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 = vessel (Clic here for more details about this article) |
2/21. Acute hemorrhage in late radiation necrosis of the temporal lobe: report of five cases and review of the literature.Hemorrhage in late cerebral radiation necrosis is a rare complication after radiotherapy for intracranial and extracranial neoplasms. We report 5 cases of acute hemorrhage in late radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma. In a review of the literature, the authors identified a total of 27 such cases. The interval period between the onset of hemorrhage and cranial irradiation is long (mean = 7.8 years). The most prominent histological feature was the proliferation of large, dilated and thin-walled new blood vessels in a background of gliosis and fibrinoid necrosis of vessels. rupture of these thin-walled new blood vessels is the proposed mechanism of hemorrhage in this condition.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
3/21. carcinoma erysipelatoides-cutaneous lymphatic vessel spread of a poorly differentiated naso-pharyngeal carcinoma.carcinoma erysipelatoides, which is frequently called inflammatory carcinoma, is an uncommon form of skin metastasis. It originates most commonly from breast carcinoma and less often from endometrial or bronchogenic carcinoma. The naso-pharynx is an unusual source for carcinoma erysipelatoides. We present a case of carcinoma erysipelatoides due to poorly differentiated naso-pharyngeal carcinoma.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
4/21. Radiation retinopathy--a case report.Radiation retinopathy is one of ocular complications in radiation therapy for many diseases. It is a slowly progressive, delayed-onset disease of retinal blood vessels. A 49 year-old Chinese female suffered from blurred vision for 2 years progressively. The best corrected visual acuity was 0.02 and 0.06 in her right and left eyes respectively. Ophthalmic fundus examination showed hard exudate, retinal hemorrhage, and macular edema in both her eyes. Tracing back her history, she had nasopharyngeal carcinoma and received irradiation treatment 11 years ago. She denied diabetic mellitus or other systemic disease. After laser photocoagulation treatment, she had better vision with the best corrected visual acuity 0.2 and 0.3 in her right and left eyes respectively 1 year later.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/21. Resection of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement.The authors report their own experiences with the diagnosis and therapy of 7 cases of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement, thereby attempt to formulate the surgical approach for resection of huge nasopharyngeal angiofibroma with extensive involvement. The results suggested that appropriate surgical approach was of paramount importance for eliminating the tumor and may effectively reduce traumatic injury during the operation. Elective embolization of the vessels feeding the tumor could reduce bleeding and therefore increase the safety of the operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/21. Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas.BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery. DESIGN: Case series. SETTING: Tertiary care medical center. patients AND methods: Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section. RESULTS: All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years. CONCLUSIONS: Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/21. Transmandibular transpterygoid approach to the nasopharynx, parapharyngeal space, and skull base.The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasma had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/21. nasopharynx paraganglioma with extension in the clivus.paraganglioma is a rare benign tumor arising from the sympathetic nervous system. Here we describe an exceptional case of a paraganglioma located in the nasopharynx with an extension through the clivus up to the dura. Atypically, no contact with any major vessels was found. A radical resection of the mass was performed by an anterior transmaxillary approach through a Le Fort I osteotomy. One year follow up reveals no signs of local or distant recurrence. No cosmetic changes can be observed after the surgery and nasal and masticatory functions are unmodified. We review the clinical presentation, workup of paraganglioma, as well as the surgical approaches to the clivus.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/21. Intracranial and extracranial nasopharyngeal angiofibroma. A surgical approach.Two patients with juvenile nasopharyngeal angiofibromas with known or suspected intracranial extension were treated successfully with a surgical procedure. The procedure involves careful preoperative examination with four-vessel carotid angiography followed by preoperative occlusion of the extracranial major feeding vessels. This is followed by craniotomy, direct control of all intracranial feeding vessels, and then total extirpation of the tumor.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
10/21. Management of nasopharyngeal angiofibroma.Successful surgical treatment of nasopharyngeal angiofibroma requires complete pre-operative evaluation and careful choice of a suitable surgical approach. Experience with 12 patients presenting with this tumor demonstrates the value of polytomography and angiography in evaluation. The use of pre-operative estrogens and temporary vessel ligation has decreased blood loss. The surgical approach is modified depending upon tumor location. A tumor confined to the nasopharynx is removed by a transpalatal approach. Extension into the sinuses or orbit necessitates a sublabial incision or lateral rhinotomy. Pterygo-maxillary tumor may be exposed by extension of the sublabial incision posterior to the maxillary tuberosity. This allows one to push the tumor back into the nasopharynx. Intracranial extension is removed by a combined otolaryngologic-neurosurgical approach.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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