Kalzifizierender Pseudotumor der Orbita

Orbital pseudotumor can be divided histopathologically into three basic types: lymphoid, granulomatous and sclerosing. Chronic lymphoid and granulomatous types may eventually transform into the sclerosing type. The calcifying orbital pseudotumor is a very rare disorder due to a chronic, idiopathic inflammatory process of the orbit. The granulomatous type shows a good response to steroids while radiotherapy is the method of choice for lymphoid lesions. In general, calcifying pseudotumors can be treated only by operative exploration and tumor removal. We report a patient with a calcifying pseudotumor of the orbital apex that was removed through an endonasal approach. Preoperative diagnostic procedures and differential diagnosis are discussed.     

Peroral fine needle aspiration cytology of parapharyngeal tumors: a study of 67 cases

Peroral fine needle aspiration cytology (FNAC) was carried out to diagnose parapharyngeal tumors in 67 patients from January 2000 to January 2008. The inflammatory lesions were excluded in the present study. The age of patients ranged from 6 years to 72 years. Analysis of results showed 35 benign tumors and 32 malignant neoplasms. Correlation with histopathology showed a diagnostic accuracy of 92.5% with no false positive report. No complication was encountered in the present study. FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report. Such a large series of parapharyngeal tumors diagnosed by FNAC has hardly been reported in India.     

Gutartige Tumoren der Glandula parotidea

Background

Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate neoplastic or inflammatory tumorous lesions of the salivary glands. This method influences the selection of the modality of surgical treatment. In cases of benign tumors of the parotid gland, a (partial) superficial parotidectomy is usually recommended. However, for tumors other than pleomorphic adenomas (such as cystadenolymphomas, other adenomas, or benign tumor-like lesions) this operation is considered an overtreatment because extracapsular satellites are rare and recurrences in case of a capsular lesion are not likely. In such cases, a less extended surgery (enucleation) with lower morbidity is sufficient and can be carried out provided that pleomorphic adenomas and non-pleomorphic benign lesions are reliably differentiated prior to surgery. The aim of this study was to evaluate the reliability of the FNAC in differentiating benign tumors of the parotid gland.

Methods

A retrospective evaluation of 160 cases of benign parotid gland tumors was performed and the cytological diagnoses compared with the histomorphological results. A collection of 26 cases with false-negative and false-positive results was reevaluated.

Results

FNAC showed a sensitivity of 74.2% and a specificity of 89.8% for differentiation between pleomorphic adenomas and non-pleomorphic benign lesions. The predictive value for pleomorphic adenomas was 82.1%, and for non-pleomorphic benign lesions 84.6%. Reevaluation showed higher sensitivity (96.2%), specificity (98.9%), and negative/positive predictive values (97.9% and 98.1%, respectively).

Discussion/conclusion

Poor quality and hypocellularity of the cytological smears seem to negatively effect the outcome of the cytological diagnosis. It is concluded that only an accurate diagnosis of non-pleomorphic adenoma or a benign tumor-like lesion, based on an adequate FNAC specimen and assessed by an experienced cytopathologist, can justify tumor enucleation because the risk of pleomorphic adenoma is only 2% under these circumstances.     

Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy

The results of a consecutive series of 1,349 fine needle aspiration (FNA) biopsies from the head and neck region of 1,193 patients has been reviewed in order to evaluate the efficacy of this method in the diagnosis of tuberculous lymphadenopathy (TBLN). Of the 108 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 68 had subsequent surgery and histological confirmation of the cytological appearance. Sixty-three had TBLN, thus the specificity of FNAC was 93 per cent in diagnosing tuberculous related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be metastatic mucoepidermal carcinoma. Of the 1,193 patients, 90 patients had subsequently TBLN confirmed histologically. Of these 90 patients, FNA from 69 showed granulomatous changes or acid fast bacilli (AFB), thus the sensitivity of FNAC in detecting tuberculous lymphadenopathy was 77 per cent. Fifty-two cytological smears were stained for acid fast bacilli. Nineteen (37 per cent) contained AFB. It is evident from this review that FNAC is an efficient way to detect cervical tuberculous lymphadenopathy.     

Isolated tonsillar sarcoidosis manifested as asymmetric palantine tonsils

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. Isolated sarcoidosis of palatine tonsils in the absence of other systemic localizations is very rare, and only a few cases have been described in literature. We report a case of a 69-year-old woman presenting an asymptomatic unilateral enlargement of palatine tonsils. The pathologic report of the tonsillectomy specimen revealed the presence of noncaseating granulomatous lesions compatible with sarcoidosis. The research of acid-fast bacilli on the biopsy material using the Ziehl-Neelsen stain was negative, and no cultural growth was documented. Further investigations confirmed the diagnosis and excluded other systemic localizations of the disease. In our experience, asymmetric tonsils caused by sarcoid disease should be taken into consideration for the differential diagnosis in tonsillar enlargement. With this report, we underline the possibility of an isolated localization of sarcoidosis in palatine tonsils manifested as asymmetric enlargement, and we point out the value of histopathologic examination after tonsillectomy in selected cases. Once sarcoid lesions are found in tonsillar specimens, further investigations are mandatory to confirm the diagnosis, to detect an eventual multisystemic disease, and to exclude a possible association with malignancy.     

Breast cancer metastasis presenting as ethmoiditis

Metastasis from primary tumours to the paranasal sinuses is infrequent. We report an unusual case of breast cancer metastasis presenting as ethmoiditis in MRI. MRI changes are unspecific and sometimes inflammatory lesions can not be distinguished from neoplastic lesions. Inflammatory changes in the paranasal sinuses are also frequently noted on MRI even in normal persons without disease. A high index of metastasis suspicion in any patient with breast cancer must be kept in mind.     

Salivary gland disease in infancy and childhood: non-malignant lesions.

The differential diagnosis for benign lesions of the salivary glands in infancy and childhood can be somewhat overwhelming, especially in light of their infrequent occurrence in a general otolaryngologic practice. The purpose of this review is to discuss these conditions under the headings of inflammatory conditions, immunologic disorders, granulomatous disease, trauma, cysts, systemic disorders and benign neoplasms. Basic techniques of diagnosis and treatment as they apply to children will be outlined.     

The role of fine-needle aspiration cytology and magnetic resonance imaging in the management of parotid mass lesions

Conclusion. Fine-needle aspiration cytology (FNAC) is the diagnostic modality of first choice for characterization of parotid mass lesions, while magnetic resonance imaging (MRI) should not be requested routinely. MRI can be reserved until FNAC shows the indication for surgical intervention. Objectives. Although both FNAC and MRI are useful preoperative diagnostic modalities for parotid mass lesions, it is not well established which modality is more effective. In the present study we sought to address the relative value of FNAC and MRI in relation to the differential diagnosis of benign and malignant parotid mass lesions. Subjects and methods. Eighty-one patients with parotid mass lesions (60 benign and 21 malignant) who had preoperatively undergone FNAC and MRI were reviewed retrospectively. Results. Unsharp margin and infiltration into adjacent tissues on MRI significantly correlated with a malignant histology. The sensitivity/specificity/accuracy of FNAC and MRI were 90%/95%/94% and 81%/92%/89%, respectively. Either FNAC or MRI served equally to predict the malignant nature of parotid mass lesions. Furthermore, the combination of FNAC and MRI yielded no diagnostic advantage over either modality alone. Accurate histological typing rates by FNAC were 80% and 62% for benign and malignant lesions, respectively.     

Kann die präoperative Feinnadelpunktion bei Parotistumoren die definitive histologische Diagnose erschweren?

Introduction

Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure that offers high specifity and acceptable sensitivity in the preoperative diagnosis of parotid tumors. FNAC provides information that can be particularly valuable in surgical planning and patient education. In some cases, it may even help prevent unnecessary surgery. After an FNA procedure, on rare occasions, morphological changes in the tumor may be observed and can make a definitive histological examination difficult or even impossible.

Methods

Histopathological changes in parotid tumors after preoperative FNAC are described on the basis of a case report and a survey of the literature.

Results

In rare cases, puncture-induced histopathological changes, such as hyalinization of the subepithelial stroma, necrosis and squamous metaplasia, so extensive that a definitive histological diagnosis is difficult, are observed. In the present case report, fine-needle aspiration of a 3×2 cm tumor, which had been classified as malignant on the basis of cytological findings, resulted in complete necrosis and made a definitive histological diagnosis impossible. Similar cases have been described by other authors in recent years.

Discussion

In rare cases, histological changes in the tumor tissue can occur after an FNA procedure, making a definitive histological examination difficult or even impossible. When a preoperative FNAC is performed, the pathologist in charge should be advised accordingly. In addition, patients should be informed about this infrequent risk before undergoing the procedure.     

The role of fine-needle aspiration cytology and magnetic resonance imaging in the management of parotid mass lesions

Conclusion. Fine-needle aspiration cytology (FNAC) is the diagnostic modality of first choice for characterization of parotid mass lesions, while magnetic resonance imaging (MRI) should not be requested routinely. MRI can be reserved until FNAC shows the indication for surgical intervention. Objectives. Although both FNAC and MRI are useful preoperative diagnostic modalities for parotid mass lesions, it is not well established which modality is more effective. In the present study we sought to address the relative value of FNAC and MRI in relation to the differential diagnosis of benign and malignant parotid mass lesions. Subjects and methods. Eighty-one patients with parotid mass lesions (60 benign and 21 malignant) who had preoperatively undergone FNAC and MRI were reviewed retrospectively. Results. Unsharp margin and infiltration into adjacent tissues on MRI significantly correlated with a malignant histology. The sensitivity/specificity/accuracy of FNAC and MRI were 90%/95%/94% and 81%/92%/89%, respectively. Either FNAC or MRI served equally to predict the malignant nature of parotid mass lesions. Furthermore, the combination of FNAC and MRI yielded no diagnostic advantage over either modality alone. Accurate histological typing rates by FNAC were 80% and 62% for benign and malignant lesions, respectively.     

The value of fine-needle aspiration cytology in salivary gland lesions, 1994-2004

OBJECTIVE: Fine-needle aspiration cytology (FNAC) of the salivary gland is a commonly accepted, sensitive and specific technique in the diagnosis of both neoplastic and nonneoplastic lesions of the salivary gland. The aim of this study was to investigate the efficacy of FNAC of salivary gland lesions and to decide whether the radiologist could perform it or not. METHODS: We aspirated 162 salivary gland lesions of 56 patients undergoing biopsy and excision. A cytopathologist and a surgical pathologist made histopathological and cytological examinations in a blinded fashion. RESULTS: In the present study, among the FNAC performed in 162 patients with salivary gland masses, 15 (9%) were inadequate, and the remaining 147 were diagnostic. Of the 162 cases, 56 (35%) were also checked histologically. With FNAC there were 89 (55%) nonneoplastic and 58 (36%) neoplastic lesions. With FNAC 45 of the neoplastic lesions were benign and 13 malignant tumors. When cytohistopathological correlation was performed, the overall accuracy in diagnosing benign and malignant lesions was 91 and 78%, respectively, except for 2 malignant lymphoma cases. The sensitivity and specificity for benign and malignant lesions were 72 and 100%, respectively. The diagnostic sensitivity for all neoplastic and nonneoplastic lesions was 84% and the specificity 92%. There was 1 false-positive result, in which a nonneoplastic lesion was misdiagnosed as a Warthin's tumor. Fifteen (26%) cases were false-negative, 12 of which were undefined. CONCLUSION: FNAC is a useful and reliable tool in the diagnosis of salivary gland masses when performed by a radiologist or a clinician. There are no contraindications, and complications are minimal.     

Localised Wegener's granulomatosis in otolaryngology: a review of six cases

Wegener's granulomatosis (WG) is a necrotising granulomatous disease affecting the upper and/or lower respiratory tracts and is associated with focal glomerulonephritis. Formerly believed to be a multisystem disease, a localised form (LWG) is now recognised as a distinct subtype. We describe 6 cases of LWG with no renal or pulmonary involvement detected at the presentation or during follow-up. The total follow-up period ranged from 3 to 7 years in 5 cases. The diagnosis was based on clinical features, antineutrophil cytoplasmic antibody test and histological findings (necrotising granulomatous vasculitis, epithelioid granulomas with varying degrees of chronic inflammatory cells). All patients responded to standard immunosuppressive treatment. Our cases highlight the predilection of LWG for the head and neck region and hence these patients frequently present in the ENT departments. LWG has been discussed as a subtype of WG with a better prognosis and the previous literature has been reviewed on this subject. A high index of suspicion helped by serology and histology enables an early diagnosis, and commencement of proper treatment can prevent the irreversible destructive lesions.     

Vascular malformation of the sphenoid sinus

Isolated sphenoid sinus lesions are usually inflammatory lesions or mucoceles. We report an unusual case of a thrombosed arteriovenous malformation presenting as a unilateral primary vascular malformation of the sphenoid sinus. To the best of our knowledge, no one has ever reported such an entity in the medical literature. Differential diagnosis of sphenoid sinus lesions and possible etiologies for this case will be detailed.     

Thyroid fine needle cytology complicated by recurrent laryngeal nerve palsy and unnecessary radical surgery

Fine needle aspiration cytology (FNAC) is an important tool in the investigation of thyroid nodules and has few reported complications. We present the first report of recurrent laryngeal nerve palsy arising as a complication of thyroid nodule FNAC. This complication led to inaccurate diagnosis and unnecessarily radical surgery, with consequent increased morbidity.     

FNAC of salivary gland lesions with histopathological correlation

Hypothesis: Analysis of salivary gland lesions by FNAC and correlation with histopathology. To evaluate utility of FNAC in salivary gland lesions.Back ground: Salivary gland lesions form about 2–6.5% of all head and neck neoplasms in adults. They are easily accessible for FNAC (Fine Needle Aspiration Cytology) and risks of fistula formation or tumour implantation are low compared surgical biopsy. Also, cytology can provide a distinction between asalivary and non salivary lesion, benign and malignant lesions so also specific and non specific inflammation. Methods: Seventy patients were studied prospectively over two years. FNAC was done using 10 cc syringes and 20–22 no. needle. Histomorphology was assessed on routine H & E (haemotxylin and eosin) stained paraffin sections. SPAS (periodic acid Schiff) and mucicarmine satins were also done. Results: 80% of the lesions were neoplastic (61% benign, 31% malignant) and 20% were neoplastic. Pleomorphic adenoma was the most frequent benign neoplasm while mucoepidermoid carcinoma was the most frequent malignant lesion. Among the non neoplastic lesions, the maximum number of cases were of chronic sialadentis. In the present study, FNAC has a sensitivity of 94.54% and specificity of 80.95% for neoplastic lesions. Conclusions: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.     

Adenoid cystic carcinoma of the tongue

Malignant tumours of the salivary glands in children are extremely rare. We present here a 12-year-old girl initially diagnosed as pleomorphic adenoma on fine needle aspiration biopsy, and adenoid cystic carcinoma (ACC) after the lesion was excised and examined by histopathology. A wide resection of the lesion and bilateral supraomyohyoid neck dissection was performed. To our knowledge this is one of the youngest patients with ACC of the minor salivary glands. Due to its benign histological appearance, the biological agressiveness of ACC is usually underestimated. Although fine needle aspiration cytology (FNAC) is very valuable in diagnosis, cytological variations of pleomorphic adenoma must be considered. ACC of the tongue in a young age group should be treated with wide resection and selective neck dissection if the tumour is localized in places where the risk of metastasis is increased and if there is a clinically palpable lymph node. In such cases the clinician should not avoid radical operations even in a young patient.     

Laryngeal actinomycosis

Actinomycosis is a rare infectious disease in our practice and clinically it is charactherized by the presence of granulomatous lesions of subacute or chronic evolution. Most of the cases of actinomycosis are localised in the cervico-facial area, being the laryngeal one uncommon. We present a clinical case of a 53 years-old male diagnosed of primary laryngeal actinomycosis and we realise a bibliographic revision on this subject emphazising the diagnosis techniques and the differential diagnosis of this kind of lesions.     

Inflammatory pseudotumor in head and neck

Background

Inflammatory pseudotumor (IPT) is a tumefactive lesion characterized by fibroblastic proliferations and a prominent inflammatory component. It behaves as a locally benign or aggressive lesion, clinically and radiologically mimicking a neoplastic process. Numerous entities can be diagnosed as IPT, from reactive lesions to true neoplasms. The diagnosis of IPT requires further elaboration, and IPT should be distinguished from other similar entities such as inflammatory myofibroblastic tumor and IgG4-related sclerosing disease.

Case summary

We report two cases of IPT arising from the head and neck region. One occurred at the orbit and the other at the parapharyngeal space. Histologically, they showed aggregates of myofibroblasts and inflammatory cells. Immunohistochemically, the number of IgG4-positive cells was less than 40% of the number of IgG positive cells, and the myofibroblastic cells were negative for anaplastic lymphoma kinase. The diagnosis was IPT/not otherwise specified. One patient was treated by systemic administration of corticosteroid and had good response. The other, who was treated by local administration of corticosteroid, partially responded and is currently stable with limited disease.

Discussion

IPT has been reported to occur in various anatomical sites, most commonly in the lungs. The incidence in the head and neck area is extremely rare. Treatment of IPT is controversial and may involve corticosteroids or surgical resection, or both. Other chemotherapeutic agents and radiotherapy may be considered in steroid-resistant patients. The pathological subtype, safety of resection, and safety of corticosteroid use must be included in the decision-making process for treatment.     

Intranasal granuloma faciale

A 49-year-old man had a recurring intranasal mass accompanied by erythematous plaques on the forehead. Biopsy specimens of the skin and intranasal mass led to a diagnosis of granuloma faciale, a rare benign skin disorder. Lateral intranasal location and associated facial lesions help to clinically differentiate this lesion from more ominous midline granulomatous diseases. The lesions were treated with intralesional steroid injections. This may be the first reported intranasal occurrence of granuloma faciale.     

Lymphknotensarkoidose der Submandibularisloge

Sarcoidosis is a granulomatous systemic disease of unknown etiology. Besides the landmark pulmonary lesions, extrathoracic manifestations of the disease can also occur. We report the case of a 53-year-old woman with an obscure swelling of both submandibular compartments. The radiological and pathohistological evaluations confirmed the uncommon diagnosis of sarcoidosis of the submandibular compartment. The tumor in each compartment consisted of a huge lymph node conglomerate respectively displacing the submandibular gland. The major salivary glands and the thorax were not involved.