Sinonasal disorders in hematopoietic stem cell transplantation

Introductionhematopoietic stem cell transplantation (HSCT) is associated with more respiratory infections due to immunosuppression.Objectivethis study aimed to verify the frequency of rhinosinusitis after HSCT, and the association between rhinosinusitis and chronic graft vs. host disease (GVHD) and type of transplantation, clinical treatment, surgical treatment, and survival.Methodsthis was a retrospective study in a tertiary university hospital. A total of 95 patients with hematological diseases undergoing HSCT between 1996 and 2011 were selected.Resultschronic myeloid leukemia was the most prevalent disease. The type of transplant most often performed was the allogenic type (85.26%). The frequency of rhinosinusitis was 36%, with no difference between the autologous and the allogenic types. Chronic GVHD occurred in 30% of patients. Patients with GVHD had a higher frequency and recurrence of rhinosinusitis, in addition to more frequent need for endoscopic sinusectomy and decreased overall survival.Conclusionthere was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment.     

Malignant triton tumor of the sinonasal tract

INTRODUCTION: The combination of a malignant peripheral nerve sheath tumor with rhabdomyosarcomatous elements has been termed Malignant Triton Tumor (MTT). This tumor was first reported in 1932 and the prognosis was poor. Involvement of the sinonasal tract is rare with only 10 case reports. CASE: We report the case of a 80-year-old woman who presented an obstruction of the right nasal fossa which developed over several years without anosmia. She consulted because of recurrent epistaxis. The CT-scan revealed a tumor occupying the right ethmoid the right maxillary sinus and the homolateral nasal fossa. Resection was achieved via an extended mediofacial route. The histological diagnosis was low-grade schwannosarcoma with a discretely extended rhabdomyosarcomatous component, i.e. MTT. No complementary treatment was given. Eight months later, the tumor relapsed with cerebral involvement. Despite new surgery with two teams, a neurosurgical and a radiotherapy team, the tumor relapsed at the ethmoid-nasal level. After five years, the patient is alive with local progression without metastasis. DISCUSSION: MTT of the sinonasal tract is a rare disease that clinicians should be aware of and that must be included in the differential diagnosis of malignant lesions involving the sinonasal tract. Most of the reported cases involving localizations other than the ethmoidonasal cavities, are associated with von Recklinhausen neurofibromatosis and occurr in young subjects (mean age 35 years). There have however been sporadic cases, mainly in older women or after radiotherapy. The prognosis is somewhat better for ethmoidonasal localizations.     

Oral changes in individuals undergoing hematopoietic stem cell transplantation

IntroductionPatients undergoing hematopoietic stem cell transplantation receive high doses of chemotherapy and radiotherapy, which cause severe immunosuppression.ObjectiveTo report an oral disease management protocol before and after hematopoietic stem cell transplantation.MethodsA prospective study was carried out with 65 patients aged > 18 years, with hematological diseases, who were allocated into two groups: A (allogeneic transplant, 34 patients); B (autologous transplant, 31 patients). A total of three dental status assessments were performed: in the pre-transplantation period (moment 1), one week after stem cell infusion (moment 2), and 100 days after transplantation (moment 3). In each moment, oral changes were assigned scores and classified as mild, moderate, and severe risks.ResultsThe most frequent pathological conditions were gingivitis, pericoronitis in the third molar region, and ulcers at the third moment assessments. However, at moments 2 and 3, the most common disease was mucositis associated with toxicity from the drugs used in the immunosuppression.ConclusionMucositis accounted for the increased score and potential risk of clinical complications. Gingivitis, ulcers, and pericoronitis were other changes identified as potential risk factors for clinical complications.     

Prognostic value of sinus CT scans in hematopoietic stem cell transplantation

Hematopoietic Stem Cell Transplant (HSCT) causes immunosuppression and predisposition to sinusitis. CT scans are complementary exams used in the diagnosis of sinusitis; however, its use in every patient is questionable.Aimto check the usefulness of ordering a CT scan prior to HSCT and to study the relationship between anatomical variations and sinusitis.Methodprospective study in which we performed paranasal CT scans before and after HSCT, using the Lund and Mackay score.Results77.5% and 61% of CT scans showed no evidence of sinus disease before and after HSCT. CT staging was not associated with sinusitis after HSCT. Anatomical variations were related to radiographic disease severity, but not to development of sinusitis after HSCT. There was no relation between pre-CT staging and sinusitis after BMT.ConclusionCT scans are not useful for all patients before HSCT. Anatomical variation is not a predictive feature to sinusitis but it can determine its severity.     

原发性甲状腺恶性淋巴瘤2例

原发性甲状腺恶性淋巴瘤（primary malignant lymphoma of thyroid,PMLT）是起源于甲状腺内淋巴细胞的恶性肿瘤,不包括转移至甲状腺的淋巴瘤及颈部淋巴结病变的直接侵犯。PMLT罕见,占所有甲状腺恶性肿瘤的1％～5%,占所有结外恶性淋巴瘤的比例低于2％,缺乏特异性临床表现,诊断困难,容易误诊。我科诊治2例PMLT患者,报告如下。     

角膜缘干细胞移植术治疗翼状胬肉的疗效观察(附100例报告)

目的评估角膜缘干细胞移植术治疗翼状胬肉的疗效.方法对100眼行翼状胬肉切除联合角膜缘干细胞移植术,术后随访半年以上,与既往行翼状胬肉切除联合带蒂球结膜转移术的100眼对照.结果实验组治愈85例,好转10例,复发5例.对照组治愈70例,好转22例,复发8例,2组差异有显著性( P<0.05).结论角膜缘干细胞移植可提高手术疗效.     

腮腺恶性肿瘤120例临床分析

对1984～1993年住院手术和术后放疗的腮腺恶性肿瘤120例进行了回顾。男63例,女57例。初治71例,复治49例;单纯手术治疗64例,手术加术后放疗56例。结果,腮腺恶性肿瘤的5、10年生存为80．0％和58．2％。单纯手术分别为79．7％,47．4％;手术加术后放疗分别为80．4％和63．9％。两种治疗方法的10年生存对比有明显差异（X2＝5．77,P＜0．05）。有无淋巴结转移的5年生存率分别为59．1％,83．6％,有明显差异（X2＝4．78,P＜0．05）。腮腺恶性肿瘤的疗效评价应区分高度和低度恶性。首次术式选择合理,术后放疗是减少局部复发的重要因素,颈淋巴结转移和分化差的晚期癌是影响预后的关键。     

上颌窦恶性肿瘤术后缺损及修复方法

目的探讨上颌窦恶性肿瘤术后缺损的外科重建及贋复体修复。方法60例上颌窦恶性肿瘤术中采用带蒂额瓣、胸锁乳突肌皮瓣、颞肌筋膜瓣、胸大肌皮瓣及腭瓣修复软组织缺损18例,术后选用贋复体修复50例。结果术后语音、吞咽、通气功能及面容恢复良好者占68.3%,一般占20%,较差者占11.7%。胸大肌皮瓣与腭部裂开3例,边缘坏死1例,内眦部皮肤瘘口3例,开口受限8例。结论外科重建与贋复体并用即刻修复上颌窦恶性肿瘤术后缺损,方法简便、经济,贋复体周围软组织良好的固位形和封闭性是功能恢复及面容美观的关键。     

Two cases of malignant melanoma in turbinate and maxillary sinus

Malignant melanomas develop from malignant transformation of melanocytes that are present in the skin and mucosal linings throughout the body. The overall rate of mucosal melanoma is rare and malignant melanomas developing from turbinates or maxillary sinuses are extremely rare. Symptoms of nasal melanoma are generally nonspecific, and patients often fail to seek prompt medical attention. Diagnosis can be confirmed by the immunochemical profile of staining with anti-S100 and HMB-45 antibodies, even in the case of melanin-free pigment melanoma. The present study reports two cases of primary malignant melanoma in the turbinate and maxillary sinus.     

角膜缘干细胞移植与羊膜移植治疗翼状胬肉的Meta分析

目的 以循证医学证据评价角膜缘干细胞移植和羊膜移植治疗翼状胬肉的临床疗效。方法 通过计算机检索Pubmed数据库、EMBASE、万方数据库、中国期刊全文数据库和维普数据库,并结合文献追溯的方法,收集关于角膜缘干细胞移植和羊膜移植治疗翼状胬肉临床疗效的随机前瞻性对照试验(RCT),并按 Cochrane协作网推荐的方法对符合纳入标准的35个研究,共3126只眼进行Meta分析,发表偏倚用漏斗图评估。结果 Meta分析结果显示,与羊膜移植组相比,角膜缘干细胞移植组能降低术后翼状胬肉复发率(P＜0.00001)、术后并发症的发生率(P=0.01),缩短术后角膜创面上皮愈合时间(P＜0.00001)。结论 与羊膜移植术相比,角膜缘干细胞移植术能有效预防翼状胬肉复发、术后睑球粘连,缩短角膜创面上皮愈合时间。     

鼻腔,鼻窦恶性肿瘤侵犯眼眶55例报告

报告５５例鼻腔，鼻窦恶性肿瘤侵犯眼眶患者的临床资料。５５例中３２例为复发性肿瘤，３０例接受第２次手术。３年生存率为７８．１％。５年生存率４３．８％。并且提出，在以手术治疗此种患者时，对眶内膜已受肿瘤侵犯者，应行眶内窜物全切术，否则短期内易复发。     

Clinical study of neck dissection for lymph node metastasis in patients with malignant skin tumors of the forehead and face

We reviewed the records of 10 patients with malignant skin tumors of the forehead and face who underwent neck lymph node dissection at Kurume University Hospital between 2000 and 2004. Two patients underwent selective neck dissection (SND), 5 patients underwent SND and superficial parotidectomy (SP) and 3 patients underwent modified radical neck dissection and SP. Lymph node metastasis to the upper jugular group was found in 3 patients, and metastasis to lymph nodes of the parotid region was found in 3 patients. In a patient with malignant melanoma of the forehead, the patent blue dye was injected intradermally around the tumor and blue-stained lymph nodes were identified in the upper jugular group and parotid region. From these results, we consider that the sentinel lymph nodes of frontal and facial malignant tumors are located in the upper jugular group and parotid region. Thus, in malignant skin tumor patients, SND and SP might be mandatory.     

The "kite" flap in the reconstruction after excision of a basal cell carcinoma of the face. Our experience with 45 cases

The "Kite" flap is a triangular protruding flap attached underneath the skin. The authors present the results of the utilisation of this type of flap in reconstruction after removal of baso-cellular cancer of the face. After a brief historical and technical recall, they contemplate a study of 45 patients operated on by this method. The preferential localisations of this type of flap are analyzed (sub-orbital region, naso-genien region, labiogenien region). Other techniques of repair are discussed region by region. However, the authors emphasize the facility of execution of the "Kite" flap and its excellent aesthetic results, its principal use being in the reconstruction of the sub-orbital region.     

Atypical lipomatous tumors of the face: a controversial issue

We reviewed the topic of atypical lipomatous tumors including definition, diagnosis and management, with special emphasis on head and neck location and to report on the management of a rare case located in the temporalis muscle. Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLS) are rarely reported in the head and neck. Their behavior dictates a complete resection. Resection with a safety margin is sometimes needed according to the histological characteristics. Tumors located to the masticator space can be accessed through a mucosal approach achieving relative safety to the facial nerve. ALT constitute a group of tumors of a borderline behavior. Their management can be affected by some histological criteria and by their location in the head and neck region where vital structures can be affected.     

咽旁间隙恶性肿瘤的诊断与治疗

目的 探讨咽旁间隙恶性肿瘤的临床特征、诊断和治疗方法。方法 回顾性分析5例咽旁间隙恶性肿瘤患者的临床资料,均行颈部B超及CT扫描,3例行增强MRI检查;均行颈侧入路切除肿瘤,其中2例同期行同侧功能性颈淋巴结清扫术,3例术后行放射治疗;术中快速病理、术后常规病理及免疫组织化学检查,明确诊断。结果 5例中恶性神经纤维瘤1例,恶性神经鞘膜瘤1例,腮裂癌1例,未分化癌1例,滑膜肉瘤1例;术前B超、CT、增强MRI检查可以明确肿瘤的位置、大小、形态、边界及与周边结构的关系,有助于手术入路及手术方式的选择;5例术后随访,3例随访1年内无复发,1例随访3年后死亡,1例半年后失访。结论 咽旁间隙恶性肿瘤组织类型复杂多样,预后差,颈部B超、CT扫描、增强MRI检查对肿瘤的诊断有帮助,选择合适入路肿瘤切除术是首选的治疗方法,综合治疗对患者的预后很关键。