Sinonasal adenocarcinoma: clinical study of nine cases in Taiwan

OBJECTIVE: Sinonasal adenocarcinoma is an uncommon disease in Taiwan. This paper presents details of the management and outcome of the disease. MATERIAL AND METHODS: The medical records of patients with sinonasal adenocarcinoma who presented to the Department of Otolaryngology, National Taiwan University Hospital between 1983 and 2002 were retrospectively reviewed. Tumors were staged based on the American Joint Committee of Cancer staging criteria. The series included 5 males and 4 females (mean age 51 years; range 28-75 years). RESULTS: No association between sinonasal adenocarcinoma and occupations such as furniture making, wood working or textile working was found. Epistaxis and nasal obstruction were the most common symptoms. Metastasis to bone or liver was found initially at diagnosis in two cases. Treatment was given according to the tumor stage, the clinical condition of the patient and the patient's wishes: two received combined treatment comprising wide surgical resection and radiotherapy, two received radiotherapy only, one received wide surgical resection only and four received no treatment. At a mean follow-up of 30 months (range 2-68 months), 2 patients were free from the disease and 1 was alive with the disease. Six cases died of the disease. Advanced-stage disease was associated with a poor prognosis. Early-stage disease, a well-differentiated histologic type and surgical resection combined with radiotherapy were associated with a favorable result. CONCLUSION: Sinonasal adenocarcinoma has a low incidence in the general population in Taiwan. However, prognosis is poor owing to delayed diagnosis and the consequent advanced stage of the disease.     

Sinonasal leiomyoma: report of 2 cases

Leiomyomas are benign smooth-muscle tumors that are common in the alimentary tract, uterus, skin, and subcutaneous tissue. They are very uncommon in the upper respiratory tract and rare in the nasal cavity and paranasal sinuses. To the best of our knowledge, only 23 such cases have heretofore been published in the literature. We report 2 new cases of sinonasal leiomyoma that originated at different sites in the nasal cavity. We also discuss the various investigative and therapeutic modalities available.     

鼻腔鼻窦恶性黑色素瘤17例临床分析

目的探讨鼻腔鼻窦恶性黑色素瘤的诊断和治疗,提高本病的诊疗水平。方法回顾性分析1980年3月-2011年6月收治的17例鼻腔鼻窦恶性黑色素瘤的临床资料,分析其临床病理特点、诊断、治疗及预后。结果患者的主要症状为单侧鼻塞,涕中带血,头痛;病灶位于鼻腔外侧壁和鼻中隔。17例患者中1例放弃治疗,2例行单纯放疗,14例行手术治疗,3、5年生存率分别为36．4％和22．2％。患者死亡原因为局部复发和远处转移。结论鼻腔鼻窦恶性黑色素瘤恶性程度高,易复发和转移,预后差,临床上尽早确诊。广泛彻底手术切除肿瘤,并辅以放疗、化疗、免疫治疗等综合治疗,是提高本病生存率的关键。     

Sinonasal sarcoidosis: review and report of fifteen cases

OBJECTIVES: Sinonasal sarcoidosis remains a poorly understood and uncommon chronic granulomatous disease of unclear origin. We have attempted to characterize the main clinical and radiologic criteria for diagnosis and to discuss the treatment. METHODS: A retrospective study of 15 cases of chronic, symptomatic, and biopsy-proven sinonasal sarcoidosis and a review of the literature are realized. RESULTS: Among the 15 patients, there were 8 women and 7 men with a mean age of 44 years. The most frequent presentation was a chronic, often crusty, rarely destructive inflammatory rhinosinusitis with nodules on the septum and/or the turbinates. Pulmonary sarcoidosis was associated in 12 cases. Involvement of the nasopharynx, the pharyngolarynx, the skin, the lachrymal and salivary glands, and the liver was associated in some cases. Levels of angiotensin-converting enzyme were elevated in 10 cases and normal in 3 cases. Gallium scan performed in three cases was positive. Radiologic studies showed nodules on the septum and/or the turbinates in 14 cases, complete or subtotal opacification of the sinuses and/or the nasal cavities in 13 cases, and nasopharyngeal or pharyngolaryngeal lesions in 4 cases. Treatment with corticosteroids, methotrexate, azathioprine, and surgery appear globally disappointing in view of the side effects and the relapses during a long follow-up (3-15 yr; mean, 6 yr). CONCLUSION: On the basis of this study, we propose the following diagnostic criteria: 1) histopathologic confirmation of noncaseating granuloma; 2) chronic rhinosinusitis poorly responsive to conventional treatment and radiologic evidence of rhinosinusitis, often with nodules on the septum and/or the turbinates; 3) elevated level of angiotensin-converting enzyme; 4) positive gallium scan (if performed); 5) frequent evidence of systemic, especially pulmonary, sarcoidosis; 6) no evidence of other granulomatous diseases, such as Wegener granulomatosis.     

Sinonasal intestinal-type adenocarcinoma: report of 7 cases

The intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses are uncommon tumors, with less than 4% of the total of malignancies of this region. They have histological similitudes with the glandular estructure of the intestinal mucosa. In some aspects they are similar to others tumors of this area, symptoms, an etiological relation with the exposure to wood dust ... but they have differences in the local aggressivity, this is important for the tractament, evolution and survival. The authors present a revision about clinic characteristics, diagnostic and tractament of seven cases of nasosinusal intestinal type adenocarcinoma.     

Nasal Schneiderian papillomas: a study of 83 cases

Nasal Schneiderian papillomas are unique lesions involving the mucosa of the nasal cavity and paranasal sinuses. Most often epidermoid in histological appearance, they favour 2 sites: the septum and the lateral wall of the nasal cavity. The medical literature on these tumours contains a plethora of contradictions concerning the nomenclature and no less than 54 separate designations are used. The synonyms are discussed and the term Schneiderian papilloma is proposed as the most suitable alternative. This study includes 83 patients with Schneiderian papillomas in whom the history, clinical and radiological findings, treatment procedures, pathological sections, recurrences, and associated malignancies were analyzed. Histological and clinical features were not helpful in predicting recurrence, but the recurrence rate was related to the treatment modalities; with 17% recurrences using an extranasal approach (lateral rhinotomy) and 59% using intranasal approach with limited excision. Schneiderian papillomas were associated with squamous cell carcinoma in 7 patients. Simultaneous papilloma and carcinoma were demonstrated in 4 patients at presentation (5%) and subsequently developing carcinoma in 3 patients (4%). As recurrences are frequent after inadequate removal and as association with maligancies may occur in both septal and lateral wall papillomas, radical aggressive surgery, thorough histological examination of the entire specimen, and careful follow-up are advocated.     

Sinonasal involvement in sarcoidosis: a report of seven cases and review of literature

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating inflammation involving one or more organs with predilection for pulmonary and upper respiratory tract involvement. It presents with a variety of signs and symptoms which can be generalized or focused on a single organ. Sinonasal involvement is reported in about 1% of cases of sarcoidosis. Sarcoidosis can involve both the mucosa as well as bony structures in the nose and the paranasal sinuses. We present seven cases of sarcoidosis with sinonasal involvement. Four cases presented with nasal and sinus symptoms, and the other three cases developed or presented with nasal and sinus symptoms after the diagnosis of sarcoidosis was confirmed. The nasal and sinus symptoms in these patients were managed by local and systemic steroids. In four patients, endoscopic sinus surgery was performed with good outcome. Nasal and sinus symptoms, differential diagnosis and the treatment are discussed.     

A longitudinal study of stuttering in children: a preliminary report.

The objectives of this pilot study were to establish methods for longitudinal research of stuttering in children and to provide preliminary data on the variations that occur in disfluencies during the developmental course of stuttering. Twenty-seven preschool-aged children were followed for a minimum of 2 years shortly after they began stuttering. Tape-recorded speech samples were obtained from the children at several intervals during this period. The number of various types of disfluencies was counted in the speech samples obtained in each testing period. Twenty-one children continued to be followed for varying periods of up to 12 years. Eighteen of the 27 subjects received a few speech treatment sessions during the initial period of the study, whereas 9 children did not receive direct treatment. Results indicated that for the two subgroups there was a marked deceleration over time in the mean frequency of stuttering-like disfluencies. Individual subjects' data showed considerable variability in the longitudinal development of disfluency but most subjects followed the patterns of the group means. Much of the reduction took place during the early stage of the disorder, especially near the end of the first year post-onset. There were indications that group differences between chronic and recovering stutterers become distinct by approximately 20 months post-onset.     

A clinical and epidemiological study of nasopharyngeal carcinoma

The incidence of Nasopharyngeal carcinoma is higher in North-Eastern India as compared to the all India average seen commonly in inhabitants of Nagaland and some areas of Manipur. Hidden by the palatine curtain and situated under the base of the skull, the onset of the disease being insidious, it usually reaches an advanced stage before giving rise to alerting symptoms. Histopathological study and stage classification plays significant roles in treatment planning. Early detection by arousal of suspicion amongst the physicians can improve the prognosis. Field survey, cytological study, serums antibody titre for E. B. Virus etc. are some areas to be probed in order to increase our knowledge about the disease.     

Bilateral vocal process papillomas: report of a case

We describe a case of bilateral vocal process lesions in a 65-year-old man. His history was strongly suggestive of vocal process granulomas: previous gastroesophageal reflux, intubation, smoking, and oral squamous cell carcinoma. Medical management with a proton-pump inhibitor, reflux precautions, voice therapy, and adequate hydration yielded no results. Subsequent surgical intervention revealed that he had squamous papillomas. We also provide a brief review of vocal process granulomas and squamous papillomas.     

Inverted papilloma: a follow-up study including primarily unacknowledged cases

Inverted papillomas (IPs) in the nose or the paranasal sinuses exhibit a tendency for rapid growth with bone destruction, a high recurrence rate, and an association with malignancy, requiring early diagnosis and aggressive surgical therapy. A number of operative approaches have been reported in the literature, with greatly varying results. Furthermore, the incidence of IP and the association with carcinoma are not well-established. In this study, we present a series of 42 patients with IP. Drawing from the resources of two institutes of pathology, we reviewed all specimens of nasal cavity or paranasal sinus tissue taken between the years 1975 and 1986, and performed a thorough follow-up of all IP patients. The incidence was found to be 0.6 cases per 100,000 inhabitants per year in a well-defined representative geographic region. Two patients had concomitant carcinoma. When the initial surgical approach was lateral rhinotomy, the recurrence rate was 50%. This was not significantly different from that noted following excision through a sinusectomy (62%) or simple endonasal excision (43%). However, initial procedures were selected individually, mainly on the basis of tumor size and location. Accordingly, a limited procedure is considered justified even in cases with lateral lesions, if the tumor is sufficiently visible and confined. In other cases, lateral rhinotomy is required. Septal IPs are often detected at an early stage and are therefore often amenable to local excision.     

Laryngeal papillomas: clinical aspects in a series of 231 patients

The records of 231 patients with laryngeal papillomas were reviewed. Considering age at onset and sex distribution, the patients were divided into four groups: juvenile solitary, juvenile multiple, adult solitary, and adult multiple papillomas. The main conclusions are (1) it is in general impossible to predict the course in individual cases, but solitary papillomas in adults follow a less severe course than do juvenile and adult multiple cases; (2) late recurrences (up to 42 years) makes it impossible to declare a patient cured; (3) there is no linkage between puberty and the disappearance of laryngeal papillomas; (4) a latent infection, acquired at or before birth, is unlikely to be responsible for adult papillomas.     

A clinical epidemiological study in 2169 patients with vertigo

Objective

To investigate the clinical epidemiological characteristics of vertigo.

Methods

Retrospective study on 2169 patients with vertigo (male 883, female 1286, 7–90 years old) of the past 20 years.

Results

More than 50 kinds of causative diseases were recognized. Peripheral, central, and unclassified vertigo took up 33.8, 17.2 and 26.8% of patients, respectively, while vertigo of unknown origin was around 22.2%. Vertigo patients increased according to age and reached its peak in the 1960s among all three categories. Although female patients were seemingly overwhelmed the male, no significant difference in the incidence rate was recognized in two genders. Only 2.2% (48 cases) of the total vertigo patients were children, while elders occupied 30.0% (650 cases). Compared to younger patients, the elderly have a high tendency of suffering central vertigo.

Conclusion

Vertigo attacks patients in all age spans, with various causative diseases.     

Sinonasal leiomyosarcoma: review of literature and case report

OBJECTIVES/HYPOTHESIS: To determine prognosis of primary sinonasal leiomyosarcomas after treatment. STUDY DESIGN: Literature review and case report. METHODS: Review of English literature from MEDLINE and independent sources with the addition of our case. RESULTS: Including our case, 63 cases have been reported. Primary treatment includes resection with or without radiation. Chemotherapy has not been reported to be effective. In our case, however, chemotherapy, consisting of etoposide and high-dose ifosfamide, caused the tumor to shrink significantly. On the basis of a review of all reported cases, the overall survival rate at a mean follow-up of 38.24 month is 66%. The minimal overall survival rates at 5 and 10 years are 20% and 6%, respectively. CONCLUSION: The prognosis for primary sinonasal leiomyosarcomas is poor. However, a 10-year survival has been reported in a few patients. Chemotherapy may be a useful adjunct when managing extensive lesions unamenable to curative resection.     

Sinonasal adenoid cystic carcinoma-role of on-site FNAC: a case report

Background

Adenoid cystic carcinoma (ACC), a rare tumor of epithelial cell origin, commonly arises from the major salivary glands. Uncommonly it may be found outside the salivary glands and it's especially rare in the nasal cavity.

Case presentation

A 71-year female had complaints of swelling at the base of nose, Fine needle aspiration (FNA) from the swelling revealed features of adenoid cystic carcinoma; cell block & IHC for CD-117 was positive.

Conclusions

Sino-nasal ACC (SNACC) continues to pose diagnostic and therapeutic challenges to clinicians. Due to its rarity & vague presentation, early diagnosis requires a high index of suspicion. FNA can be used as an invaluable diagnostic tool in the evaluation of these lesions. Since it’s incidence in sinonasal region is rare; our attempt to report this case will heighten the physician’s awareness of this disease, helping further treatment.

     

颈部坏死性筋膜炎6例

目的：提高临床医师对颈部坏死性筋膜炎的认识。方法：回顾分析6例颈部坏死 性筋膜炎患者的临床资料及治疗结果。结果：6例患者经手术及药物治疗,5例治愈,1例因并发脓毒血症导致多器官功能衰竭死亡。结论：颈部坏死性筋膜炎 是一种进展迅速、病情凶险的感染性疾病,治疗上以尽早彻底清创、应用广谱抗菌素及支持治疗为主,增加对该病的认识有利于早期诊断,并有利于提高颈部坏死性筋膜炎的疗效。