Steroid resistance in nasal polyposis: role of glucocorticoid receptor and TGF-beta1.

BACKGROUND: Glucocorticoids (GCs) are considered drugs of choice for treating nasal polyps (NPs). However, a subset of patients shows a limited clinical response even to high doses of GCs. Altered expression of glucocorticoid receptors (GRs), namely GR-alpha; and GR-beta;, is a potential mechanism underlying GC insensitivity. GCs modulate the expression of several cytokines, including transforming growth factor-beta (TGF-beta), which may contribute to cellular proliferation in NPs. The study investigates some biomolecular features of GC-resistant NPs, and examines possible differences from normal mucosa (NM). METHODOLOGY: Radioligand binding assay (binding) was used to determine GR-alpha; binding capacity; Western blotting was used to evaluate GR-alpha;, GR-beta;, and TGF-beta; expression and GR-alpha; subcellular distribution. NPs were sampled in 32 patients during ethmoidectomy; NM was taken from 15 healthy patients during rhinoplasty. RESULTS: GR-alpha; was present in NPs and NM, with lower affinity for the ligand in NPs. GR-alpha; was prevalent in the cytosol of NPs that were GR-alpha-negative to the binding assay. GR-beta was expressed in NPs and absent in the majority of NM. TGF-beta1 expression was higher in NPs than in NM. CONCLUSIONS: GR-beta and TGF-beta1 might be involved in NP pathogenesis, but their role in modulating GC sensitivity is still unclear.

Intracranial complication of rhinosinusitis from actinomycosis of the paranasal sinuses: a rare case of abducens nerve palsy.

Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.

Hyalinizing trabecular tumor of the thyroid: a case report.

Hyalinizing trabecular tumor (HTT) of the thyroid is a rare neoplasm that was first described by Carney in 1987. It is a tumor of follicular derivation with peculiar nuclear, architectural, histochemical, and immunohistochemical features. We report a case of HTT in a 69-year-old woman with a mutinodular goiter. Since the clinical and ultrasonographic features were nonspecific, fine needle aspiration biopsy (FNAB) of the left lobe-dominant node was performed that resulted in an indeterminate cytologic diagnosis (category THY-3). The patient underwent total thyroidectomy, with a histologic diagnosis of HTT. We discuss the clinical and diagnostic approach, including the role of FNAB, and the pathologic features of HTT with special reference to the possible differential diagnosis. Total thyroidectomy or hemithyroidectomy represent adequate treatments, while radioiodine ablation is not standard. Although rare cases of malignant HTT have been documented, this tumor should be considered a benign neoplasm or, at most, a neoplasm of extremely low malignant potential. As a consequence, once this diagnosis is rendered, clinical management should be conservative, which may include a precautionary annual follow-up in order to exclude the very rare possibility of recurrence, as exceptionally reported.