Acinic cell carcinoma of maxillary sinus

Acinic cell carcinoma is a tumor that occurs most commonly in the parotid glands. We have experienced a rare case of acinic cell carcinoma of the left maxillary sinus. The patient was a 71-year-old female. She noticed her left nasal congestion and epiphora from left eye in April 1994. She had a history of left maxillary sinus surgery in February, 1972. Antrotomy was performed and histopathological examination of specimen from the maxillary sinus proved acinic cell carcinoma. The tumor was considered to be the recurrence 22 years after initial surgery, because it coincided with the surgical specimen of previous surgery. Radical resection of maxilla was performed for complete resection of tumor with palate reconstruction by left scapula and latissimus dorsi myocutaneus flap. No recurrence is observed for more than 4 years after surgery. Although this tumor is of low grade malignancy, complete resection with adequate surgical margin is advisable due to high incidence of this tumor to recur after long periods of time.     

Maxillary sinus carcinoma: the only symptom was neck lymph node swelling

OBJECTIVE: Since maxillary sinus is composed of bone structure, the main symptoms of maxillary sinus carcinoma are related to the anatomical feature and the destructive lesion of the bony wall, such as cheek pain and nasal obstruction. METHODS: We report a female case with undifferentiated carcinoma in the right maxillary sinus, only appearing cervical swelling which was revealed as lymph node metastasis. RESULTS: CT and MRI findings showed just maxillary sinusitis with minor bone destruction. However, fluorine 18-labelled deoxyglucose positron emission tomography (FDG-PET) was useful for the detection of the primary site. The patient received concomitant chemoradiotherapy, and showed a complete response both in the primary site and neck lymph nodes. She has no recurrence for 18 months after the primary therapy. CONCLUSION: The main symptoms of maxillary sinus carcinoma are related to the local progression, and known to have less cervical lymph node metastasis. However, like the present case, there is a rare case that has no symptom and organic features associated with the local mass. With the best use of advanced diagnostic technique, e.g., FDG-PET, we could diagnose and treat atypical maxillary sinus carcinoma patients.     

Rhabdomyosarcoma of the maxillary sinus. A case report

A rare case of adult rhabdomyosarcoma originating from the left maxillary sinus is reported. A 22-year-old Japanese woman was referred to the Department of Otolaryngology, Hiroshima University, for investigation of the primary source of a metastatic tumor in the bone marrow. An X-ray of the sinuses revealed a tumor in the left maxillary sinus with extension into the nasal cavity, ethmoidal and sphenoidal sinuses. The patient was managed with a chemotherapeutic regimen consisting of high-dose methotrexate, adriamycin, vincristine, cyclophosphamide and prednisolone. After three courses of this chemotherapy, the tumor had decreased in size by about 90 per cent, as indicated by X-rays. The remaining tumor was removed by an extended Denker's operation. Following the surgery another seven courses of chemotherapy were given and during the eight months following the operation the patient has been free from any local recurrence.     

Sinonasal cystic adenoid carcinoma with epiphora and orbital involvement. Report of a case and review of the literature

We report the clinical case of a 41 years old male with nasal obstruction of 1 year, epistaxis and epiphora. The ENT exam showed a bleeding red mass in left nasal fossa and CT joint to IRM revealed a tumoral process on that level and informed about its extension to adyacents structures (cavum, ethmoides, sphenoids and maxillary sinus). The biopsy was positive for cystic adenoid carcinoma. Our patient was operated by paralateronasal rhinotomy with removal of the tumor. One year later we found recurrence on the left orbital floor and maxilar sinus. The Oncology Department informed that it was not possible a treatment with radiotherapy or chemotherapy because the low sensitivity of that lesion those treatment.     

鼻腔鼻窦腺样囊性癌放疗后诱发未分化多形性肉瘤1例报道

目的 总结鼻腔鼻窦腺样囊性癌放疗后诱发未分化多形性肉瘤(UPS)的诊疗经验.方法 回顾性分析1例鼻腔鼻窦腺样囊性癌术后4年放疗诱发未分化多形性肉瘤患者的临床资料,并结合文献进行分析.结果 患者于2015年1月行鼻侧切开上颌骨大部分切除术,术中完整切除肿瘤,术后病检结果提示为左侧上颌窦腺样囊性癌,术后规律行放化疗,201...     

儿童上颌窦异位脑膜瘤4例报告并文献复习

目的：探讨儿童上颌窦异位脑膜瘤的临床表现及诊治方法。方法：对4例儿童上颌窦异位脑膜瘤的临床资料进行回顾性分析并复习文献。结果：4例患儿表现为进行性鼻塞,其中1例伴有眼球突出,临床检查4例于鼻腔外侧壁可见类球状新生物,黏膜光滑,质硬。CT检查显示,上颌窦鼻腔新生物高密度影,边界清楚,周围可见骨质吸收。治疗均于全身麻醉下手术切除,3例采用面中翻揭术,1例采用鼻侧切开术,随访4～6年无复发。结论：CT对上颌窦异位脑膜瘤的诊断有重要意义,完整切除肿瘤是治疗儿童上颌窦异位脑膜瘤的最佳方法。     

泪道置管联合鼻内镜下上颌窦内壁扩大切除术治疗上颌窦占位性病变

目的探讨和完善鼻内镜下彻底切除鼻腔、上颌窦内占位性病变,降低术后复发率的手术方法。方法回顾分析1999年1月至2008年12月在我院经泪道置管联合鼻内镜行上颌窦内壁扩大切除术治疗的上颌窦占位性病变且随访资料完整的69例的临床资料。术中先行泪道置管,并应用动力系统切除鼻腔内瘤体,切除上颌窦内壁大部,在30°镜下于肿瘤基底部周围骨膜下剥离肿瘤,局部骨骼化,用电刀烧灼基底部残余软组织,以防止复发,术后长期随访。结果患者均在鼻内镜下随访。1例鼻内翻性乳头状瘤患者于术后4个月复查时发现后组筛窦内复发,咬除肿物后用电刀烧灼,随访至今未见复发。1例淋巴瘤术后半年死于广泛转移。其余67例经随访1~9年,未见复发,无溢泪及其他并发症,治愈率为97.10%。鼻内翻性乳头状瘤患者与对照组行Caldw ell-Luc手术或鼻侧切开术治疗相比较,治愈率差异有统计学意义(P0.05)。结论在正确选择适应证的前提下,泪道置管联合鼻内镜下上颌窦内壁扩大切除术可有效切除上颌窦占位性病变,可作为上颌窦占位性病变的首选术式。     

Fibrous dysplasia with cystic appearance in maxillary sinus

Fibrous dysplasia (FD) in the paranasal sinuses is uncommon, and its management may be difficult. We report the case of a 25-year-old female with FD exhibiting a cystic appearance in the maxillary sinus. The patient had been complaining of facial swelling for few years. Imagery study showed a cystic lesion and dense bone changes in the maxillary bone. Inferior meatal antrostomy with a nasal endoscope failed to confirm a histological diagnosis. After a 3-year follow-up, the degree of facial swelling was unchanged, and the patient underwent middle meatal antrostomy and was diagnosed with FD.     

Ewing's sarcoma/primitive neuroectodermal tumour occurring in the maxillary sinus

A 12-year-old boy complained of swelling of the left cheek. Fiberscopic examination revealed the presence of a soft reddish mass in the middle meatus of the left nostril. CT scan showed a large mass completely filling the left maxillary sinus. The lesion originated from the maxillary sinus and extended to the middle nasal meatus; bone destruction and invasion of the subcutaneous tissue of the cheek were noted. T2-weighted MRI images revealed a heterogeneous signal in the left maxillary sinus. Under general anaesthesia, biopsies were obtained through an intraoral incision. On pathology, atypical cells containing irregular nuclei with scanty cytoplasm were noted. The tumour cells were strongly positive for CD99 and reacted weakly with NSE however the cells were negative for synaptophysin, LCA and cytokeratin on immunohistochemical examination. Based on these findings, the tumour was diagnosed as a Ewing's sarcoma/primitive neuroectodermal tumour. The patient was treated with radiotherapy and combination chemotherapy; subsequently, the tumour's size decreased markedly. After 20 months of follow-up, the patient showed no evidence of local tumour growth or metastasis.     

Brown tumors of the jaws associated with primary or secondary hyperparathyroidism. A clinical study and review of the literature

PURPOSE: The aim of this article is to present the development of brown tumors in the jaws as a definite feature of hyperparathyroidism (HPT), whether primary or secondary. PATIENTS AND METHODS: The study included 2 cases of primary HPT and 3 cases of secondary HPT associated with brown tumors in the jaws. The patients presented in our clinic at the "G. Papanikolaou" Hospital in Thessaloniki for treatment of their disease. The patients were 4 women and 1 man, and patient's ages ranged from 21 to 76 years. Four cases of the brown tumors involved the mandible, and 1 case involved the maxilla and the maxillary sinus. The surgical excision of bone lesions and treatment of primary or secondary HPT were performed on the patients in our study. RESULTS: Patient 1 (primary HPT, caused by an adenoma of the right parathyroid glands) was treated with surgical removal of the maxillary lesion and excision of the adenoma. Three years later, the patient is free of the disease, with no recurrence of the brown tumor. Patient 2 (primary HPT, caused by an adenoma of the right parathyroid glands) was treated with excision of the adenoma. One year later, a second bone lesion developed in the mandible, and 3(1/2) of the fourth parathyroid (right) glands was removed. The patient is being observed. The other 3 patients with brown tumors associated with secondary HPT were treated with excision of the bone lesions; HPT was treated with hemodialysis (2 patients) and renal transplantation (1 patient). For the patients treated with hemodialysis, the disease is under control and there is no recurrence of the brown tumors. The patient who underwent transplantation is free of the disease 7 years later. CONCLUSIONS: Primary or secondary HPT may be recognized by the presence of an osteolytic lesion with giant cells, a condition referred as "brown tumor." The most useful therapy for patients with brown tumors is surgical excision of bone lesions and therapy (surgical or medical) for primary or secondary HPT.     

Solitary neurofibroma of the maxillary sinus

Neurofibromas are benign tumours of peripheral nerve tissue, frequently associated with neurofibromatosis type I. Their isolated occurrence in the maxillary sinus is rare, with only 6 cases described in the literature. We present the case of a 70-year-old woman who consulted for left hemifacial paresthesias of 10 years' evolution. CT showed a heterogeneous lesion in the left maxillary sinus, eroding its lateral wall without signs of infiltration. Endoscopic surgery with nasalisation of the maxillary sinus was performed. The pathology was neurofibroma (positive for S-100 protein and vimentin). After 18 months, no tumour growth has been found.     

Aneurysmal bone cyst of the mandible

The aneurysmal bone cyst (ABC) is a benign, solitary lesion of bone which is most commonly found in the long bones and vertebral column. Its occurrence in the mandible is uncommon. Because of its infrequent appearance, the ABC may be mistaken for neoplastic lesions. In the past, management has consisted of curettage, cryotherapy and local resection. In this publication we present a case of ABC of the mandible. We include a review of the literature, a discussion of the etiology, pathogenesis and management of this interesting lesion.     

Respiratory epitheloid adenomatoid hamartoma of the nasal cavity--case report and review of the literature

BACKGROUND: Hamartomas are tumour-like malformations, resulting from excessive proliferation of otherwise normal local tissue components. Hamartomas of the nasal cavity and paranasal sinuses are relatively rare, especially respiratory epithelial adenomatoid hamartomas. This benign lesion is characterized by a glandular proliferation originating from the surface of the respiratory epithelium. In the German speaking literature this entity has not been described before. PATIENT AND RESULTS: We report the case of a 51-year-old white female, presenting with a respiratory epithelial adenomatoid hamartoma of her left nasal cavity. The patient suffered from nasal obstruction. The CT scan showed a soft tissue like lesion obstructing the patient's left choana. After local resection of the tumour, which originated from the superior turbinate through functional endoscopic sinus surgery the patient's symptoms were gone. Follow-up after six months showed no evidence of recurrence. CONCLUSION: The histopathological differential diagnosis of respiratory epithelial adenomatoid hamartomas includes inverted papilloma and adenocarcinoma. Therefore the histological recognition of these hamartomas impacts on therapy. Misinterpretation as a true neoplasm may result in unnecessarily radical surgery. Local surgical resection is the treatment of choice for this lesion.     

Caldwell—Luc进路联合鼻内镜治疗上颌窦病变

目的 探讨治疗上颌窦良性病变较好的手术方法。方法 采用传统的Caldwell—Luc手术进路与鼻内镜手术联合治疗39例上颌窦病变。上颌窦息肉12例，其中伴鼻腔筛窦息肉7例，出血坏死性息肉3例，上颌窦后鼻孔息肉2例；上颌窦、筛窦息肉术后复发9例；慢性上颌窦炎3倒；真菌性上颌窦炎7例；上颌窦囊肿5例；上颌蜜内翻性乳头状瘤2例；上颌窦炎性假瘤1例。结果 39例经6个月～3年的随访，治愈32例（82．1％），好转6例（15．4％）．1例炎性假瘤术后1个月复发并发眶内感染，总有效率为97．4％。结论 Caldwell—Luc手术联合鼻内镜治疗上颌窦病变。视野清楚，操作方便．既能彻底清除病变，叉保证了窦内黏膜纤毛系统功能的恢复，减少了复发率。     

A case of invasive paranasal aspergillosis that developed from a non-invasive form during 5-year follow-up

Invasive paranasal aspergillosis has been previously reported, but there have been no case reports of non-invasive paranasal aspergillosis that progressed to the invasive form during follow-up. A case of non-invasive aspergillosis of the maxillary sinus that appeared to become invasive during 5-year follow-up is reported. The patient was diagnosed as having non-invasive aspergillosis at the first visit because CT images revealed only mucosal thickening and calcifications in the right maxillary sinus. Five years later, CT images showed an invasive mass lesion in the orbit and large bone destruction of the posterior wall of the maxillary sinus. The patient was rescued by total removal of the orbital contents with zygomatic ostectomy followed by appropriate antifungal chemotherapy irrespective of residual tissue invasion. We would propose that appropriate surgical treatment and antifungal agents are necessary to improve the prognosis of invasive aspergillosis.     

Odontogenic myxoma of the maxillary

INTRODUCTION: Odontogenic myxoma is a rare benign tumor that arises from the mesenchymal portion of the tooth germ. It has a va-riable non-specific clinical and radiological appearance, and may be confused with other lesions such as ameloblastoma. CASE REPORT: We describe the case of a young, African male patient with a large odontogenic myxoma of the maxillary. The patient presented a painless firm swelling of the left maxillary. The radiograph showed a radiolucent lesion that was compatible with several diagnoses. DISCUSSION: The diagnosis was based on clinical, radiographic and histopathologic features. This tumor is locally aggressive, inducing important facial deformation and tooth displacement. Radical treatment with surgery or prosthesis is needed due to the high rate of recurrence.     

鼻内开窗术治疗巨大上颌骨囊肿的临床察

目的探讨鼻内开窗术治疗巨大上颌骨囊肿的临床疗效。方法选择术前穿刺并且经鼻窦CT及MRI检查诊断为上颌骨囊肿的患者5例,囊肿均大于3.5 cm,所有患者采用鼻内镜下鼻内开窗术,根据囊肿与鼻腔、鼻窦的毗邻关系,分别选择鼻底开窗术、下鼻道开窗术,必要时行泪前隐窝开窗术,手术切除囊壁,其中2例患者因囊肿局限、主要靠近鼻底而选择单纯鼻底开窗术;2例患者因囊肿波及上颌窦内而选择下鼻道开窗术,其中1例术前因牙痛就诊,术后建议拔除患牙;1例患者因囊肿位置特殊,靠近上颌窦前壁因而行下鼻道开窗术联合泪前隐窝开窗术,对位缝合切口,术后予以碘仿纱条压迫及盐水冲洗,清理术腔,保证开窗口通畅引流。结果5例患者均未出现严重并发症,术后3个月左右囊腔上皮化,术后随访半年,窗口引流通畅,未见复发。结论鼻内开窗术是一种简单并且常用的手术方式,具有出血少、创伤小、复发率低等优点,保证开窗口通畅引流是减少上颌骨囊肿复发的关键。     

A large atypical osteoma of the maxillary sinus: a report of a case and management challenges

An osteoma within the paranasal sinuses is a rare benign fibro-osseous tumour. Osteomas occurring in the maxillary sinus are exceedingly rare and account for only 5% of the cases. A case of a 38-year-old female with an osteoma of the maxillary sinus is presented and the disease and its management are discussed. A 2 cm spherical lesion in her right maxillary sinus was picked up incidentally on a magnetic resonance imaging scan whilst being investigated for unrelated neurological symptoms and in the absence of any sinonasal symptoms. An endoscopic biopsy demonstrated that the mass was an osteoma. The management of paranasal sinus osteomas is surgical and is governed by patient symptoms, tumour size and location, in the light of the risk of future intracranial or intraorbital complications. The choice of surgical approach is determined by the location of the tumour and, the experience of the surgeon. In this case a combined external and endonasal approach was the most appropriate management due to the size of the tumour and the risk of intraorbital complications. The patient underwent a combined Caldwell-Luc and transnasal endoscopic resection without complication.     

Pneumosinus dilatans of the maxillary sinus: a case report and review of the literature

Pneumosinus dilatans (PSD) is an abnormal dilatation of one or more of the paranasal sinuses and must be included in the differential diagnosis of expansile lesions of the sinonasal tract. The frontal and sphenoid sinuses are the most frequently involved sites. Herein, we present the case of a 30-year-old woman with a 6-year history of right nasal obstruction and pain in the right maxillary region, elicited by rapid changes in atmospheric pressure. Computed tomography (CT) detailed an abnormal expansion of the right maxillary sinus resulting from a process of hyperpneumatization with no evidence of bone erosion, leading to the diagnosis of PSD. Restoration of permanent pressure equilibrium in the right maxillary sinus and improvement in the patency of the nasal fossa were achieved by a subtotal resection of the medial wall of the maxillary sinus by an endoscopic approach. Two years later, the patient was asymptomatic, and a CT scan showed no progression of the disease.     

左侧上颌窦恶性黑色素瘤1例

患者,男,62岁,因左侧鼻腔涕中带血10个月,加重半年余于2012年10月9日入院。患者于2012年春节时因过度疲劳出现右侧涕中带血,时有鼻塞,面部稍有胀痛,曾行间断抗炎治疗后无明显好转。2012年9月,患者因左侧牙疼行拔牙处理后左侧鼻腔出现涕中带血,较右侧为多。