and by patients in 78.4%. Persistent complications due to reduced blood flow were not observed. CONCLUSION: The reshaping of the nasal ala as part of the defect reconstruction with an all-layer suture demonstrates very good aesthetic as well as functional results and can be performed in a single-stage procedure. .


Assuntos
Carcinoma Basocelular , Neoplasias Nasais , Rinoplastia , Carcinoma Basocelular/patologia , Humanos , Nariz/patologia , Nariz/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Estudos Prospectivos , Rinoplastia/métodos , Retalhos Cirúrgicos/cirurgia , Suturas
18.
Endocr Pathol ; 33(2): 264-273, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35522392

RESUMO

Sinonasal neuroendocrine neoplasms (SN-NENs) are rare and mostly include neuroendocrine carcinoma (NEC), whereas neuroendocrine tumor (NET) is exceptional in this site. Olfactory neuroblastoma (ONB) is a malignant neuroectodermal neoplasm arising in the nasal cavity. Albeit crucial for correct patients' management, the distinction of high grade ONB from NEC is challenging and requires additional diagnostic markers. The transcription factor SATB2 has been recently introduced in routine diagnostics as an immunohistochemical marker of distal intestine differentiation. No specific data are available about SATB2 and GATA3 expression in SN-NENs. GATA3, SATB2, and, for comparison, CDX2 expression were investigated in a series of epithelial and non-epithelial SN-NENs. We collected 26 cases of ONB and 7 cases of epithelial SN-NENs diagnosed and treated in our Institution. ONBs were graded according to Hyams' system and epithelial NENs were reclassified into 5 NECs, 1 MiNEN, and 1 amphicrine carcinoma. Immunohistochemistry was performed using standard automated protocols. Hyams' grades 1-3 ONBs stained diffusely and intensely for SATB2, whereas grade 4 ONBs and NECs were globally negative. The non-neuroendocrine component of MiNEN and the amphicrine carcinoma were strongly positive. GATA3 was heterogeneously and unpredictably expressed in Hyams' grades 1-3 ONBs, whereas grade 4 ONBs and NECs were completely negative. CDX2 was negative in all cases. Our study identifies, for the first time, SATB2 and GATA3 expression as features of Hyams' grades 1-3 ONBs, expands the spectrum of SATB2 and GATA3-positive neoplasms, and suggests that Hyams' grade 4 ONBs are not only clinically but also biologically different from low graded ONBs.


Assuntos
Carcinoma Neuroendócrino , Estesioneuroblastoma Olfatório , Proteínas de Ligação à Região de Interação com a Matriz , Neoplasias Nasais , Biomarcadores Tumorais/metabolismo , Carcinoma Neuroendócrino/patologia , Estesioneuroblastoma Olfatório/diagnóstico , Estesioneuroblastoma Olfatório/metabolismo , Estesioneuroblastoma Olfatório/patologia , Fator de Transcrição GATA3 , Humanos , Imuno-Histoquímica , Recém-Nascido , Proteínas de Ligação à Região de Interação com a Matriz/metabolismo , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/metabolismo , Neoplasias Nasais/patologia , Fatores de Transcrição
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