鼻窦胆固醇肉芽肿24例

目的探讨鼻窦胆固醇肉芽肿患者的病因、发病机理以及治疗方法。方法回顾性总结分析1996年3月至2003年3月经手术和病理证实的24例鼻窦胆固醇肉芽肿患者的临床资料。结果24例患者中，术前诊断为慢性鼻窦炎10例，鼻窦黏液囊肿8例，鼻息肉或出血坏死性鼻息肉5例，考虑可能为胆固醇肉芽肿者仅l例。主要症状有鼻塞(20／24)、鼻漏(18／24)、嗅觉减退(10／24)、头痛(7／24)、眼眶痛(5／24)、复视(2／24)等。鼻窦CT及MRI提示为慢性鼻窦炎、鼻窦囊肿以及鼻息肉和(或)黏膜息肉样变。所有病例均因保守治疗无效而采取外科手术治疗，即鼻内镜术或Caldwell-Luc术，仅l例行鼻侧切开术。23例手术效果良好，随访1年以上无复发；仅l例Caldwell-Luc术后2年复发，再次行鼻内镜术，术后3年未复发。结论鼻窦胆固醇肉芽肿的病因主要有三：含气腔通气受阻、引流障碍、含气腔出血。鼻窦胆固醇肉芽肿似乎与鼻窦慢性炎性疾病关系密切，尤其是鼻窦黏液囊肿。术式的选择应根据病变范围和程度来决定，其原则是彻底清除病变，保持鼻窦通畅引流。     

Endoscopic or endoscope-assisted surgery for sinonasal malignancy]

OBJECTIVE: To discuss the feasibility and therapeutic efficacy of resection of sinonasal malignant tumours through endoscopic or endoscope-assisted surgery. METHODS: Since 1997, 11 cases of malignant tumours were resected under endoscope or by endoscope-assisted surgery. Among them, 5 patients were followed-up for more than 3 years, including one case of nasal septum squamous cell carcinoma; one case of ethmoid sinus squamous cell carcinoma; one case of maxillary sinus adenoid cystic carcinoma and two cases of olfactory neuroblastoma. RESULTS: In the patients who were followed-up for more than three years, no local recurrence was found. There was only one case of cervical lymph node metastasis found on a patient with olfactory neuroblastoma 2. 5 years after resection. Four years after operation, this patient was suspected to have extensive metastasis in meninges, and only palliative treatment was suggested. CONCLUSIONS: By endoscope or by endoscope-assisted surgery, some of selected sinonasal malignant tumours can be thoroughly resected. The advantages are mini-invasive and avoidance of facial scar so as to improve the quality of life (QOL) of patients. Large amount of cases, random clinical study with lone- term follow-up are still needed to verify the feasibility and efficacy of endoscopic or endoscope-assisted surgery.     

内镜下或内镜辅助下的鼻腔-鼻窦恶性肿瘤手术

目的　探讨内镜下或内镜辅助下切除鼻腔 鼻窦恶性肿瘤的可行性和手术效果。方法总结 1997年起 ,在内镜下或内镜辅助下施行鼻腔 鼻窦恶性肿瘤手术的 11例患者的临床资料 ,并对部分术后患者进行随访 ,其中 5例手术后随访时间在 3年以上。 5例患者中行鼻中隔鳞状细胞癌 (简称鳞癌 )切除术 1例 ,行筛窦鳞癌切除术 1例 ,行上颌窦腺样囊性癌切除术 1例 ,行嗅神经母细胞瘤切除术 2例。结果　术后随访时间超过 3年的 5例均无局部复发 ,仅 1例嗅神经母细胞瘤术后 2年 8个月出现左侧颈淋巴结转移 ,术后 3年 10个月出现广泛的脑膜侵犯。结论　内镜下或内镜辅助下可以彻底切除经过选择的鼻腔 鼻窦恶性肿瘤 ,优点是创伤小 ,避免了颜面部瘢痕 ,提高了患者的生存质量 ,但还有待于进一步开展大样本、随机分组、长期随访的临床研究     

Ancient schwannoma of the nasal septum associated with sphenoid sinus mucocele

Schwannoma is a benign tumor arising from the sheath of myelinated nerve fibers and may occur in any part of the body. Ancient schwannoma, a variant of schwannomas, in the head and neck region is uncommon, and its occurrence in the nasal cavity and paranasal sinuses is extremely rare with only one case reported to date. Herein, we describe a rare case of sinonasal ancient schwannoma. The tumor arose from the nasal septum and extended to the sphenoid sinus. It was successfully treated by endoscopic sinus surgery, and the patient showed no evidence of recurrence 24 months postoperatively.     

Paraganglioma of the maxillary sinus

Primary paragangliomas of the paranasal sinuses are very rare conditions with only few cases described in the literature. Paragangliomas are locally aggressive, often recur and can metastasize. Usually, open surgery is used to resect such tumors from the sinonasal tract. Here, a case of a large paraganglioma of the left maxillary sinus and nasal cavity, which was successfully removed using the Onyx^® embolic agent two days prior to minimally invasive image guided endoscopic sinus surgery, is reported. This case demonstrates that large vascular tumors of the sinonasal tract can be successfully managed by endoscopic endonasal sinus surgery. The patient has no evidence of recurrence after 12 months of follow-up.     

上颌窦胆固醇肉芽肿(附2例报告)

为探讨胆固醇肉芽肿形成的机理，报告２例发生于上颌窦的胆固醇肉芽肿。该病的常见症状是鼻阻塞，严重者可引起骨质破坏。其病因可能源于上颌窦窦口阻塞、粘膜息肉样病变内部出血或上颌窦囊肿瘤壁内胆固醇沉积。文献复习表明：窦腔通气不良，长期的炎症渗出或出血可导致胆固醇肉芽肿的形成。治疗主要是行上颌窦根治术，以达到永久治愈的目的。     

Malignant schwannoma of the sinonasal tract

Malignant Schwannoma of the sinonasal tract is an extremely rare tumour. So far, only 19 cases have been reported in the literature. We report herein a case of malignant schwannoma involving nasal cavity, maxillary antrum and ethmoid sinus in a 60-year-old male patient. The patient was treated with surgery and post-operative radiotherapy. He currently remains free of the disease 15 months after the diagnosis and twelve months after completing therapy.     

Sarcomatoid carcinoma in the sinonasal cavity: A retrospective case series from a single institution

ObjectivesSarcomatoid carcinoma (SC) is rare in the sinonasal cavity with poor prognosis. This study aimed to summarize the clinical characteristics, treatment and prognosis of patients with sinonasal SC from a single tertiary medical center.MethodsRetrospective review of the clinical data of seven patients diagnosed with sinonasal SC from May 1988 to February 2021.ResultsSeven patients with SC in nasal cavity and paranasal sinus, including six males and one female, aged 34-77 years (mean, 58.3 years), were included in this case series. The common presenting symptoms included epistaxis and nasal obstruction. The tumor usually occurred in nasal cavity, maxillary sinus and ethmoid sinus. Most patients were diagnosed at advanced stages with the involvement of orbit and skull base. Open and endoscopic surgery were performed in five and two patients, respectively. The follow-up period ranged from 3 to 26 months. Four patients died of disease within one year, though two received adjuvant chemotherapy and one received radiotherapy. Two patients survived without recurrence at the end of follow-up, both of them underwent adjuvant radiotherapy. One patient received palliative re-irradiation due to local recurrence of the tumor three months after the surgery, however, this patient was lost to follow-up.ConclusionsSinonasal SC is a rare entity with an aggressive behavior and poor prognosis. Early diagnosis and multimodality treatment are recommended to improve the survival.     

Primäres sinunasales Ameloblastom bei einer 49-jährigen Frau

Sinonasal ameloblastoma is a rare tumor, which most frequently affects male patients in the 6th–7th decade. We report on the case of 49-year-old female patient presenting with nasal obstruction. Computed tomography revealed a solid and hypodense mass filling the maxillary sinus and the nasal cavity. The histological examination showed a plexiform ameloblastoma without significant bone erosion. Viewing this together with the literature review, we suggest that sinonasal ameloblastoma in female patients becomes apparent approximately one decade earlier than in male patients. This tumor should be considered in the differential diagnosis of unilateral sinonasal symptoms.     

The role of endoscopic sinus surgery in chronic sinonasal sarcoidosis

The aim of this study was to define a role for endoscopic sinus surgery (ESS) in the treatment of chronic sinonasal sarcoidosis. All patients seen for sinonasal sarcoidosis in an otolaryngology practice in a tertiary care center from 1991 to 2000 were reviewed. Of 86 patients, 6 were treated with ESS for an operative rate of 7%. Surgeries were performed on those patients with significant sinonasal anatomic blockage. This included nasal obstruction from nasal polyposis and chronic and recurrent acute sinusitis from granulomatous lesions of the ostiomeatal complex. Patients remained symptom free for years after surgery on a nasal steroid regimen. Endoscopic sinus surgery is a viable treatment for those few patients with nasal obstruction or chronic sinusitis due to anatomic blockage from sinonasal sarcoidosis. Although it does not eradicate the disease or prevent recurrence, it does markedly improve quality of life by relieving severe symptoms and reducing the need for systemic steroids. This is the first study to advocate a role for surgery in sinonasal sarcoidosis beyond biopsy and management of complications. Although it may not be the appropriate approach for every patient, ESS certainly should be considered in the treatment options.     

鼻腔鼻窦鳞状细胞癌中细胞质凋亡抑制蛋白2和半胱氨酸蛋白水解酶4的表达

OBJECTIVE: To examine the expression of apoptosis-related genes c-IAP2 and caspase-4 in sinonasal squamous carcinoma. To investigate the role and mechanism of the two apoptosis-related genes in nasal cavity and sinus squamons carcinoma. METHODS: Forty-one pathologically confirmed specimens of nasal cavity and sinus squamons carcinoma were subjected for immunohistochemical staining to analyze the expression of c-IAP2 and caspase-4, in addition 10 normal nasal mucosa were used as control. RESULTS: The positive rate of c-IAP2 in sinonasal squamons carcinoma was 87.8%, among which 14 cases were strongly stained(+ + +), 15 cases were stained(+ +), 7 cases were stained (+), only 5 cases were negative. In 10 normal control tissues, no case was stained(+ + +), 2 cases were stained (+ +), 3 cases were stained(+), the other 5 cases were negative. Higher level expression of c-IAP2 protein was detected more often in squamons carcinoma specimens than that in normal nasal mucosa. There was statistically significant difference between the two groups for the staining(P < 0.05). The expression of c-IAP2 was not correlated with clinical staging (P > 0.05), but there were positive correlation with clinical prognosis (P < 0.01) and pathological classification (P < 0.01); The positive rate of caspase-4 in nasal cavity and sinus squamons carcinoma was 58.5%, among which 4 cases were strongly stained (+ + +), 7 cases were stained (+ +), 13 case was stained(+), 17 cases were negative. The expression of caspase-4 protein was more deletion in squamons carcinoma specimens than that in control group, there was statistically significant difference between the two groups for the staining (P < 0.05). The expression of caspase-4 protein was negatively correlated with clinical prognosis (P < 0.01) and pathological classification ( P < 0.01), not correlated with clinical staging(P > 0.05). The expression of c-IAP2 was negativelly correlated with the experssion of caspase-4. CONCLUSIONS: The results indicates that in sinonasal squamous carcinoma, c-IAP2 is activated, while caspase-4 is restrained, the signal transduction pathway of apoptosis is arrested, leading to surviving of tumor cells, this maybe directly associated with the development of sinonasal squamons carcinoma, and with the failure of tumor trentment.     

Primary non-Hodgkin's lymphoma of the frontal sinus: case report and review of the literature

Non-Hodgkin's lymphoma of the sinonasal tract is an uncommon lesion, representing 1.5 to 15% of all lymphomas. Most cases of primary non-Hodgkin's lymphoma of the sinonasal tract occur in the maxillary sinus, ethmoid sinus, and nasal cavity; its occurrence in the frontal sinus is extremely rare. We report a case of primary type B non-Hodgkin's lymphoma of the frontal sinus in a 43-year-old man. The patient complained of frontal headaches that had not improved with analgesic drugs, and he presented with a frontal bulge that involved the left upper eyelid; the bulge had progressively enlarged over a 3-month period A biopsy of the mass identified the type B non-Hodgkin's lymphoma. Immunohistochemical study not only confirmed the histologic type of the tumor, it also provided some important information about the primary tumor site. Advances in immunohistochemistry have shown that type B non-Hodgkin's lymphoma is more common in North American and European patients, whereas subtype T is more common in Asians and in some Latin Americans. The treatment of this condition is still controversial, but the combination of radiotherapy and chemotherapy has yielded the best results in all stages of the disease.     

Sinonasal disease in patients with sarcoidosis.

Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.     

Cholesterol granuloma of the posterior ethmoid sinus mimicking meningocele

Cholesterol granuloma is usually associated with chronic middle ear disease, less common in the orbit, and rare in the paranasal sinus. Cholesterol granuloma is thought to be initiated by hemorrhage, impaired drainage, and interruption of aeration. Here we report a case of cholesterol granuloma arising in the posterior ethmoid sinus mimicking meningocele. Magnetic resonance imaging is useful for differential diagnosis, and endoscopic surgery is effective for the management of cholesterol granuloma arising in the ethomoid sinus.     

Cholesterol granuloma of the maxillary sinus resembling an invasive,destructive tumor

The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. Radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.     

复发性鼻腔及鼻窦恶性黑色素瘤的治疗

目的 探讨鼻腔及鼻窦恶性黑色素瘤复发的原因和治疗方法.方法 回顾性分析1993～2003年我科收治的11例复发性鼻腔及鼻窦恶性黑色素瘤患者的临床资料.结果 临床误诊或误治引起的复发患者4例,病理明确手术治疗后复发7例,其中5例为单纯手术后复发,2例为手术加术后放疗后复发.11例复发病例中,局部复发局限于鼻腔及鼻窦7例;局部复发侵犯眼眶、颅底、软腭及硬腭1例;局部复发侵犯腮腺和皮肤1例;面部、眼眶及颅底广泛侵犯者1例;颈部淋巴结转移复发1例.首次复发时间最短为治疗后10个月.所有病例再次手术治疗后的累积生存率为:1年生存率72.7%,2年生存率18.2%,3年生存率9.1%.结论 减少误诊,选择适当的治疗方法是提高复发性鼻腔及鼻窦恶性黑色素瘤治愈的主要手段.     

Effects of endoscopic sinus surgery on nasal spray deposition using dye-based methods for humans and a human silicone sinonasal cavity model

ObjectiveWe have evaluated that the deposition patterns of corticosteroid nasal spray in the sinonasal cavity of both post-operated human cases, which were further compared with a computed tomography-based sinonasal airway model.MethodsFifty-one patients with chronic rhinosinusitis following an endoscopic sinus surgery were enrolled in this study. Nasal spray mometasone furoate hydrate (Nasonex®) containing 0.1% indigocarmine was applied to the patients' nasal cavities and the sinonasal cavity was observed by endoscopy and video documentation. A single plaster sinonasal model was used to quantify the sinonasal deposition of nasal sprays containing 10% red ink solution using 12 round paper strips.ResultsThe predominant areas of the spray deposition of the operated sinonasal cavities were recognized in the ethmoid sinus and the olfactory cleft in the human study. The droplets were mainly deposited in the inferior turbinate followed by the posterior part of the ethmoid sinus, the olfactory cleft, and anterior part of the ethmoid sinus in a sinonasal model.ConclusionThe corticosteroid nasal spray efficiently reached the olfactory cleft and the ethmoid sinus in post-operative conditions, which was demonstrated by post-operated human cases and a computed tomography-based sinonasal airway model.     

Prevalence of rhinosinusitis among atypical cystic fibrosis patients

The objective of this paper is to study the correlation between sinonasal involvement and type of cystic fibrosis (CF) in Israeli’s CF patients. The comparative study includes 70 CF patients: 40 typical and 30 atypical CF patients. History and physical examination data were recorded, including endoscopic nasal examination as well as sinus computer tomography scan. The data collected from the two groups were statistically analyzed. Twenty-seven percent of atypical CF patients compared with 2.5% of typical CF patients had CF presenting symptoms of chronic rhinosinusitis (CRS) or obstructive nasal polyps (p < 0.001). Although severe CRS was found slightly more often in patient with atypical CF (43 vs. 32.5%), this difference did not reach statistical significance. Nine patients with severe CRS underwent endoscopic sinus surgery. Among these patients, six (66.6%) had atypical CF and only three (33.3%) had typical CF (p = 0.09). In conclusion, severe CRS is a common diagnosis among patients with typical and atypical CF disease. In the current study, no significant difference in the frequency of CRS was found between the two groups. High awareness toward the diagnosis of atypical CF, careful medical history focusing on sinonasal involvement and physical examination, including nasal endoscopy, for all CF patients (typical and atypical CF) may contribute to an early detection and treatment of significant sinonasal involvement, and may improve the quality of life of the patients.     

上颌窦胆固醇肉芽肿5例分析

目的：探讨上颌窦胆固醇肉芽肿的病因、发病机制以及治疗方法。方法：所有患者均行上颌窦根治术。结果：所有患者均病理诊断为鼻窦胆固醇肉芽肿,随访2个月～12年,均未见复发。结论：本病病因为高血脂症,含气腔通气受阻,引流障碍。确诊需要病理检查,治疗上应对高脂血症进行干预与治疗,手术可以根治。