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.

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.

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

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.

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。

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.

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。

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.

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.

An association between Helicobacter pylori and upper respiratory tract disease: Fact or fiction?

Helicobacter pylori(H. pylori) is a major cause of chronic gastritis and gastric ulcers and considerable evidence supports the notion that infection with this bacterium is also associated with gastric malignancy in addition to various other conditions including pulmonary, vascular and autoimmune disorders. Gastric juice infected with H. pylori might play an important role in upper respiratory tract infection. Although direct and/or indirect mechanisms might be involved in the association between H. pylori and upper respiratory tract diseases, the etiological role of H. pylori in upper respiratory tract disorders has not yet been fully elucidated. Although various studies over the past two decades have suggested a relationship between H. pylori and upper respiratory tract diseases, the findings are inconsistent. The present overview describes the outcomes of recent investigations into the impact of H. pylori on upper respiratory tract and adjacent lesions.

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.

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.

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。

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.