1/21. Angiectatic nasal polyps that clinically simulate a malignant process: report of 2 cases and review of the literature.BACKGROUND: Approximately 5% of inflammatory or allergic sinonasal polyps develop extensive vascular proliferation and ectasia with deposition of pseudoamyloid. These so-called angiectatic nasal polyps (ANPs) can grow rapidly and exhibit an aggressive clinical behavior that could simulate malignancy preoperatively. OBJECTIVE: To systematically address the differential histologic diagnosis of ANPs. methods: We evaluated by light microscopy, immunohistochemistry, and electron microscopy biopsy and resection specimens from 2 large ANPs (8 and 10 cm in diameter) that presented in 2 adult men with life-threatening epistaxis and facial deformity, respectively. RESULTS: The tumors were firm, lobulated, and covered by smooth, partially ulcerated mucosa. Histologically, clusters of dilated, thin-walled blood vessels embedded in pools of congo red-negative eosinophilic material, associated with patchy necrosis and atypical stromal spindle cells, were seen. Electron microscopy and immunohistochemistry (CD34, factor viii) confirmed the endothelial nature of the cells lining the spaces, whereas the atypical stromal cells were classified as myofibroblasts. CONCLUSIONS: These 2 cases represent extreme examples of ANPs that clinically simulate a malignant process. awareness of the histological features of ANPs should prevent confusion of such lesions with other vascular or spindle cell lesions of the nasopharynx that would require different treatment and carry a different prognosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/21. Anti-CD20 monoclonal antibody therapy in Epstein-Barr Virus-associated B cell lymphoma following lung transplantation.Post-transplant lymphoproliferative disease is a complication of bone marrow and solid organ transplantation, mostly associated with Epstein-Barr virus infection and chronic immunosuppression. Even if spontaneous resolution after cessation of immunosuppressive therapy can be observed, the prognosis of this disorder is usually poor with a low response to specific treatment. We describe a case of B-cell lymphoma of the nasopharynx occurring 6 months after double-lung transplantation. In spite of its monoclonal nature, anti-CD 20 monoclonal antibody given in the presence of reduced immunosuppression resulted in a complete response. The patient also received "consolidation" radiation therapy to prevent the recurrence. The treatment was well tolerated with minimal side effects. The patient was asymptomatic and had a well functioning graft more than 1 year after therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/21. Hamartomatous gastric polyposis in a patient with tuberous sclerosis.A 42-year-old female diagnosed with tuberous sclerosis was found to have multiple polyps in the fundus of stomach. On histologic examination, the lesions were hamartomatous polyps. In tuberous sclerosis, many lesions occur in multiple organs and there are several reports about the frequent association of hamartomatous polyps of the colon. However, gastric manifestation of tuberous sclerosis has not been established probably due to its asymptomatic nature. This is the first report of multiple gastric hamartomatous polyposis in patient with tuberous sclerosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/21. Aspiration biopsy. An aid in the diagnosis of para-nasal tumours.Three cases are reported to demonstrate (1) the difficulty in diagnosing the nature of nasopharyngeal tumours (2) the assistance given by the fine-needle aspiration biopsy technique in cases of paranasal tumours. Reliance should not be placed on this technique alone. It should be performed at the initial examination together with conventional techniques. In this way, the patient may be spared the need for multiple anaesthetics and a diagnosis may be arrived at more promptly so that treatment may be instituted more quickly.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/21. Nasopharyngeal angiofibroma.Based on this patient's history and the imaging studies, all the consultants agree that they are dealing with a juvenile nasopharyngeal angiofibroma. They agree that a biopsy is not necessary. However, angiography would be obtained by 2 physicians (Drs. Seid and Weber). When treating an extensive JNA, the consultants differ in their approaches. One favors a lateral infratemporal fossa approach (Dr. Gantz), but the others favor a combined approach (Drs. Seid and Weber). In this particular case, 2 experts favor resection (Drs. Gantz and Weber), but one would irradiate (Dr. Seid). There is also disagreement regarding the severity of morbidity. Minor problems include conductive hearing loss, paresis of the third division of the fifth cranial nerve (Dr. Gantz), and a transient facial nerve paralysis (Dr. Weber). They are more concerned about the long-range problems from skull-base radiotherapy including brain-stem compromise, pituitary dysfunction, and radiation-induced malignancies. No one suggests chemotherapy or multimodal therapy. Regarding the natural history of JNA, the views range from no spontaneous regression (Dr. Gantz), gradual involution over time (Dr. Seid), or an indolent nature that requires tapering the treatment to the benign nature of the process (Dr. Weber).- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
6/21. Nasopharyngeal carcinoma spreading along the eustachian tube: the imaging appearance.Nasopharyngeal cancer (NPC) is one of the most common cancers in taiwan. It can spread anteriorly, laterally, posteriorly, superiorly and inferiorly. skull base invasion is the common presentation, in up to one-third of cases. We report a rare spreading pathway of NPC, via the eustachian tube. A 44-year-old male suffered from NPC and got radiotherapy about 2 years ago. He suffered from middle ear effusion and facial nerve palsy on the right side recently. The computed tomography and magnetic resonance image could clearly depict the infiltrating tumor over the mastoid region and tympanic cavity on the right side, spreading along the eustachian tube. It could result in eustachian tube dysfunction and middle ear effusion. The nature of the right facial palsy was most likely due to tumor infiltration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/21. Loss of reflex tearing: an expected consequence of juvenile nasopharyngeal angiofibroma.OBJECTIVE: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN AND SETTING: A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia. RESULTS: One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA. CONCLUSION: The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery. SIGNIFICANCE: The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM Rating: C.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/21. A five-week-old girl with inspiratory stridor due to infantile hemangiopericytoma.A 5-week-old girl with inspiratory stridor is presented. No immediate cause of the stridor was found, but eventually a diagnosis of infantile hemangiopericytoma located in the rhinopharynx was made. After surgery all respiratory symptoms disappeared. Conclusion: Infantile hemangiopericytoma is a rare tumour of infancy and a very rare cause of inspiratory stridor in this age group. The mainstay of treatment is surgery. The overall prognosis is favourable but because of the unpredictable nature of the tumour, long-term follow-up is recommended.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/21. Recurrent juvenile nasopharyngeal angiofibroma treated with gamma knife surgery.radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of recurred JNA with gamma knife surgery (GKS). A 48-yr-old man was presented with right visual acuity deterioration and brain magnetic resonance images (MRI) disclosed a 3 cm-sized intraorbital mass in the right orbit. He underwent a right fronto-temporal craniotomy and the mass was subtotally removed to preserve visual function. Histological diagnosis confirmed JNA in typical nature. However, the vision gradually worsened to fail four years after operation. MRI then showed regrowth of the tumor occupying most of the right orbit. GKS was done for the re-curred lesion. A dose of 17 Gy was delivered to the 50% isodose line of tumor mar-gin. During the following four-year follow-up period, the mass disappeared almost completely without any complications. Usually JNA can be exclusively diagnosed by radiological study alone. So this report of successful treatment of JNA with GKS may provide an important clue for the novel indication of GKS.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/21. Lipid-rich rhabdomyosarcoma--a potential source of diagnostic confusion.rhabdomyosarcoma is an often primitive tumor capable of diverse morphologic manifestations. The article describes three cases of childhood rhabdomyosarcoma in which a significant population of lipid-rich tumor cells was present. The lack of specificity and potentially confusing nature of this feature are discussed, and the ultrastructural diagnosis of rhabdomyosarcoma is briefly reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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