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 ex...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.展开更多
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 ...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.展开更多
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 mal...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.展开更多
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 pap...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.展开更多
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 pros...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 (CT<sub>MD</sub>). CT<sub>3mm</sub> was reconstructed from CT<sub>MD</sub> data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CT<sub>MD</sub> and CT<sub>3mm</sub> (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 CT<sub>3mm</sub> scans. The intra-observer reproducibility of CT<sub>3mm</sub> 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 CT<sub>3mm</sub> in comparison to CT<sub>MD</sub> 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.展开更多
<strong>Introduction:</strong> Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacen...<strong>Introduction:</strong> 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. <strong>Objective:</strong> To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. <strong>Method:</strong> Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. <strong>Result:</strong> 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. <strong>Conclusion:</strong> Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.展开更多
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) p...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.展开更多
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 conside...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.展开更多
Surgical excision and postoperative radiotherapy are widely accepted therapeutic modalities for sinonasal teratocarcinosarcoma (SNTCS). Previous studies have shown that intensity-modulated radiation therapy (IMRT)...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.展开更多
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 defin...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.展开更多
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 ...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.展开更多
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 allergen...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.展开更多
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 identificatio...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.展开更多
Background Distinguishing inverted papilloma (IP) from malignant tumors in the nasal cavity is difficult in a substantial number of cases,thus hindering the administration of appropriate therapeutic strategies.This ...Background Distinguishing inverted papilloma (IP) from malignant tumors in the nasal cavity is difficult in a substantial number of cases,thus hindering the administration of appropriate therapeutic strategies.This study aimed to evaluate whether magnetic resonance imaging (MRI),including dynamic contrast enhanced MRI (DCE-MRI),could improve differentiation between IP and malignant tumors,and to identify which MRI features were the best in discriminating IP from malignant tumors in the nasal cavity.Methods Non-enhanced,static,and dynamic contrast enhanced MRI was performed in 88 patients with an IP or a malignant tumor in the nasal cavity that had been confirmed by histological results.MRI features of IP and malignant tumors including side,margin,T1 signal intensity,T1 homogeneity,T2 signal intensity,T2 homogeneity,lobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,pattern of enhancement,Tpeak,Tmax,Clmax,and TIC type were evaluated and correlated with histological findings.Results There were significant differences between IP and malignant tumors in T2 homogeneity,Iobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,Tpeak,Tmax and TIC types.A convoluted cerebriform pattern had a higher sensitivity and specificity in diagnosis of IP while washout-type TIC had a higher sensitivity and specificity in diagnosis of malignant tumors in the nasal cavity.Non-enhanced combined with static and dynamic enhancement MRI was significantly superior to non-enhanced combined with static enhancement MRI in the differentiation of IP and malignant tumors in the nasal cavity.Multivariate logistic regression analysis identified that the best MRI features were a convoluted cerebriform pattern,extra-sinonasal involvement,and washout-type TIC for both observers (Wang XY and Zhang ZY).Conclusion Non-enhanced and static combined with dynamic contrast-enhanced MRI improves differentiation of IP and malignant tumors in the nasal cavity.展开更多
Background Quantitative dynamic contrast enhancement MR imaging (DCE-MRI),used to measure properties of tissue microvasculature and tumor angiogenesis,is a promising method for distinguishing benign and malignant tu...Background Quantitative dynamic contrast enhancement MR imaging (DCE-MRI),used to measure properties of tissue microvasculature and tumor angiogenesis,is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment.The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area,which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.Methods One hundred and forty-three patients with sinonasal tumors,including 78 malignant tumors and 65 benign tumors and tumor-like lesions,underwent clinically used DCE-MRI.Parametric maps were obtained for quantitative parameters including Ktrans,kep and ve.Two radiologists reviewed these maps and measured Ktrans,kep and ve in the tumor tissue.Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.Results Ktrans,kep and ve showed significant differences between benign and malignant tumors in the sinonasal area (P=-0.000 1).The accuracy of Ktrans,kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0%,76.2% and 67.1%,respectively.There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas (P <0.05).Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3%,sensitivity of 88.2%,specificity of 68.0%,positive predictive value of 66.7%,and negative predictive value of 90.9%.However,no significant difference in Ktrans and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area (P >0.05).Conclusions It is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region.Preliminary findings suggest an increased value for quantitative DCE-MRI in the evaluation of sinonasal tumors in clinical practice.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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 (CT<sub>MD</sub>). CT<sub>3mm</sub> was reconstructed from CT<sub>MD</sub> data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CT<sub>MD</sub> and CT<sub>3mm</sub> (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 CT<sub>3mm</sub> scans. The intra-observer reproducibility of CT<sub>3mm</sub> 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 CT<sub>3mm</sub> in comparison to CT<sub>MD</sub> 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.
文摘<strong>Introduction:</strong> 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. <strong>Objective:</strong> To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. <strong>Method:</strong> Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. <strong>Result:</strong> 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. <strong>Conclusion:</strong> Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
基金This work was supported by Beijing Excellent Talents Foundation (No. 2010D003034000033), Beijing Municipal Natural Science Foundation (No. 7112030), and High Levels of Health Technical Personnel in Beijing City (No. 2011-3-047).
文摘Background Distinguishing inverted papilloma (IP) from malignant tumors in the nasal cavity is difficult in a substantial number of cases,thus hindering the administration of appropriate therapeutic strategies.This study aimed to evaluate whether magnetic resonance imaging (MRI),including dynamic contrast enhanced MRI (DCE-MRI),could improve differentiation between IP and malignant tumors,and to identify which MRI features were the best in discriminating IP from malignant tumors in the nasal cavity.Methods Non-enhanced,static,and dynamic contrast enhanced MRI was performed in 88 patients with an IP or a malignant tumor in the nasal cavity that had been confirmed by histological results.MRI features of IP and malignant tumors including side,margin,T1 signal intensity,T1 homogeneity,T2 signal intensity,T2 homogeneity,lobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,pattern of enhancement,Tpeak,Tmax,Clmax,and TIC type were evaluated and correlated with histological findings.Results There were significant differences between IP and malignant tumors in T2 homogeneity,Iobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,Tpeak,Tmax and TIC types.A convoluted cerebriform pattern had a higher sensitivity and specificity in diagnosis of IP while washout-type TIC had a higher sensitivity and specificity in diagnosis of malignant tumors in the nasal cavity.Non-enhanced combined with static and dynamic enhancement MRI was significantly superior to non-enhanced combined with static enhancement MRI in the differentiation of IP and malignant tumors in the nasal cavity.Multivariate logistic regression analysis identified that the best MRI features were a convoluted cerebriform pattern,extra-sinonasal involvement,and washout-type TIC for both observers (Wang XY and Zhang ZY).Conclusion Non-enhanced and static combined with dynamic contrast-enhanced MRI improves differentiation of IP and malignant tumors in the nasal cavity.
基金This work was supported by grants from Beijing Excellent Talents Foundation (No.2010D003034000033),Beijing Municipal Natural Science Foundation (No.7112030),High Levels of Health Technical Personnel in Beijing City (No.2011-3-047) and China Postdoctoral Science Foundation (No.2011M500026).
文摘Background Quantitative dynamic contrast enhancement MR imaging (DCE-MRI),used to measure properties of tissue microvasculature and tumor angiogenesis,is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment.The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area,which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.Methods One hundred and forty-three patients with sinonasal tumors,including 78 malignant tumors and 65 benign tumors and tumor-like lesions,underwent clinically used DCE-MRI.Parametric maps were obtained for quantitative parameters including Ktrans,kep and ve.Two radiologists reviewed these maps and measured Ktrans,kep and ve in the tumor tissue.Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.Results Ktrans,kep and ve showed significant differences between benign and malignant tumors in the sinonasal area (P=-0.000 1).The accuracy of Ktrans,kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0%,76.2% and 67.1%,respectively.There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas (P <0.05).Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3%,sensitivity of 88.2%,specificity of 68.0%,positive predictive value of 66.7%,and negative predictive value of 90.9%.However,no significant difference in Ktrans and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area (P >0.05).Conclusions It is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region.Preliminary findings suggest an increased value for quantitative DCE-MRI in the evaluation of sinonasal tumors in clinical practice.