Long term administration of itraconazole with surgical treatment in fungal and bacterial infections of the paranasal sinuses

A case of chronic paranasal sinuses with recurrent polyposis caused by miscellaneous infection--fungal (Aspergillus, Candida) and bacterial (Staphylococcus aureus, Enterobacter, Streptococcus) is described. The patient underwent 5 times surgical treatment (polypectomies, sinus operations). Good result was achieved after 2-years application of itraconazole and local Amphotericin B.     

Fungal infections of the paranasal sinuses

Fungal infections can be mainly grouped into four types. The invasive forms are acute sinusitis (fulminant), chronic sinusitis (indolent), whereas the non-invasive forms are mycetoma and allergic fungal sinusitis. From December 1993 to December 1997, 27 cases of fungal sinusitis, 22 of which were noninvasive forms, and 5 of which were invasive forms, were treated and are presented in this study. When we classified the patients with fungal sinusitis, 11 were diagnosed as mycetoma, 9 as allergic fungal sinusitis, 3 as acute fulminant sinusitis and 2 as chronic indolent sinusitis, while 2 patients were not included in our four groups of sinusitis. In all mycetoma cases the active agent was Aspergillus. Patients with non invasive forms of sinusitis were all treated with endoscopic sinus surgery. 2 of the patients with invasive forms of sinusitis underwent maxillectomy and they were given Amphotericin-B. With a mean follow up of 20 months, only 3 recurrences were seen. The infection recurred in 2 patients with allergic fungal sinusitis and 1 patient with chronic invasive sinusitis. However, 2 patients with acute fulminant invasive sinusitis died before they were operated on, and 1 patient died postoperatively.     

Primary malignant melanoma of the nose and paranasal sinuses

Primary mulignant melanomas are rare tumours in the head and neck. The pigmentation of ths mucous membrane with or without the pigmentation of skin around it should raise the suspicion and should be confirmed by pathologist from a fresh biopsy specimen Radical surgery is the preferred treatment followed by radiotherapy in case of doubt regarding radicality of the surgical procedure. Six cases of malignant melanoma of nose and paranasal sinuses who reported within fourteen months are presented. This paper was presented in 43rd Annual conference of AOI at Jaipur.     

Primary small cell carcinoma of the paranasal sinuses

An unusual case of small cell carcinoma of the ethmoid sinuses is reported in which electron microscopy confirmed the presence of dense-core granules. The relationship to Pearse's "neuroendocrine programmed" cells is cited. With increasing numbers of different extrapulmonary primary sites for this tumor now being identified, it is believed that these sites must be investigated in any case of suspected small cell carcinoma that cannot be readily attributed to the lung.     

Primary intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses

Forty-nine cases of adenocarcinoma of the nasal cavity and paranasal sinuses were reviewed, in which 5 cases showed a marked similarity to colonic adenocarcinoma. Diagnosis of intestinal-type adenocarcinoma chiefly depends on pathological examination and mucous staining. Although well differentiated, the intestinal-type adenocarcinoma has a marked propensity for recurrence and a lethal potential.     

Primary adenocarcinoma of the nasal cavity and paranasal sinuses.

Eight cases of primary adenocarcinoma of the nasal cavity associated with wood dust exposure are reported. The patients include seven men and one woman between the ages of 31 and 81 years. All the patients had a history of wood dust exposure. Carpentry was the occupation in four patients; inspector for railroad boxcars in one; teacher in a wood-work shop in another and worker in a desk factory in the other. The only female patient was a school teacher whose husband had a wood-work shop at home. Clinically, epistaxis and/or nasal obstruction were the most common symptoms. The histology of the tumors varied and consisted of well differentiated adenocarcinoma, clear cell adenocarcinoma, papillary-mucinous adenocarcinoma, and "colonic-type" adenocarcinoma. Follow-up data showed that three patients were alive of whom two had either recurrent or metastatic disease at one and three years following the initial diagnosis, respectively. The third patient was alive and well four years after initial diagnosis. Three other patients died but a direct cause of death was not identified. The remaining two patients were lost to follow-up.     

Histopathologic assessment of fungal involvement of the paranasal sinuses in Turkey

OBJECTIVE: To assess paranasal sinus material histopathologically for the presence of fungus. MATERIAL AND METHODS: Paraffin-embedded archival biopsy samples of patients who underwent endonasal sinus surgery between 1992 and 2002 were retrospectively assessed for the presence of fungi. Hematoxylin-eosin-stained sections of the materials were re-evaluated, and Gomori's methanamine silver stain was also applied as required. RESULTS: Fungus (Aspergillus) was detected histopathologically in only 21476 patients, both of whom were immunocompetent. One patient was considered to have chronic indolent sinusitis and the other allergic fungal sinusitis. CONCLUSIONS: Although histopathologic assessment is one of the most important diagnostic tools, on its own it may lead to underestimation of fungal involvement of the paranasal sinuses. Alternatively, fungal involvement of the paranasal sinuses may be very infrequent in Turkey.     

Endoscopic treatment of nasolacrimal sac obstruction secondary to fibrous dysplasia of paranasal sinuses

Fibrous dysplasia involving paranasal sinuses mostly has asymptomatic features, but sometimes may cause signs and symptoms which relate to the location and extent of bony abnormalities. The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the left nasolacrimal sac and simultaneous intranasal endoscopic dacryocystorhinostomy with silicone intubation is presented. The procedure and advantages of endoscopic approach over the external approach are outlined in this paper.     

Origin and spread of allergic fungal disease of the nose and paranasal sinuses

Although expansion of bony walls occurs in allergic fungal disease of the nose and paranasal sinuses by increased mucus secretion and fungal growth, the latter is apparently confined to the lumen and does not invade the tissues. Nevertheless, spread of the disease process from paranasal sinuses to orbit, cheek and intracranial cavity is well described. An imaging and histopathological study was carried out in 16 cases to determine how the disease originates and spreads. The infection starts in the nasal cavity, the lumen of a sinus or in a seromucinous gland or duct. A thin vascular zone of intense allergic inflammation surrounds the infected mucin. Erosion of bone takes place focally, probably by substances produced by the inflammatory tissue, allowing intromission by the thin vascular layer together with its underlying fungus-containing mucus and so extension of the disease process through the eroded bone.     

Primary B cell lymphoma of paranasal sinuses: a diagnostic surprise

Primary lymphomas of paranasal cavities are rather uncommon entities. They have a variable presentation from fulminant destructive manifestations to chronic indolent type of disease. Chronic indolent form may mimic invasive fungal sinusitis in its presentation. Unless high index of suspicion is held and appropriate histopathology sections are taken from specimen, its diagnosis can be deceitful. We here by report a case of primary lymphoma of the paranasal sinuses which was radiologically and clinically suspected to be a invasive fungal sinusitis and later was proven to be a B cell lymphoma. Clinical similarities between lymphoma and invasive fungal sinusitis along with management issues are discussed in this article.     

Inverted papilloma of the nose and paranasal sinuses: diagnosis and treatment

The authors present a retrospective study of 6 patients with inverted papilloma, which appeared in the material of ENT Clinic in Wroc?aw in years 1996-2001. In the group of treated patients, we can recognize 5 men and one woman at the age between 42 to 82. Average age amounted to 62 years. At all the patients the papilloma inversum was diagnosed completely accidentally, during histopathological examination, after having polypectomy or Calwell-Luca operation. Operating treatment was proceeded by performing the CT or NMR test. In four cases the Denker's operation was done, in one case More's and in another one we performed the endoscopy operation (limited changes to ethmoidal labyrinth). The patients stay under the observation for 8 months to even 5 years. In one case we observed a relapse, which occurred after 8 months (patient after the Moure's operation). In all the rest cases a relapse was not identify.