Sinonasal teratocarcinosarcoma involving the nasal cavity,unilateral paranasal sinuses,and intracranial invasion:A case report

BACKGROUND Sinonasal teratocarcinosarcoma(SNTCS)is a rare and highly invasive neoplasm originating from the nasal cavity and sinuses.Typically,it exhibits an invasive behavior towards adjacent structures;however,in exceptional instances,it may infiltrate the intracranial compartment.Due to the tumor's rarity and lack of distinctive features on computed tomography(CT)and magnetic resonance imaging(MRI)images,SNTCS is often misdiagnosed.CASE SUMMARY In this study,we present a case of SNTCS in a 56-year-old patient who exhibited unexplained cognitive impairment before admission.CT and MRI scans revealed the presence of a mass in the right nasal cavity,with lesions extending to the right ethmoid sinus and right frontal region.Subsequently,the patient underwent pathological examination for confirmation and received surgical intervention to excise the tumor.The future advancement in our understanding of this disease will significantly contribute to the precise diagnosis and treatment of SNTCS.CONCLUSION SNTCS is an exceptionally rare malignant tumor that originates from the nasal cavity and paranasal sinuses,presenting a diagnostic challenge due to its nonspecific imaging findings.MRI accurately delineates the location,morphological characteristics,size,internal structure,extent of surrounding involvement,and metabolic information of the lesion.These aspects play a pivotal role in the precise localization and qualitative assessment of SNTCS.Nevertheless,a definitive diagnosis still requires a pathological biopsy.

Advance in the Studies on Small Cell Neuroendocrine Carcinoma of the Paranasal Sinuses

Small cell neuroendocrine carcinoma (SCNEC) of the paranasal sinuses is extremely rare,with an unclear pathogenesis.The presence of neuroendocrine granules is suggestive of neuroendocrine differentiation.It was reported that this disease relates to the presence of accessory salivary glands,and some basic research has shown that it might originate from the multi-potent stem cells.There are no specific clinical symptoms but rhinal and ophthalmological symptoms are found in most cases.Diagnosis mainly depends on histopathological manifestations,immunohistochemical results and features of the electron microscopic ultra-structure.Pathological differentiation from poorly differentiated squamous carcinoma,melanoma,esthesioneuroblastoma and neuroglioma etc.is needed.No unified regimen has been employed in treating the disease.At present,combined therapy has a manifest therapeutic effect,such as success with the 2003 French regimen.Tumor relapse is common and prognosis is poor.A complete combined treatment plan will be helpful to improve the prognosis.

Use of Diode Laser in Excising Bilateral Inverted Papilloma of Paranasal Sinuses

The inverted papilloma is an uncommon unilateral benign unilateral tumor of the nose & paranasal sinuses. Although a benign pathology, it is associated with aggressive local destruction and recurrence after removal and malignancy. The clinical picture presents non-specific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral nasal inverted papilloma and the use of diode laser in surgical excision & making a literature review. The uniqueness in our case was the use of diode laser in excision of inverted papilloma.

Study of MR image for involvement of paranasal sinuses in 56 cases with nasopharyngeal carcinoma

Objective： The aim of the study was to study the nuclear magnetic resonance image （MRI） feature for involvement of paranasal sinuses in patients with nasopharyngeal carcinoma （NPC）. Methods： The MRI of 56 patients with NPC and paranasal sinuses infringed were evaluated between December 2003 and August 2004. Results： Among them, 56 （100%） showed breakage in the wall of paranasal sinuses, 29 （51.8%） had thick mucous membrane in sinuses, 36 （64.3%） showed tumour invasion sinuses, 55 （98.2%） connected with primary carcinoma with the lesion, and 14 （25%） stored up fluid in si- nuses. On MRI scan technique, the positive ratios of diagnoses were 66.1%, 76.8%, and 98.2% respectively （P 〈 0.000） in the horizontal section, coronal section and sagittal section. And nearly 60% was in the TlWl and T2Wl, but 100% in strengthen scan. Conclusion： The findings of sinuses wall breakage, thick mucous membrane in sinuses, tumour invasion cavity connective mass, and same enhancement signal in MR image may indicate the paranasal sinuses involved by primary turnout. The sagittal section and enhanced MRI scans are helpful to diagnosis.

The Endonasal Endoscopic Management of Paranasal Sinuses Mucoceles

Introduction: Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. Objective: To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. Method: Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. Result: Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. Conclusion: Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.

Low-grade myofibrosarcoma of the maxillary sinus:Two case reports

BACKGROUND Low-grade myofibroblastic sarcoma(LGMS)is an extremely rare tumor characterized by the malignant proliferation of myofibroblasts.LGMS most commonly develops in adults,predominantly in males,in the head and neck region,oral cavity,especially on the tongue,mandible,and larynx.This article presents 2 cases of LGMS localized to the maxillary sinus and provides an overview of the available literature.CASE SUMMARY Two patients with LGMS located in the maxillary sinus underwent surgery at the Department of Head and Neck Surgery.Case 1:A 46-year-old patient was admitted to the clinic with suspected LGMS recurrence in the right maxillary sinus(rT4aN0M0),with symptoms of pain in the suborbital area,watering of the right eye,thick discharge from the right nostril,and augmented facial asymmetry.After open biopsy-confirmed LGMS,the patient underwent expanded maxillectomy of the right side with immediate palate reconstruction using a microvascular skin flap harvested surgically from the middle arm.The patient qualified for adjuvant radiotherapy for the postoperative bed,with an additional margin.Currently,the patient is under 1.5 years of observation with no evidence of disease.Case 2:A 45-year-old man was admitted to our clinic with facial asymmetry,strabismus,exophthalmos,and visual impairment in the right eye.Six months earlier,the patient had undergone partial jaw resection at another hospital for fibromatosis.A contrast-enhanced computed tomography scan revealed a tumor mass in the postoperative log after an earlier procedure.An open biopsy confirmed lowgrade fibrosarcoma(rT4aN0M0).The patient qualified for an extended total right maxillectomy with orbital excision and right hemimandibulectomy with immediate microvascular reconstruction using an anterolateral thigh flap.The patient subsequently underwent adjuvant radiotherapy to the postoperative area.After 9 months,recurrence occurred in the right mandibular arch below the irradiated area.The lesion infiltrated the base of the skull,which warranted the withdrawal of radiotherapy and salvage surgery.The patient qualified for palliative chemotherapy with a regimen of doxorubicin+dacarbazine+cyclophosphamide and palliative radiotherapy for bone metastases.The patient died 26 months after surgical treatment.The cases have been assessed and compared with cases in the literature.CONCLUSION No specific diagnostic criteria or treatment strategies have been developed for LGMS.The treatment used for LGMS is the same as that used for sinonasal cancer radical tumor excision;adjuvant radiotherapy or chemoradiotherapy should also be considered.They have low malignant potential but are highly invasive,tend to recur,and metastasize to distant sites.Patients should undergo regular follow-up examinations to detect recurrence or metastasis at an early stage.Patients should be treated and observed at the highest referral centers.

Poor Reproducibility in the Evaluation of Paranasal Sinus X-Rays in Chronic Rhinosinusitis

Objective: The aim of this study was to evaluate intra- and inter-observer reproducibility of sinus x-rays in comparison to sinus computed tomography (CT) in chronic rhinosinusitis (CRS) patients. Methods: This was a prospective controlled study for which 14 adult CRS patients were recruited. Patients underwent a sinus multi-detector CT scan as well as additional sinus x-rays at the same time. Symptom interview and skin prick tests were performed. Lund-Mackay (LM) scores and 43 other findings in paranasal sinuses were analyzed by three blinded observers from CT-scans and x-rays. We compared agreement between sinus CT and x-rays (intra-observer reproducibility) and between three observers (inter-observer reproducibility) by Cohen’s kappa. Results: In at least 90% of the cases, the status of 47/49 structures was detectable in CT scans, whereas the status of only 8/49 structures was detectable in x-rays. The majority of the 25 visualized structures had poor intra-observer and inter-observer reproducibility. Conclusion: Only a few structures can be visualized in paranasal sinus x-rays and compared to paranasal sinus CT-scans, their reproducibility is poor. Our results strongly support the current consensus of radiation dose reduction by limiting the number of x-rays.

Lung adenocarcinoma metastasis to paranasal sinus:A case report

BACKGROUND Lung cancer is often metastasized to the brain,liver,kidneys,bone,bone marrow,and adrenal glands;however,metastasis of primary lung cancer to the paranasal sinuses is extremely rare.CASE SUMMARY In this paper,we present a case of metastatic tumors of the sinus secondary to lung adenocarcinoma.The patient was a 46-year-old woman who underwent surgical removal of lung carcinoma.Four months after the surgical removal of the lung tumor,the patient presented with epistaxis,and on investigation,the diagnosis was confirmed to be nasal sinus tumors due to metastasis of lung adenocarcinoma.CONCLUSION Thorough investigation of patients with epistaxis and a history of lung cancer is necessary to diagnose metastatic sinus tumors.We reviewed relevant literature and found that there are no characteristic clinical or radiologic features for metastatic sinus tumors;however,the diagnosis can be confirmed by histopathological examination of biopsied tumor sample.

Reproducibility of 3 mm-Slice-Thick Reconstruction of Paranasal Sinus Computed Tomography Scans

Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this prospective study was to evaluate whether this study method might be eligible in studies aiming at radiation dose reduction. Sinus CT scans were chosen as a model because of the high variation of the radiological anatomy of surgically important sinonasal structures. We hypothesized that 3 mm-slice-thick reconstruction CT had poor reproducibility. Methods: 59 CRS patients underwent routine multi-detector sinus CT (CTMD). CT3mm was reconstructed from CTMD data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CTMD and CT3mm (intra-observer reproducibility), and between three observers (inter-observer reproducibility) by using Cohen’s kappa. Results: The inter-observer agreement was moderate (kappa 0.4 - 0.6, p < 0.01) in the majority of structures of CT3mm scans. The intra-observer reproducibility of CT3mm scans was very good in most structures, however, it was poor in important structures such as frontal and spheno-ethmoid recess, lamina papyracae, and location of optic nerve or anterior ethmoidal artery. The grade of surgeon’s confidence of CT3mm in comparison to CTMD was lower (kappa 0.2 - 0.4, P < 0.05). Conclusion: This methodology might have some use in studies aiming at radiation dose reduction. As was expected, 3 mm-slice-thick reconstruction CT had poor reproducibility and surgeon’s confidence. More recent methods such as cone beam computed tomography scans have nowadays more relevant dose reduction potential.

原发性鼻窦黏膜黑色素瘤研究进展

原发性鼻窦黏膜黑色素瘤(SNMM)是一种侵袭性恶性肿瘤,具有转移性高、预后不良等特点。SNMM出现的症状是非特异性的,鼻腔是最常见的起源部位。SNMM在组织病理学上具有多样性,基因表达谱分析已经识别了许多常见的基因突变,这些突变可能为新兴的生物治疗提供潜在的靶点。另外了解AJCC手册提供的TNM分期对临床有重要意义,在手术基础上结合多模式治疗可能使患者获益。SNMM患者常在就诊时已达晚期,因此本文将SNMM近年发病情况、组织病理学特点、特有分子标记物、临床分期及临床治疗方案与预后的最新信息进行总结。

计算机体层成像对嗅窝深度的Keros分类及评估

目的:根据Keros分类,使用CT对嗅窝深度进行评估,并探讨成人两侧嗅窝深度的差异。方法:对2022年6月至2023年3月进行副鼻窦CT平扫的521例患者进行回顾性研究,使用PACS软件在冠状位上测量筛板与筛顶之间的垂直距离进行分类及评估。结果:1042侧嗅窝中,KerosⅡ型最常见,其次是Ⅲ型,然后是Ⅰ型。嗅窝平均深度左、右两侧差异有统计学意义,男、女之间差异有统计学意义(均P<0.05)。根据性别比较,右侧嗅窝平均深度在不同性别之间差异无统计学意义(P>0.05),左侧则差异有统计学意义(P<0.05)。左右两侧嗅窝Keros分类在男、女之间差异均无统计学意义(P>0.05)。结论:成人两侧及不同性别之间的嗅窝深度存在差异,术前对副鼻窦进行CT扫描对于外科医生评估前颅底的解剖、确保手术入路的正确规划和预防相关可能的手术并发症至关重要。

Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis:A case report

BACKGROUND Primary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare.In addition,Epstein-Barr virus(EBV)has been reported to play a role in the development of human immunodeficiency virus(HIV)-related malignant lymphomas.To the best of our knowledge,there is no report for the HIVassociated,EBV-positive primary diffuse large B-cell lymphoma(DLBCL)in the frontal sinus.CASE SUMMARY We present a unique case of HIV-associated,EBV-positive DLBCL in the frontal sinus in a 46-year-old man.Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling.Based on the clinical and radiological findings,the initial diagnosis was complicated frontal sinusitis,presenting Pott’s puffy tumor.Unexpectedly,HIV testing was positive on preoperative laboratory test,and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.CONCLUSION Through this article,we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses.We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.

Large Foreign Body in the Nasal Cavity, Maxillary Sinus and Infratemporal Fossa—Atypical Presentation

A 59-year-old male presented with complaints of trismus and discharge of altered blood from nose for 1 year. Patient had a history of facial trauma one year back. Nasal endoscopy and CT scan revealed a foreign body lodged in posterior half of both nasal cavity, left maxillary sinus and left infratemporal fossa penetrating the walls of maxillary sinus and nasal septum. Foreign body was removed by infratemporal fossa approach. This case has a rare location of a forgotten foreign body with atypical presentation.

A Case of Maxillary Sinus Cholesteatoma Originating from the Retromaxillary Sinus Wall

Cholesteatomas are often observed in the middle ear or mastoid cavity. However, cholesteatomas in areas other than the middle ear or mastoid are extremely rare and thus are not often reported in the literature. We recently treated an 18-year-old female patient with an incidentally detected maxillary sinus mass. A paranasal sinus computed tomography examination revealed a cystic lesion in the left maxillary sinus infiltrating the posterolateral walls of the left maxillary sinus. An endoscopic operation was performed for definitive diagnosis. Histopathological examination of the mass confirmed the diagnosis of cholesteatoma. Despite the rarity of paranasal cholesteatoma in comparison with cholesteatomas in the tympanum, a few cases involving the frontal sinus have been reported. However, retromaxillary cholesteatoma is even less common than sinus cholesteatoma and is reported rarely. To our knowledge, this is the first reported case of a maxillary cholesteatoma originating from the retromaxillary area. For this reason, we present this case along with a literature review.

Histopathologic Observation and Three Dimeninal CT Reconstruction of the Nasal Cavity and Paranasal Sinuses in Children with Cleft Palates

The morphologic characteristics of nasal cavity and paranasal sinuses in childred with cleft plaate were studied by

鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值

目的探究鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值。方法对北京京煤集团总医院2019年8月~2022年8月间收治的鼻内镜手术患者150例(300侧)进行回顾性分析,患者术前均行鼻窦CT扫描,测量筛板和筛孔中心之间外侧板的长度(LLCP长度)并进行Keros分型,测量筛前动脉(anterior ethmoidal artery,AEA)至颅底的距离并进行分型,采用Spearman相关性分析AEA悬空与Keros分型的相关性,测量LLCP与筛板向外侧的延长线所形成的夹角(LLCP-CP角),根据LLCP-CP角进行医源性损伤风险分型(Gera分型),观察钩突上附着点(superior attachment of uncinate process,SAUP)的解剖位置并进行分型,分析SAUP分型与钩突内引流、外引流以及额窦炎发生率的关系。结果150例患者嗅凹深度(5.82±1.16)mm,AEA至颅底距离(3.78±1.09)mm,AEA至额嘴长度(13.97±2.45)mm,LLCP长度0.5~13(5.60±1.24)mm,LLCP-CP角69.22°±12.85°;AEA位置I型64例(42.67%),Ⅱ型28例(18.67%),Ⅲ型58例(38.67%),AEA悬空率38.67%,AEA悬空与AEA非悬空患者AEA至额嘴长度差异无统计学意义(P>0.05);不同Keros分型的AEA悬空率差异有统计学意义(P<0.05),且Spearman相关性分析显示,AEA悬空率与Keros分型呈正相关(r=0.613,P<0.001);Gera分型Ⅰ型35例(23.33%),Ⅱ型108例(72.00%),Ⅲ型7例(4.67%),Gera分型与Keros分型无显著相关性(P>0.05);150例患者(300侧)中,SAUP分型Ⅰ型164侧(54.67%),Ⅱ型16侧(5.33%),Ⅲ型12侧(4.00%),Ⅳ型60侧(20.00%),Ⅴ型48侧(16.00%),钩突内引流162侧,钩突外引流138侧,钩突内引流额窦炎发生率高于钩突外引流(P<0.05)。结论慢性鼻窦炎鼻内镜术前行鼻窦CT检查,可明确AEA位置、LLCP-CP角、SAUP位置等的解剖变异情况,有助于识别颅底损伤高风险患者。

鼻窦炎相关颅内眼眶并发症CT表现及危险因素分析

目的探讨鼻窦炎相关的眼眶及颅内并发症的CT征象及发生的危险因素。方法收集因鼻部症状或怀疑有鼻窦炎而来放射科行鼻窦CT检查的鼻窦炎患者194例,其中有眼眶或颅内并发症患者39例,无并发症患者155例,分析并发症发生的相关危险因素及并发症的CT征象。结果并发症组和非并发症组的小于18岁的未成年人、急性鼻窦炎、男性、额窦炎、筛窦炎、发病至入院时间、Lund-Mackay评分分别为66.67%比16.78%、84.62%比30.97%、74.36%比47.1%、79.49%比25.81%、89.74%比43.87%、20.46±7.45比13.45±8.46、10.82±4.01比6.86±3.92,并发症组指标明显高于非并发症组,组间比较有统计学差异(P<0.05)。对上述单因素分析有统计学差异的变量进行多因素Logistic回归分析显示,筛窦炎、额窦炎、小于18岁、急性鼻窦炎、延迟入院规范治疗有统计学差异(P<0.05),是鼻窦炎眼眶或颅脑并发症发生的危险因素,男性、Lund-Mackay评分则没有统计学差异(P>0.05)。并发症主要有眼眶脓肿、眼眶骨膜下脓肿、眼眶蜂窝织炎,均表现为眼眶内异常密度;眶周蜂窝织炎表现为眼眶周围软组织肿胀和密度增加;硬膜下和硬膜外脓肿表现为颅内轴外形态不同的液体聚集;脑炎和脓肿表现为脑实质低密度区域和液体聚集;Pott’s肿表现为额骨前方的骨膜下液性密度聚集伴前额部软组织肿胀。结论未能及时规范治疗的儿童急性筛窦或额窦炎患者是发生眼眶或颅脑并发症的高危人群;CT扫描能为鼻窦炎并发症的诊断提供可靠的依据。

中西医结合治疗鼻腔鼻窦非角化型未分化癌1例

鼻腔鼻窦未分化癌临床罕见,本文介绍1例中西医结合治疗鼻腔鼻窦非角化型未分化癌。此病例采取中西医治疗手段,早期以六君子汤为主方调理脏腑功能、顾护正气,中期酌情使用攻伐之药以祛邪扶正,后期使用健脾生髓方以助气血之生化,填补西医治疗空窗期,巩固手术治疗效果,缓解放化疗所带来的副作用,有效地改善了肿瘤的预后及促进了机体的康复。

筛蝶区域与视神经管和颈内动脉的毗邻关系

观察１００侧正中矢状切开颅骨的视神经管、颈内动脉与最后筛房、蝶窦的毗邻关系和形态特征。结果是：①视神经管全管与最后筛房毗邻３９侧，与蝶窦毗邻４３侧，与两者共同毗邻１８侧；②视神经管在最后筛房、蝶窦外侧壁形成隆起者分别为４８侧和４７侧；③各段颈内动脉在蝶窦外侧壁形成隆起者为５３％～７７％。测量视神经管隆起和颈内动脉隆起的高度和骨壁厚度，提出蝶窦和后筛窦发育状态组合关系的变异以及视神经管、颈内动脉在最后筛房和蝶窦外侧壁的隆起和压迹是内窥镜筛蝶区域手术可能发生严重并发症的解剖学因素。

经鼻内窥镜筛蝶窦脑脊液鼻漏修补术

采用内窥镜鼻窦外科技术修补筛窦、蝶窦脑脊液鼻漏５例。其中４例是外伤性，经保守治疗无效者，１例是经鼻内窥镜筛板一前颅底进路切除浸入鼻腔的脑膜瘤时发生的严重脑脊液鼻漏。５例均一次手术治愈。介绍了修补术的方法，并就经鼻内窥镜脑脊液鼻漏修补术的有关问题进行了讨论。