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.

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.

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

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.

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。

鼻腔鼻窦畸胎癌肉瘤1例

鼻腔鼻窦畸胎癌肉瘤（sinonsal teratocarcinosarcoma,SNTCS）是一种罕见的同时具有畸胎癌和肉瘤特征的高度恶性肿瘤。国外曾报道86例,国内报道更少。我科曾收治1例,现报道如下。

双表型鼻腔鼻窦肉瘤1例

1 临床资料 患者,男,75岁,因反复左鼻出血半月余,于2021-09-16入院。患者半月余前无明显诱因下突然出现左鼻出血,出血量中,不能自止,无全身性出血,无紫癜、瘀斑、呕血等症状。行鼻腔填塞后出血明显缓解,但仍有间断渗血;随后出现嗅觉减退及左侧面部胀痛,持续1周。查体:鼻腔黏膜稍充血,左侧鼻腔嗅区及中鼻道充满灰褐色新生物,表面光滑,触之易出血。

Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) cases.METHODS: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases. METHODS: The study included 400 cases(191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography(CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83(mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell(74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus(P < 0.001). Besides,the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus,and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant(P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases(P = 0.004 and P = 0.002,respectively).CONCLUSION: Sinonasal region has a great number of variations,and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.

Intensity-modulated Radiotherapy for Sinonasal Teratocarcinosarcoma

Surgical excision and postoperative radiotherapy are widely accepted therapeutic modalities for sinonasal teratocarcinosarcoma （SNTCS）. Previous studies have shown that intensity-modulated radiation therapy （IMRT） is safe and effective for the treatment of some sinonasal malignancies. We hypothesize that use of IMRT for SNTCS may result in clinical benefits. We report here two cases of SNTCS that were treated by IMRT. One patient was given extensive IMRT involving elective neck irradiation. Follow-up examinations revealed no recurrence and metastasis 3.5 years after IMRT. Another patient simultaneously suffered from multiple systematical diseases and was administered involved-field radiotherapy. He was found to have a marginal recurrence during the follow up and eventually died 8 months after disease diagnosis. It was suggested in this study that appropriate use of IMRT for the treatment of SNTCS may achieve excellent local control.

Commentary on:“Evaluation of variations in sinonasal region with computed tomography”

This letter is a commentary on the article titled "Evaluation of variations in sinonasal region with computed tomography", published in the January 2016 issue of World Journal of Radiology. The authors definition of the secondary middle turbinate is incorrect. The authors stated that the secondary middle turbinate is an accessory turbinate that is seen between the superior and middle turbinates. It should originate from the middle meatus posterosuperior to the ethmoid infundibulum.

鼻腔鼻窦孤立性纤维瘤侵及颅底1例

1临床资料患者,男,34岁,因“双侧鼻塞2年余”入院。患者2年前无明显诱因出现双侧鼻塞,呈间断性。1个月前出现右侧鼻背部隆起,逐渐加重,伴左侧鼻腔反复出血,可自止,无头痛、发热、头面部闷胀感,无脓涕,无嗅觉减退,无溢泪、视力下降及复视。既往体健。专科查体:右侧鼻背部隆起,无明显压痛。鼻中隔左偏,鼻腔黏膜稍充血。右侧鼻腔见淡红色新生物堵塞,表面光滑,质韧;左侧下鼻甲稍充血、肿胀,弹性可。

Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019

Coronavirus disease 2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus 2.This disease as well as its various treatments like steroids,antivirals,and antibacterials can alter the immune state of the affected individuals and result in secondary infections such as mucormycosis.Mucormycosis is a well-known opportunistic fungal infection that affects immunocompromised subjects,particularly those with diabetes mellitus,prolonged antibiotic or steroid use,and patients with organ transplantation,neutropenia,and hematological malignancies.Rhino-orbital-cerebral mucormycosis is an aggressive disease owing to its ability to invade the blood vessels by fungal hyphae,leading to necrosis of the involved structures.Large cases were reported from India,indicating that this clinical entity shows a geographical variation.The affected patients are suffering on a clinical spectrum depending on the stage of the disease.Radiological assessment,including computerized tomography and magnetic resonance imaging,is necessary to evaluate the stage of the disease and choose the appropriate surgical treatment.A multidisciplinary approach is required to treat rhino-orbital-cerebral mucormycosis and includes local or intravenous antifungal drugs,debridement of the dead tissues,and appropriate management of any predisposing conditions.The disease has a very poor prognosis with a death rate of 50%.This review aimed to sum-marize the demographic and clinical risk factors,investigations,treatments,and outcomes of coronavirus disease 2019 patients with rhino-orbital-cerebral mucormycosis.

颅底骨折的CT诊断

本文对98例颅底骨折病例CT扫描中所出现的各种征象,加以统计、分析,结果表明:颅底骨折线不是颅底骨折后所出现的唯一征象,颅内积气、副鼻窦积血、乳突积血等间接征象,对颅底骨折的CT诊断,同样具有十分重要的意义。

Sex Predictive Value of Frontal Sinus Index Compared to Maxillary Sinus Index:Lateral Cephalometric Study

Sex estimation is a crucial step to outline the biological profile of unknown human remains.The frontal and maxillary sinuses have unique anatomical features and can be utilized efficiently in individual identification.Previous studies investigated the frontal and maxillary sinus indexes separately for sex prediction.However,comparing the predictive value of the frontal sinus index(FSI)to the maxillary sinus index(MSI)has not been investigated yet.This study aimed to evaluate the sex predicting value of FSI compared to MSI assessed on digital lateral cephalometry.This retrospective cross-sectional study included 88 digital lateral cephalometric images of known sex(44 males and 44 females)and age(20-50 years).Two radiologists measured the maximum anteroposterior sinus width and height of the frontal sinus and maxillary sinus.Then,the sinus index was calculated for each radiograph.The obtained frontal and maxillary sinuses parameters were tabulated,along with the patient’s sex and age,and subjected to statistical analysis.Our results revealed significant differences between males and females regarding frontal sinus width,FSI,and MSI.The discriminant function analysis obtained in this study accurately predicted sex with an overall accuracy of 71.6%(81.8%of males and 61.4%of females)using FSI,and 60.2%(63.6%in females and 56.8%in males)using MSI.Frontal and maxillary sinus indexes can be useful tools for sex prediction.Discriminant function equations were developed for both the frontal and maxillary sinus indexes with higher accuracy rates for FSI compared to MSI.

冠状位CT对副鼻窦炎诊断及鼻内窥镜手术的指导意义

目的 :探讨冠状位 CT在慢性副鼻窦炎诊断、病因分析及对鼻内窥镜手术的价值。方法 :收集手术证实的患者 12 0例 ,并对其 CT表现及其临床资料进行回顾性分析。结果 :几乎所有慢性副鼻窦炎的发生均于窦口通道区的梗塞有关。结论 :窦口通道区引流不畅是慢性副鼻窦炎产生的原因 ,冠状

Clinical Characteristics and Endoscopic Endonasal Removal of Foreign Bodies within Sinuses, Orbit, and Skull Base

Background：Foreign bodies within the sinuses,orbit,and skull base （FBSOS） are rare;hence,diagnosis and management guidelines are lacking.Endoscopic sinus surgery （ESS） removal is preferred because of the less invasiveness and minimal morbidity.This study was designed to summarize clinical experience with ESS management of FBSOS.Methods：We retrospectively reviewed clinical manifestations,imaging findings,treatment,and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center.The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.Results：There were 23 male and five female patients,with median age of 11 years.FBSOS were located within the sinuses （86%）,orbit （75%）,and skull base/intracranial region （46%）.Wooden FBSOS had a significantly higher risk of infection （78%） compared with nonwooden FBSOS （5%,P 〈 0.05）.Contrast-enhanced computed tomography （CT） plus three-dimensional reconstruction was sensitive in all cases.Twenty-seven （96%） FBSOS were removed by ESS alone,while 1 （4%） FBSOS was removed using the combined ESS and lateral cervical approach.Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid （CSF） leak and received endoscopic CSF leak repair.Twelve （43%） patients suffered complications （meningitis,diplopia,and vision loss）.Conclusions：ESS is a minimally invasive,safe,and promising surgical approach for FBSOS removal.Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance.Wooden FBSOS had higher risk of infection,thus antibiotics are recommended.

Association of allergic rhinitis with hypothyroidism, asthma, and chronic sinusitis: clinical and radiological features

Background: Allergic rhinitis (AR) is characterized by mucosal inflammation that leads to a variety of symptoms, such as nasal congestion, rhinorrhea, and sneezing. This rhinitis is triggered by inhalation of allergens, such as pollen, and this condition has a negative impact on the quality of life. AR was shown to be associated with a number of co-morbidities, including hypothyroidism, asthma, and chronic sinusitis.Objective: This study aimed to assess AR-associated comorbidities in patients presenting symptoms and paranasal sinus computed tomography (CT) scan findings in Taif City, Saudi Arabia.Methods: This cross-sectional study evaluated medical and radiological records of AR patients retrospectively from the period of December 2018 to September 2019 in Al-Hada Armed Forces Military Hospital, Taif City, Saudi Arabia.Results: A total of 103 AR patients with a mean age of 39.0 ± 15.6 years with 55.3% males and 44.7% females. The three most common associated comorbidities in allergic rhinitis patients were chronic sinusitis (28.2%), hypothyroidism (21.4%), and asthma (8.7%). Nasal obstruction (30.1%) was the symptom most frequently presented by all patients. Mucosal thickening occurred most frequently in patients with associated chronic sinusitis, while bilateral osteomeatal complex obliteration was observed mostly in asthmatic patients, and bony boundary thinning was more prevalent among patients with associated hypothyroidism.Conclusion: The gender distribution of AR was 10% more common among males;however, the most common three comorbidites in allergic rhinitis patients were chronic sinusitis, hypothyroidism, and asthma, and most of those patients were females. Hypothyroidism can be a hidden predisposing factor for AR, while chronic sinusitis can be caused by AR due to secretion stasis or immune system activation.