Glioma of the sphenoid sinus in an adult

Benign congenital lesions resulting from the deficient regression of neuroglial tissue in normal embryonic development are called gliomas. They are usually located in the nasofrontal region and are diagnosed in the postnatal period. They are included in the differential diagnosis of nasofrontal midline masses. We review the case of a 62 year-old woman who was originally studied for a polypoid mass in the left nasal cavity. CT revealed occupation of the left ethmoidofrontal recess and turbinate by a glioma. We report this case as a rare finding in a 62 year-old woman because of its importance in differential diagnosis. We reviewed craniofacial gliomas.     

Nasopharyngeal glioma in a new-born girl

Nasal gliomas are uncommon tumours of neurogenic origin that occur sporadically. They are diagnosed with MRI and a preoperative biopsy, and surgery is the treatment of choice. Most of the gliomas emerge from the nasal cavity, but only a few cases of nasopharyngeal gliomas have been reported. We present one case of a nasopharyngeal glioma and two cases of nasal gliomas.     

Nasofrontal abscess following rhinoplasty

Infections are the most common objective complication following rhinoplasty. They may remain localized, extend intracranially, or result in generalized septicemia. The most common infections involve the skin and subcutaneous tissues of the nose. We report an uncommon case of nasofrontal abscess following a rhinoplasty that required aggressive surgical and medical treatment.     

Nasal glial heterotopia: embryological and clinical approaches

INTRODUCTION: Nasal gliomas or heterotopia are nonhereditary congenital malformations composed of heterotopic neuroglial tissue. They usually present in infancy. Evaluation should include preoperative imaging with CT scan and/or MRI to rule out intracranial extension. There have been several cases reported in which nasal gliomas were misdiagnosed as capillary hemangiomas. The differential diagnosis includes prenasal space developmental impairment, which are nasoethmoidal meningoencephaloceles, nasal dermoid and epidermoid cysts. CASE REPORT: We describe the case of a newborn male infant presenting at birth with a paramedial nasal glioma. An embryological and clinical analysis of nasal gliomas is proposed. DISCUSSION: Nasal glioma is an uncommon congenital lesion presenting as a large panel of midline craniofacial anomalies. The embryological and anatomical origins of nasal gliomas are reviewed. The most known embryological theory was described by Grünwald in 1910 and is called the "prenasal space" theory. This theory is very attractive because of the embryopathogenic continuum proposed among dermoids, gliomas, and encephaloceles. In this article, we discuss major embryological theories on nasal gliomas pathogenesis and propose that while the prenasal space theory can explain the occurrence and the continuum between basal anterior or prenasal encephaloceles and gliomas, it cannot explain the occurrence of craniofacial demoids of the same topography. Better knowledge of embryological mechanisms implicated in the pathogenesis of nasal gliomas can help clinical management of this kind of malformations.     

Malignant schwannoma of the ENT area

Malignant schwannomas are uncommon in the head and neck. They are derived from Schwann cells of cranial, cervical or sympathetic nerves and occur as solitary tumours or in association with neurofibromatosis (von Recklinghausen's disease). We present a patient of 30 years of age with a tumour of the right nasal and paranasal sinus system and a 68-year-old woman with the first described intratracheal malignant epitheloid Schwannoma. After the diagnosis of a malignant Schwannoma wide surgical excision is the recommended treatment, depending on the individual case, eventually followed by radiation therapy. As the tumour is more aggressive in patients with neurofibromatosis, the prognosis is better for patients without neurofibromatosis.     

Extraosseous chordoma of nasopharynx in paediatric age

Intracranial chordomas are relatively rare locally aggressive tumours that probably originate from embryonic remnants of the notochord. They typically arise from the sacrum and secondly in the skull base/clivus region. When skull base chordomas occur at an extraosseous location (without lytic bone destruction), they may mimic other lesions of the nasopharynx. We present a case of primarily extraosseous chordoma in paediatric age, involving the nasopharynx, to improve preoperative diagnosis and postoperative management of this rare tumour.     

Clival giant cell tumor presenting with isolated trigeminal nerve involvement

Giant cell tumour (GCT) constitutes about 5 % of all skeletal tumors. They rarely occur in the skull. When involved, they preferentially involve the sphenoid or temporal bones. Skull-base GCTs generally present with multiple cranial nerves involvement, most commonly sixth followed by the third cranial nerve. We describe a case of clival GCT presenting with an isolated trigeminal nerve involvement in a 19-year-old man which was managed by surgery and adjuvant radiation. At 18 months of follow-up, the patient is clinically asymptomatic. Clival GCT should also be considered in the differential diagnosis of any isolated trigeminal nerve palsy. Adjuvant radiation has an important role to play in managing this tumour.     

Follicular dendritic cell sarcoma arising from the hypopharynx

Follicular dendritic cell (FDC) tumours have been described recently as malignant tumours arising from accessory cells of the lymph nodes. They are rare tumours with fewer than 70 cases occurring worldwide. They usually present in cervical or abdominal lymph nodes, with very few occurring extranodally. We present the first case of an FDC tumour to occur in the hypopharynx with simultaneous cervical node metastases. The pathology is discussed and the literature reviewed.     

Surgical Anatomy of the Nasofrontal Duct: Anatomical and Computed Tomographic Analysis

Objectives Although complete anatomical knowledge of the nasofrontal duct has been of great importance, little is known about it. The aim of this study is to examine the drainage site of the nasofrontal duct and to investigate the anatomical boundaries of the nasofrontal duct according to the drainage site. Study Design One hundred sagittally divided adult head specimens were analyzed by computed tomography and dissection under the surgical microscope. Methods Computed tomography scans of 50 adult cadaver heads were taken sagittally at 1‐mm intervals and coronally at 3‐mm intervals to find the nasofrontal duct. One hundred specimens, made up of sagittally divided adult cadaver heads, were dissected under the microscope to study the structure of the nasofrontal duct. Results We identified the anterior, posterior, medial, and lateral boundaries of the nasofrontal duct. In the most common type, the superior portion of the uncinate process formed the anterior border and the superior portion of the bulla ethmoidalis formed the posterior border of the nasofrontal duct. The conchal plate formed the medial border and the suprainfundibular plate formed the lateral border of the nasofrontal duct. Other variations are described in detail. Conclusions To widen the nasofrontal communication, removing the upper portion of the ground lamella of the ethmoid bulla, which is the posterior boundary of the nasofrontal duct, with cutting forceps seems to be a safe and easy method.     

Anterior skull base reconstruction after tumour resection using the posterior wall of the frontal sinus

IntroductionThe authors describe their experience of surgical closure of the anterior skull base after tumour resection, using the posterior wall of the frontal sinus.Material and methodThe authors describe their anterior skull base closure technique performed in three patients after tumour resection. Tumour resection via a transglabellar approach resulted in an anterior skull base defect. Reconstruction consisted of direct implantation of the posterior wall of the frontal sinus without using a bone substitute (except when nasofrontal duct obstruction is required).ResultsThree patients were operated by this surgical procedure with complete tumour resection in every case and no infectious complications. This technique was easy to perform, despite one case of persistent CSF leak. Follow-up imaging showed no displacement of the onlay bone graft.ConclusionAnterior skull base reconstruction after tumour resection using autologous frontal sinus bone graft is easy to perform with a low complication rate.     

Schwannoma of larynx — a rare presentation

Neurogenous tumours of the larynx are extremely uncommon. Schwannoma of larynx is a variant of neurogenous tumour. The patient underwent microlaryngoscopic excision of that tumour. We present here the clinical findings of the case, along with direct laryngoscopic view, the photograph of the mass after removal and histological slide compatible with the diagnosis of schwannoma.     

Benign pedunculated tumours of the hypopharynx. 3 case reports, 1 with late malignant transformation

Benign pedunculated tumours of the hypopharynx are very rare. Only a few cases of hypopharyngeal fibrolipomas have been reported. This paper adds 2 more cases with characteristic clinical features. We also present a case of recurrent fibromatous tumours of the hypopharynx with malignant change after 20 years. Malignant transformation of an originally benign hypopharyngeal tumour is extremely unusual. The clinical and pathological aspects of pedunculated benign tumours of the hypopharynx are discussed. Symptoms and signs are few and uncharacteristic. The diagnosis is difficult and often delayed. There is a risk of suffocation by laryngeal obstruction by the tumour. When the accurate diagnosis is established, the treatment of choice should be a lateral pharyngotomy with complete removal of the tumour. Long-term follow-up is recommended.     

Primitive neuroectodermal tumour of the tongue

Peripheral primitive neuroectodermal tumours, which belong to the Ewing sarcoma tumour family, are extremely rare. These tumours are highly aggressive and are known to have a poor prognosis. Immunostaining with at least two neural markers and evidence of an abnormal t(11;22)(q24;q12) translocation are hallmark features in this diagnosis. We present the first reported case of peripheral primitive neuroectodermal tumour to occur in the tongue.     

Nasal glioma and ala defects

Congenital nasal mid-line masses are rare, and nasal gliomas account for approximately 5% of all of them. They are benign lesion containing “ectopic brain tissue” Encephaloceles and gliomas are thought to have a close embryological origin and faulty closure of the anterior nasopore is suggested as a possible explanation. We present the case of an eight month old male who presented to us at Great Ormond Street Hospital for Sick Children, London. He had a left sided nasal glioma and also an ipsilateral ala notch. Only two other reference were found commenting on this unusual link between nasal glioma’s and ipsilateral ala defects. This association perhaps suggests an alternative more complex embryological origin to the nasal glioma.     

Endolymphatic sac tumours

We present a case of a papillary tumour of the petrous bone. The established terminology for this rare neoplasm is endolymphatic sac tumour (ELST) but the true origin remains controversial. ELSTs are associated with von Hippel-Lindau disease. They are locally invasive, highly vascular and often require endovascular embolization prior to surgery. Both radiologically and histologically ELSTs are easily mistaken for other more common tumours such as paragangliomas and renal or papillary thyroid carcinoma metastases. This is important because local excision is curative.     

Paediatric granular cell tumour of the larynx: case report of laser resection with frozen section

Granular cell tumours of the larynx are a very rare cause of persistent hoarse or husky voice in children. We report the case of a 13-year-old girl who presented with a three-year history of progressively huskier voice. We discuss the presentation, location and diagnosis of the tumour. In addition, we present a method of surgical treatment of the tumour, involving the hitherto unreported technique of laser excision and frozen section of the lesion.     

Lymphangioma of the larynx

Lymphangiomas are uncommon congenital lesions of the lymphatic system. Most of these lesions present in infancy or early childhood with a swelling in the head and neck region. We report a case of adult lymphangioma of the larynx. We also discuss the presentation, diagnosis and management of this tumour, and we present the current debate on sclerotherapy versus surgery for these tumours.     

Schwannoma of the larynx: case report

Neurogenous tumours of the larynx are extremely uncommon. We present a rare case of schwannoma of the larynx. Clinical findings are presented together with computed tomography (CT) and magnetic resonance images. The tumour was located in the right aryepiglottic fold of the larynx. CT showed a well defined and hypodense mass extending from the right aryepiglottic fold to the right vocal cord. The patient underwent an excision of the mass through a lateral thyrotomy and the tumour was completely removed. The diagnosis and treatment of this tumour are discussed. Received: 11 May 2000 / Accepted: 5 September 2000     

Giant cell tumour of the hyoid--first reported case

Giant cell tumours of bone are most commonly found in the epiphyses of weight-bearing long bones. They are rarely found in the head and neck and only 17 cases involving the laryngeal framework have been reported. To date, there have been no reports of a giant cell tumour arising from the hyoid bone. We present such a case which presented as a lump overlying the greater cornu of the hyoid, review the literature and discuss the management of this locally aggressive tumour.     

Dysphagia secondary to invasive candidiasis of a jejunal free flap

The presence of a mass in a jejunal free flap that causes dysphagia less than two years after a pharyngolaryngectomy for carcinoma usually indicates tumour recurrence. We present a case of invasive candidiasis of a jejunal free flap presenting with dysphagia and a mass. To our knowledge this is previously unreported. Such a cause should always be considered in the differential diagnosis, as early recognition and treatment are likely to result in a favourable outcome.