Tuberculosis of the nasopharynx: clinicopathological features.

The clinicopathological features of 10 adult patients with nasopharyngeal tuberculosis (TB) are presented. 9 patients had no evidence of chest or systemic disease. 7 patients presented with cervical lymphadenopathy, and only 4 had nasal symptoms. Examination of the nasopharynx showed no abnormality in 2 patients, lymphoid hyperplasia in 4 patients, and a tumour-like mass in 4 patients. These findings suggest that nasopharyngeal TB may occur more frequently as part of an isolated upper respiratory tract infection than as secondary to pulmonary infection. The nasopharynx may be a portal of entry for tubercle bacilli in patients who develop cervical lymphadenitis. Involvement of the nasopharynx by TB may be underdiagnosed because it does not produce obvious symptoms or physical signs in all cases.     

Tuberculosis of the nasopharynx: a rare entity revisited

OBJECTIVES: Tuberculosis of the nasopharynx is uncommon. A large series of 17 cases is reported, and the clinical and pathological features are discussed. STUDY DESIGN: A retrospective review. METHODS: Seventeen archived cases of biopsy-proven nasopharyngeal tuberculosis were reviewed for patient age and sex, presenting complaint and duration, systemic symptoms, cervical lymphadenopathy, and chest x-ray findings. These findings were compared with a compilation of 40 cases reported in the English literature. RESULTS: There was a female predominance (13 women and 4 men), with age range of 20 to 74 years (mean age, 38 y). The most common presentation was enlargement of the cervical lymph nodes (53%), followed by hearing loss (12%), tinnitus, otalgia, nasal obstruction, and postnasal drip (6% each). The duration of the presenting symptoms ranged from 1 week to 1 year (mean duration, 16 wk). Ten patients (59%) had cervical lymphadenopathy, two (12%) had systemic symptoms (fever, weight loss, night sweats), and one patient (6%) had miliary pulmonary tuberculosis. Direct endoscopic examination showed nasopharyngeal mucosal irregularity or mass in the majority of patients (12 patients [70%]). These features were similar to those reported in the literature. CONCLUSIONS: Nasopharyngeal tuberculosis is uncommon, usually occurring without pulmonary or systemic involvement. Cervical lymphadenopathy occurs in more than half of the patients and is the most common presenting complaint; this, together with the nasopharyngeal findings of mass or mucosal irregularity, makes differentiation from carcinoma on clinical examination difficult, necessitating histological evaluation.     

Undifferentiated carcinoma of the nasopharynx: a light and electron microscopical study

Light microscopical study of 29 cases of undifferentiated carcinoma of the nasopharynx showed evidence or origin of the tumour cells from overlying epithelium in IO cases. In all cases the tumour cells had a distincitive cellular appearance of ‘empty’ chromatin deficient nuclei, prominent nucleoli and indefinite cytoplasmic margins. Electron microscopy indicated desmosomes and poorly defined tonofilaments in addition to the above cytoplasmic features. Undifferentiated carcinoma of the nasopharynx shows characteristic light and electron microscopic features which indicate that the tumour cells take origin from squamous epithelium, but are of an extreme degree of dedifferentiation.     

An unusual impacted foreign body in the nasopharynx

Foreign bodies are comonly seen in upper acrodigestive tract but these are lodge very infrequently in masopharywr.various types of foreign bodies like leech whitsle wood piece marble coin etc. have beenremoved from the masopharywr.It is unusual for a foreign body to get impacted in adcnoid tissue of the masopharywr. This article highlights one such rare incidence where a button was impacted in the adenoid mass, which could be retrived only after adenoidectomy     

SURGEON'S WORKSHOP: The Le Fort I osteotomy as an approach to the nasopharynx

Facial deformity is commonly treated by Le Fort I osteotomy. In this case it is used to treat (successfully so far) an extensive tumour of the nasopharynx. The technique was used for its ease of procedure and good exposure of the nasopharynx.     

鼻腔鼻窦窦组织细胞增生症伴巨大淋巴结病的临床病理特征分析

目的 探讨发生在鼻腔鼻窦的窦组织细胞增生症伴巨大淋巴结病(SHML)的临床、病理特征。方法 报道3例鼻腔鼻窦SHML患者的临床资料,总结分析其临床病理特征并进行相关文献复习。结果 发生在鼻腔鼻窦的SHML临床以鼻塞为主。病理组织学特点为在淋巴、浆细胞背景下,可见弥漫浸润的窦组织细胞,局部见“封入”现象。免疫组织化学染色示肿瘤细胞表达CD68、S-100。结论 SHML是一种组织细胞增生性病变,发生在鼻腔鼻窦的SHML非常罕见,临床表现缺乏特异性。病理学诊断为金标准,以手术治疗为主,但效果不佳。     

Adenoid cystic carcinoma of the nasopharynx: 27-year experience

Objective/Hypothesis: Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with special biological features. Clear consensus is not available regarding the clinical characters, management approaches, and prognostic factors. We presented one institution's experience with this tumor and the outcomes of treatment. Study Design: Retrospective clinical analysis. Methods: The medical records of 26 patients with NACC at one institution between 1976 and 2003 were reviewed. Patient records were analyzed for clinical characteristics, management approaches, and outcomes. Survival analysis was performed by Kaplan‐Meier method, comparison between groups was performed using log‐rank test. Results: The lymphatic metastases rate and distant metastases rate were 3.8% and 26.9%, respectively. Epstein‐Barr virus did not have a close relationship to the incidence of NACC. The 5‐year disease free survival rate and overall survival rate (OS) for all patients were 30.3% and 54.8%, respectively. In the stage I, II and III patients, the 5‐year OS were 87.5% and 49.4%, respectively in patients treated mainly by combined surgical treatment with radiotherapy and those treated mainly by radiotherapy. Cranial nerves invasion, advanced stage and nonsurgical treatment indicated a significant worse OS, whereas combined surgical treatment was an independent factor affecting disease free survival rate and OS. Conclusions: NACC is a malignancy with low rate of lymphatic metastases. NACC should be treated by combined surgical operation and radiotherapy. Cranial nerves invasion, stage and treatment approach might be important factors affecting the prognosis of the patients with NACC.     

鼻内窥镜下微波手术治疗鼻咽血管纤维瘤

将微波与鼻内窥镜联合应用治疗鼻咽血管纤维瘤２例，术后出血少，不需输血，出血总量较由经硬腭或鼻腔径路手术显著减少，而且无输血并发症发生，此外，也减轻患者身心痛苦和经济负担，鼻内窥镜术野清洁，明视下可准确，彻底摘除肿瘤，减少复发。     

Low-grade primary mucosa-associated lymphoid tissue lymphoma of the nasopharynx: clinicopathological study

BACKGROUND: Malignant tumors of the nasopharynx are always a challenging problem, both from the diagnostic and from the therapeutic standpoint. Most extranodal lymphomas arise in the gastrointestinal tract, but the other mucosal organs also may be involved, especially the upper aerodigestive tract. Nasopharyngeal lymphomas are rare among lymphoma of the upper aerodigestive tract. METHODS: Twenty-two patients with primary lymphoma arising in mucosa-associated lymphoid tissue of the nasopharynx have been studied with reference to age, sex, clinical symptoms, laboratory finding, radiological finding, histological subtype, and immunohistochemistry. RESULTS: All patients were diagnosed histologically as low-grade lymphoma of mucosa-associated lymphoid tissue type with its characteristic lymphoepithelial lesions and follicular colonization. The tumor cells typically exhibit the following immunophenotypes: positive for CD20, CD45RA, and proliferating markers bcl-2. It was negative for T-cell markers CD45RO (UCHLI). CONCLUSION: Ear, nose, and throat surgeons and pathologists should be aware of this type of lymphoma to avoid misinterpretation and to set up a protocol for its management.     

Cervical tuberculosis: a decision tree for protecting healthcare workers

Objectives/Hypothesis: The clinical presentation of cervical tuberculosis (TB) is a unique challenge to the otolaryngologist. To minimize the risk of nosocomial transmission, otolaryngologists must suspect the diagnosis and be familiar with recommendations for TB prevention. Study Design: Scientific review. Methods: We review current literature and recent changes in TB prevention strategies including the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health‐Care Settings, 2005.” Results: Nosocomial transmission may occur from either unrecognized pulmonary disease or from aerosolization of tubercle bacilli during diagnostic procedures. History of prior TB infection, residence in a country where TB is endemic, close contact with a TB patient, or positive tuberculin skin test should raise suspicion of cervical TB. Physical examination findings may include painless, unilateral cervical lymphadenopathy. Children and human immunodeficiency virus infected patients present unique challenges, as these groups may have atypical presentations. When cervical TB is suspected, the provider should always screen for pulmonary and laryngeal disease. Fine needle aspiration with polymerase chain reaction or culture may accurately identify cervical TB. In rare cases, excisional biopsy may be required. Conclusions: To facilitate interpretation and rapid diagnosis while minimizing risk to health care providers, we provide a decision tree based on new federal guidelines and the clinical experience of a team of infectious disease specialists and otolaryngologists.     

鼻咽及口咽Rosai Dorfman病1例

目的通过Rosai Dorfman病(RDD)患者1例报道,结合文献,分析其临床特征、病理学特点及诊疗方法,提高临床医师对该病的认识水平。方法回顾性分析2017年10月中国医科大学附属第一医院收治的RDD患者1例,该患者在颅底导航指引下行内镜经鼻结合经口径路鼻咽部肿物切除术。术后辅以激素治疗1个月,2019年1月再次发现舌根肿物,行舌根肿物切除术。结果患者手术顺利,术后病理确诊为RDD,局部伤口愈合良好,无出血及咽部狭窄等并发症,随访1年,未见复发。结论确诊RDD病的金标准是病理学检查,临床表现及影像学检查均无特异性。对于呼吸道梗阻、重要部位受压迫的患者,应尽早手术治疗,可术后辅以激素。需要定期随诊。     

Correlation between adenoid–nasopharynx ratio and endoscopic examination of adenoid hypertrophy: A blind, prospective clinical study

Objective

To determine the reliability of adenoid-nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size.

Methods

85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant.

Results

There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0 ± 2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5 ± 12.0% (range, 51-99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87 ± 0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r = 0.511; p < 0.0001).

Conclusions

A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.     

Antimicrobial resistance of Haemophilus influenzae isolated from the nasopharynx of Japanese children with acute otitis media

Conclusion. A high prevalence of penicillin-binding protein gene-mutated (PGM) strains of Haemophilus influenzae should be taken into account when treating otitis media in children. Objective. To evaluate the prevalence of β-lactamase-non-producing ampicillin-resistant strains of H. influenzae with mutations in the ftsI gene encoding penicillin-binding protein 3 (PBP3) among children with otitis media. Material and methods. A total of 644 nasopharyngeal isolates of H. influenzae were collected from pediatric acute otitis media patients with or without otitis media with effusion at the clinics of the Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University Hospital and 6 affiliated hospitals in Wakayama Prefecture between January 1999 and December 2003. MICs to ampicillin (AMP), cefdinir (CFD), cefaclor (CCL), cefpodoxime (CPD) and cefcapene (CFPN) were determined by a microbroth dilution method according to the recommendations of the National Committee for Clinical Laboratory Standards. Types of mutations in the PBP3 gene (ftsI) were evaluated by means of a polymerase chain reaction (PCR)-based genotyping method. The β-lactamase gene (bla) was also identified by means of PCR. Results. β-lactamase-producing (BLP) strains having the bla gene were identified in 16 isolates (2.5%). PGM strains were identified in 279 isolates (43.3%). There were 242 PGM1-non-BLP strains (37.6%) with mutations in the variable mutated locus of ftsI, 35 PGM2-non-BLP strains (5.4%) with mutations in the highly mutated locus of ftsI and 2 BLP-PGM strains (0.3%) with mutations in ftsI that produced β-lactamase. BLP-non-PGM strains producing β-lactamase without mutations in ftsI were identified in 14 isolates (2.2%). MICs of PGM1-non-BLP strains to AMP were 0.5–2.0?µg/ml. The MIC₉₀ of CDN to the PGM1-non-BLP strains was the lowest (0.06?µg/ml). The proportion of PGM1-non-BLP strains increased rapidly during 1999–2002 and then decreased in 2003. In contrast, the proportion of PGM2-non-BLP strains increased in 2003.     

Masses of nasal cavity, paranasal sinuses and nasopharynx: A clinicopathological study

An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Amongst the 240 cases studied, there were 144 cases (60%) of non-neoplastic lesions, 56 cases (23.33%) of benign lesions and 40 cases (16.67%) of malignant lesions. All age groups were involved and the mean age of presentation with the increasing age were: — non-neoplastic (22.5 years), benign tumors (26.8 years) and malignant tumors (35.3 years). The male to female ratio was 1.7:1 for non-neoplastic lesions; 3:1 for benign tumors: and 2.3:1 for malignant lesions. In this study maximum number of cases were present in nasal cavity (65%) followed by paranasal sinuses (20%) and least number of cases involved the nasopharynx (15%). The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.     

Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers

There are many modalities, which are being used for detection of cervical lymph nodes in head and neck cancers clinical examination, computed tomography, ultrasound, magnetic resonance imaging and radionuclide scintigraphy. Various studies in past have highlighted their benefits and drawbacks used singly or in comparison with others. Here we present the study of 100 patients comparing the result of clinical examination, computed tomography and ultrasound.     

Evaluation of mutations in penicillin binding protein-3 gene of non-typeable Haemophilus influenzae isolated from the nasopharynx of children with acute otitis media

Conclusion Younger children tend to harbor more resistant strains because they are exposed to these pathogens more often through contacts with siblings or attendance at day-care centers and are frequently treated with antibiotics. The high prevalence of BLNAR strains should be taken into account in the treatment of AOM in young children. Objective Non-β-lactamase-producing ampicillin-resistant (BLNAR) strains with mutations in penicillin-binding protein (PBP) genes of Haemophilus influenzae have been prevalent recently among younger children. Material and methods We investigated mutations in the ftsI gene encoding PBP-3 of H. influenzae isolated from the nasopharynx of children with acute otitis media (AOM) using polymerase chain reaction (PCR). Results Strains containing the bla gene (β-lactamase-producing ampicillin-resistant) were identified in 4.7% of cases. Strains with mutations in the ftsI gene (BLNAR) were identified in 23.3% of cases. Strains without mutations in the ftsI gene and that did not contain the bla gene (non-β-lactamase-producing ampicillin-susceptible) were identified in 70.7% of cases. Strains with both expression of the bla gene and mutations in the ftsI gene (β-lactamase-producing amoxicillin–clavulanate-resistant) were identified in 1.3% of cases. The MICs of ampicillin against the strains evaluated in this study were 0.5–2.0 μg/ml. Cefditoren-pivoxil had the lowest MIC₉₀ against the strains (0.06 μg/ml). Strains with mutations in the ftsI gene (BLNAR) were broadly identified among young children.     

Distribution of Lymph Nodes in the Neck in Cases of Tuberculous Cervical Lymphadenitis

Objective —To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period.

Material and Methods —This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of >6 weeks duration.

Results —Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and >2 groups in 13% of patients.

Conclusions —These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology.