Endoscopic sinus surgery treatment for a huge sinonasal fibroma

Fibromas are rare tumors of the nasal cavity, which may result from progressive inflammation or fibroblastic proliferation of the nasal mucosa. The tumors are usually too small to cause symptoms. We present a 47-year-old woman suffering through right nasal obstruction, purulent rhinorrhea and severe headaches for 6 months. A gray-white, smooth-surfaced, gigantic firm mass occupying the right nostril was found in physical examination. Sinus computed tomography revealed 4 x 3 x 3 cm soft-tissue-density mass in the right nasal cavity and right maxillary sinusitis. The huge sinonasal fibroma measuring 4.5 x 3 x 3-cm in the right posterior ethmoid sinus, which was successfully endoscopically resected. The final diagnosis of fibroma was made histologically, according to light microscopy and immunohistochemical stain examinations, which were important for determining the patient's treatment. After endoscopic resection, her initial signs and symptoms were relieved and no recurrence was noted after 2 years of follow up.     

Rhinocerebral mucormycosis with isolated sixth nerve palsy in an immunocompetent patient

We report a case of rhinocerebral mucormycosis in a 31 year old immunocompetent female presenting initially like acute rhinosinusitis with nasal stuffiness, severe headache, vomiting who soon developed isolated right lateral rectus palsy. Computed tomography (CT) scan of the Post-Nasal Spaces(PNS) showed an ill defined expansile heterogenous density mass in the sphenoid with extension into the ethmoids, nasal cavity, optic canal, superior orbital fissure, clivus and right temporal lobe with signal void in Magnetic Resonance Imaging (MRI). The debris and polypoid mucosa obtained on nasal endoscopy revealed mucormycosis on histopathologic examination. The patient was managed with urgent surgical debridement and medical management.     

Nasal septal haemangioma in pregnancy

A pregnant lady in her third trimester presented with a rapidly growing right-sided nasal mass associated with epistaxis and nasal obstruction for two months. Examination showed a non tender, protruding mass completely occluding her right nostril. Wide surgical excision was done under local anaesthesia. Histopathology revealed capillary haemangioma. In a gravid patient with a rapidly growing intranasal lesion, capillary haemangioma should be considered as a differential diagnosis. Due to the rapidity of growth, presentation with epistaxis and its macroscopic appearance which often mimics malignancy; histologic confirmation is crucial.     

Rosai-Dorfman syndrome: a case report

A 30-year-old woman presented with multiple swellings in the neck associated with febrile illness of 3 months' duration. She also complained of nasal blockade. The swellings were non-tender, non-matted with about 4-5 cm in size. CT scan of nose and paranasal sinuses revealed a mass in the right nasal cavity. Histopathology from cervical lymph nodes which showed large clusters of mononuclear foamy histiocytes-emperipolesis of lymphocytes or lymphophagocytosis was seen in some cells. The patient was treated with antibiotics and prednisolone.     

Difficulty in diagnosis of nasopharyngeal carcinoma

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.     

Congenital nasal dermoids in children

The case of a 27 month old male with a congenital midline nasal dermoid cyst is presented. The child attended the Ear, Nose and Throat outpatient’s department in July 1995, with an external midline nasal swelling, which had been present at birth and was noted to be gradually increasing in size. Magnetic resonance imaging (MRI) showed a central defect of the nasal bones, with a soft tissue mass at the upper part of the nasal bridge expanding the nasal septum. There was no radiological evidence of intracranial extension. The child had the nasal mass removed under general anesthesia, through an external rhinoplasty incision. Histopathology confirmed that the mass was a fully excised nasal dermoid cyst. Current investigation and management of this condition is discussed.     

颅面部肿瘤所致低磷软骨病2例并文献复习

目的通过对肿瘤相关性低磷软骨病（tumor-induced osteomalacia,TIO）的病例报道并文献复习,深化对该疾病的认识。方法本文报告2例中年女性病例,以往被误诊为类风湿关节炎,最终确诊为颅面部肿瘤所致TIO。病例1表现为弥漫性骨痛及肌无力4年,右眼内斜复视1个月;病例2表现为腰部及髋部骨痛伴进行性加重。生化检查均提示低血磷及尿磷排出增加。影像学检查在病例1和病例2中分别发现右侧颞骨岩尖部浸润性肿块和左侧鼻腔及筛窦软组织肿块。结果病例2的肿物被完全切除而病例1的肿物切除不完全。术后病理诊断均为混合结缔组织亚型的磷酸盐尿性间叶肿瘤。结论若患者表现为无法解释的持续低磷软骨病,应想到TIO的可能性（包括颅面部肿瘤引起的TIO）,确诊依据病理,主要依靠手术治疗。     

磁共振多模态影像在脑胶质瘤诊断及分级中的应用效果分析

目的探讨多模态脑功能定位在胶质瘤的诊断和分级中的应用价值。方法选择2016年2月至2018年3月在我院就诊的47例脑胶质瘤患者作为研究对象,按照世界卫生组织分级方法分为低级别脑胶质瘤和高级别脑胶质瘤,术前均行常规磁共振成像(MRI)、弥散张量成像(DTI)、磁共振波谱(MRS)、动脉自旋成像(ASL)检查。结果病理分级低级别(Ⅰ~Ⅱ级)和高级别(Ⅲ~Ⅳ级)瘤周水肿具有统计学意义(P<0.05)。高级别胶质瘤灌注明显升高,肿瘤实性部分CBF、患侧/健侧CBF比值均显著高于低级别患者,差异均有统计学意义(P<0.05);低级别和高级别脑胶质瘤患者健侧CBF相比较差异无统计学意义(P>0.05)。高级别和低级别患者Cho/NAA、Cho/Cr、NAA/Cr相比较差异均有统计学意义(P<0.05)。高级别和低级别脑胶质瘤患者ADC、ADC比值、FA、FA比值相比较差异均有统计学意义(P<0.05)。单纯MRS功能成像分析,正确分级胶质瘤的正确率为82.98%(39/47);仅以DTI功能成像分析,正确分级胶质瘤的诊断正确率为68.09%(32/47);仅以ASL功能成像分析,正确分级胶质瘤的诊断正确率为76.60%(36/47);综合3种功能成像分析,正确分级胶质瘤的诊断正确率为97.87%(46/47),显著高于3种功能成像单独应用(χ2=6.021、14.763、9.553,P均<0.05)。结论联合三种磁共振功能成像的多模态脑功能定位可优势互补,提高脑胶质瘤分级准确性,有助于手术方式的确定。     

流式细胞术对人脑胶质瘤多药耐药膜糖蛋白测定的临床意义

目的：探讨流式细胞术对人脑胶质瘤多药耐药膜糖蛋白（P－gp）测定的临床意义。方法：采用流式细胞术直接免疫荧光染色法检测新鲜脑胶质瘤和正常脑组织标本中P－gp的表达。结果：不同性别、年龄、肿瘤大小之间P－gp表达阳性率无明显差异（P＞0．05），不同恶性程度之间P－gp表达阳性率差异有显著性（P＜0．05）。相同级别胶质瘤中复发与原发者P－gp表达差异有显著性（P＜0．05）。结论：P－gp表达与病人性别、年龄、肿瘤大小无关，与肿瘤恶性程度呈正相关，P-gp测定可判断胶质瘤对化疗药物敏感性，指导临床应用多药耐药逆转剂，制订化疗方案，亦对判断预后有指导作用。     

立体定向大鼠脑内SHG-44人脑胶质瘤模型的建立

目的：探讨建立大鼠SHG-44脑胶质瘤模型的方法。方法：选用雄性Wistar大鼠,接种前连续3 d用地塞米松1 mg/100 g体重灌胃;在立体定向条件下选取大鼠脑右侧尾状核区为靶点,接种2×10⁵个处于对数生长期的SHG-44细胞,接种后观察大鼠生长状态,分别于第1、2周进行核磁共振(MRI)检查。在实验第2周时解剖标本,行组织病理和GFAP免疫组化检查。 结果：接种1周后核磁共振检查,脑内形成实体瘤;HE染色组织病理证实是胶质瘤,GFAP免疫组化阳性;成瘤率约60%。 结论：用预先免疫抑制的方法,成功建立了大鼠脑内人胶质瘤模型。     

右侧额颞顶叶胶质瘤的CT平扫及增强扫描影像特征分析

目的探讨CT对右侧额颞顶叶胶质瘤的临床诊断价值。方法回顾性分析我院2014年1月-2016年1月期间接收并经手术病理确诊的38例右侧额颞顶叶胶质瘤患者的CT平扫及增强扫描影像资料,并对额颞顶叶胶质瘤患者的肿瘤大小、类型、与周围组织关系以及病变级别等CT影像特征进行综合分析。结果 38例患者中诊断出星形细胞瘤26例,少枝胶质瘤7例,3例室管膜瘤以及2例髓母细胞瘤。其中低级别胶质瘤6例,高级别脑胶质瘤32例。11例患者出现右侧侧脑室受压变窄,4例伴有脑内出血现象者。结论 CT平扫结合增强扫描在对右侧额颞顶叶胶质瘤的诊断过程中,够清楚地显示出胶质瘤发育形态、大小,还能够确诊出胶质瘤类型和阶段,以及其侵犯周期组织情况,具有重要的临床应用价值,值得进一步推广和应用。     

Fibro-osseous and respiratory epithelial hamartoma of the fronto-ethmoid region

A 31-year-old lady presented to the otorhinolaryngology clinic complaining of right exophtalmus. Imaging studies revealed a right frontal sinus mass, suggestive of a mucocele, and fronto-ethmoidal ground glass opacification. In the operating room, the frontal sinuses were exposed through an osteoplastic flap, and connected to the nasal cavity through a Lothrop-like drainage pathway. The pathologic analysis revealed a frontal sinus mucocele and fibro-osseous and respiratory epithelial hamartoma of the fronto-ethmoid region. In this case report, this rare pathology is discussed, in addition to a thorough elaboration upon the surgical options as dictated by the anatomic complexity of the region.     

大鼠胶质瘤动物模型建立及肿瘤PCNA表达的观察

目的建立稳定的大鼠颅内胶质瘤动物模型及观察增殖细胞核抗原(PCNA)在肿瘤中的表达。方法在体外培养C6细胞,借用立体定向仪将C6细胞接种于大鼠右侧尾状核区,观察大鼠生存状态,分别在接种后9、15及21天处死,解剖各组荷瘤大鼠,进行组织病理学检查并检测不同时期胶质瘤PCNA的表达。结果此模型胶质瘤生长特性及组织学特征与人类极为相似,不同时期胶质瘤中PCNA均呈高表达,接种后9天组尤其明显。结论该方法建立的胶质瘤模型成瘤率高、重复性好,PCNA在各期均高表达说明胶质瘤增殖活跃。     

近红外光谱技术在胶质瘤大鼠射频热疗中的应用研究

目的: 研究近红外光谱(NIRS)技术运用于立体定向胶质瘤射频热疗手术中实时监测及疗效评估的可行性,并观察此过程中NIRS参数的变化规律.方法: 在大鼠脑右侧尾状核注入C6胶质瘤细胞建立胶质瘤大鼠模型;对正常及荷瘤大鼠进行靶向射频加热,观察并记录脑组织及肿瘤组织射频加热时靶点的NIRS参数尤其是优化散射系数的变化情况.结果: (1) 60只大鼠尾状核注入C6细胞后有55只出现活动减少,进水饮食渐行减少,体重在术后10 d减轻,经磁共振扫描证实建模成功;(2) 射频加热右侧尾状核,在各温度点下NIRS出现特征性变化曲线.结论: 利用NIRS实时活体在位监测及评估胶质瘤大鼠射频热疗的疗效是科学、可行的,其中优化散射系数是疗效评估及监测的良好指标.     

鼻内镜下上颌窦裂孔的应用解剖研究

目的为临床开展鼻内镜下上颌窦及经上颌窦翼腭窝或海绵窦手术提供上颌窦裂孔区解剖学数据。方法收集骨性鼻腔外侧壁保存完好的成人颅骨69具,鼻内镜下确定上颌窦裂孔大体标志和主要结构,测量前鼻嵴至上颌窦裂孔前缘的最上、中、下三点距离,以及前鼻嵴与上颌窦裂孔前缘最上、下两处连线与以鼻底作为水平线的夹角。根据上颌窦裂孔的解剖参数,自行设计出上颌窦盥洗针头并应用于鼻内镜下鼻窦开放术后系统随访,随访过程中使用上颌窦盥洗针头进行鼻窦盥洗,并进行鼻内镜检查,完成系统随访6个月后判断治疗效果。结果右侧前鼻嵴至上颌窦裂孔前缘的最上、中、下三点距离分别为（3.016±0.228）、（2.753±0.311）、（3.031±0.298）mm,左侧为（2.976±0.264）、（2.849±0.216）、（3.036±0.277）mm;前鼻嵴与上颌窦裂孔前缘最上、下两处连线与以鼻底作为水平线的右侧和左侧的夹角分别为（50.000±9.058）°、（39.078±9.541）°,（49.670±8.345）°、（40.980±8.709）°,左右侧距离及夹角比较,差异无统计学意义（P〉0.05）。上颌窦盥洗针头尺寸和大小、角度均有较好的设计,系统随访发现：使用上颌窦盥洗针头结合鼻内镜检查的随访技术,为鼻内镜下鼻窦手术的愈后带来良好效果。结论鼻内镜下前鼻嵴至上颌窦裂孔前缘的距离约3 cm,前鼻嵴与上颌窦裂孔前缘最上、下两处连线与鼻底水平线的夹角30°~60°。上颌窦盥洗针头的应用结合鼻内镜下鼻窦术腔的微处理模式能对鼻窦炎、鼻息肉的预后产生理想效果。     

Expression and significance of P53 protein and MDM-2 protein in human gliomas

Background  P53 is one of the most studied tumor suppressors in the cancer research, and over 50% of human tumors carry P53 mutations. MDM-2 is amplified and/or overexpressed in a variety of human tumors of diverse tissue origin. The aim of this study was to examine the expression of P53 protein and MDM-2 protein in gliomas, and to investigate the relationship between the expression of the two proteins and the histopathological grades of glioma. The relationship between MDM-2 protein expression and P53 protein expression was also analyzed.

Methods  The expression of P53 protein and MDM-2 protein was immunohistochemically detected using monoclonal antibodies in 242 paraffin embedded tissues, including 30 normal brain tissues from patients with craniocerebral injury and 212 tissues from patients with primary glioma (grade I–II group: 5 cases of grade I, 119 cases of grade II; and grade III–IV group: 53 cases of grade III, and 35 cases of grade IV).

Results  The P53 positive rate was significantly higher in the glioma groups than in the control group (P <0.0001). The P53 positive rate was significantly higher in glioma tissues of grade III–IV than in glioma tissues of grade I–II group (P=0.001). The MDM-2 positive rate was significantly higher in glioma groups than in the control group (P <0.0001). There was no significant difference in the MDM-2 positive rate between the two glioma groups (P=0.936). The expression of P53 protein was not related to expression of MDM-2 protein (P=0.069)

Conclusions  Overexpression of P53 protein might be related to the occurrence and progression of glioma. Overexpression of MDM-2 protein may play an important role in glioma tumorigenesis, but may not be involved in glioma progression. The overexpression of MDM-2 protein was an early event in malignant transformation of glioma. MDM-2 may be a key player in glioma in its own right.

     

双荧光标记的胶质瘤原位移植瘤模型的建立

目的建立一种稳定、可实时监测的胶质瘤原位移植瘤裸鼠模型。方法用带有荧光素酶(luciferase-Luc)和绿色荧光蛋白(green fluorescent protein-GFP)基因的慢病毒感染U251神经胶质瘤细胞,流式细胞仪筛选稳定表达GFP-Luc荧光的细胞系,并通过CCK-8实验、细胞周期实验、Transwell肿瘤迁移及侵袭实验等评价荧光细胞的增殖、迁移和侵袭能力是否改变;将细胞接种至裸鼠大脑尾状核,建立胶质瘤原位移植瘤模型,利用小鼠活体成像系统监测脑内肿瘤的生长情况,并通过石蜡切片,HE染色评价细胞在裸鼠脑内的病理特征及成瘤能力。结果成功构建稳定表达GFP荧光和luciferase荧光的U251胶质瘤细胞系及动物模型,慢病毒整合并未改变细胞的增殖、迁移及侵袭能力;模型生长周期适中,成瘤率高,瘤体在颅内生长稳定,HE切片符合人胶质瘤特征。结论双荧光标记的胶质瘤细胞相比于传统细胞更有利于胶质瘤动物模型的实验研究;U251-GFP-Luc胶质瘤细胞裸鼠模型,其肿瘤生长和病理特性与人胶质瘤相似,且可实时观察肿瘤生长,可作为胶质瘤实验研究的理想动物模型。     

C6大鼠脑胶质瘤动物模型建立及病理观察

目的建立简单易行、可靠稳定的大鼠C6脑胶质瘤模型,为研究脑胶质瘤的发病机制和防治方法提供操作平台。方法采用立体定向技术,将体外培养的大鼠C6胶质瘤细胞浓缩悬置,2.5×10^6个.25μ^L-1接种于SD大鼠的右侧尾壳核区,种植后连续观察大鼠的生存状态,并分别于7、14、21 d处死大鼠,立刻取脑,制作病理切片,HE染色,光镜下观察。结果大鼠接种C6胶质瘤细胞后,7 d左右生存状态良好,14 d左右出现较为明显的颅内高压症状,21 d左右时多数处于濒危状态。大体标本检查,18只大鼠中除3只意外死亡外,其余成瘤率100%,瘤体随着鼠龄的延长,中线结构明显移位,占位效应愈来愈明显。HE染色可明显观察到大鼠脑组织胶质瘤的形成。结论建立的C6大鼠脑胶质瘤动物模型可靠、稳定,其肿瘤生长特性及病理特征与人脑胶质瘤相似,可作为临床胶质瘤基础研究的理想模型。     

恶性胶质瘤中血管生成与肿瘤生长关系的研究

目的探讨血管生成与恶性胶质瘤生长之间的关系,为进一步抗血管生成治疗恶性胶质瘤提供实验依据。方法立体定向尾状核注射C6细胞制作SD大鼠脑胶质瘤动物模型并观察肿瘤生长变化;采用SABC免疫组化法,检测注射C6细胞后第9、15、21天肿瘤组织中增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）,检测CD34计算肿瘤组织中的微血管密度（microscope vessel density,MVD）。结果接种C6细胞后,随着天数的增加肿瘤体积逐渐增大;肿瘤组织中PCNA的表达逐渐增强,微血管密度明显增加,与对照组相比差异均有统计学意义（P〈0.01,P〈0.05）。结论恶性胶质瘤是生长活跃、血管增殖明显的肿瘤,血管生成与恶性胶质瘤生长间密切相关。     

应用近红外光谱技术对胶质瘤大鼠射频热疗的实时在位监测研究

目的:观察近红外光谱(near-infrared spectroscopy,NIRS)光学参数在胶质瘤射频热疗术中的变化规律,探讨利用NIRS对胶质瘤射频热疗进行实时监测的可行性.方法:将C6胶质瘤细胞注入大鼠脑右侧尾状核建立胶质瘤大鼠模型;在不同时间、温度下对荷瘤大鼠进行靶向毁损,观察并记录肿瘤组织射频加热时靶点的N...