1/9. Inverted papilloma of the sphenoid sinus presenting with auditory symptoms: a report of two cases.OBJECTIVES: The report aims to inform the reader of cases of inverted papilloma involving the sphenoid sinus presenting with auditory symptoms. STUDY DESIGN: Case series. methods: A retrospective medical record analysis was carried out to identify patients with inverted papilloma involving the sphenoid sinus that presented with a primary complaint of hearing loss or tinnitus, or both. Clinical records, including initial history and physical examination, audiologic and radiologic studies, and operative and histopathologic reports, were carefully examined. A complete literature review for relevant studies was performed to explore possible pathophysiologic factors and similar cases. RESULTS: Two patients with inverted papilloma presenting with primary auditory complaints were identified. One patient had roaring tinnitus and sensorineural hearing loss demonstrated with audiologic assessment, whereas the other had pulsatile tinnitus. Both patients had biopsy-proven inverted papilloma involving the sphenoid sinus, and both patients underwent endoscopic resection of the disease. No other cause or origin of their auditory symptoms was confirmed. The auditory symptoms of both patients improved markedly after excision of their inverted papillomas. CONCLUSIONS: tinnitus with or without hearing loss is an unusual presentation of inverted papilloma of the sphenoid sinus. Sphenoid tumors should be considered in the workup of these symptoms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. Nasofrontal dermoid sinus cyst: report of two cases.OBJECTIVE AND IMPORTANCE: Nasofrontal dermoid sinus cysts are rare. The embryological origin, presentation, treatment, and genetic associations of two cases of these cysts are discussed. Emphasis is placed on physical findings and the importance of addressing both the intracranial and extracranial components. CLINICAL PRESENTATION: The first patient, a 33-year-old woman, sought care for chemical meningitis. As a child, she was differentiated from her identical twin sister by a dimple on the tip of her nose. The second patient, a 34-year-old man, sought care for new-onset seizures. Since birth, he had a dimple on the tip of his nose. As a child, he had undergone resection of a nasal cyst. Imaging studies in both patients indicated a midline anterior cranial base mass within the falx and a defect in the crista galli. INTERVENTION: Both patients underwent biorbitofrontal nasal craniotomy. A bifrontal craniotomy was performed first, then removal of the orbitonasal ridge. The dermoid and involved falx were resected. The sinus tract was followed through the crista galli and resected up to the osteocartilaginous junction in the nose. The remainder of the tract was resected via a small incision through the nares. The dura was closed primarily by mobilizing the dura along the sides of the crista galli. After surgery, both patients still possessed their sense of smell. CONCLUSION: Nasofrontal dermoid sinus cysts have a unique embryological origin. A midline basal frontal dermoid associated with a dimple on the nasal surface with or without protruding hair and sebaceous discharge is the pathognomonic presentation. It is important to address both the intracranial and extracranial component surgically. Although concomitant anomalies and familial clustering have been described, most cases are spontaneous occurrences.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. A rare case of metastases to the maxillary sinus from sigmoid colon adenocarcinoma.Metastases of malignant tumors to the nasal cavity and paranasal sinuses are rare. A review of the world's literature reports only four cases of antral metastases from carcinoma of gastrointestinal tract. We present a case of a stenosing adenocarcinoma of the sigmoid colon with metastases within the maxillary sinus. The ENT physical examination revealed a mass involving the right alveolar ridge, the right hard palate. CT scan of the head and the neck showed a large and irregular mass involving the right maxillary sinus, the infratemporal fossa and the pterygoid muscles with resorption of the bone of the posterior portion of the right alveolar ridge and of the posterior wall of the right maxillary sinus. The neoplastic tissue showed marked positivity for CEA and expressed cytokeratin 20, confirming the diagnosis of metastases to the maxillary sinus from colorectal adenocarcinoma. When a differential diagnosis between a second primary tumor of the maxillary sinus and a metastasis has to be carried out, the gastrointestinal tract should be taken into account and detailed immunohistochemical should be performed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. Endoscopic sinus surgery treatment for a huge sinonasal fibroma.Fibromas are rare tumors of the nasal cavity, which may result from progressive inflammation or fibroblastic proliferation of the nasal mucosa. The tumors are usually too small to cause symptoms. We present a 47-year-old woman suffering through right nasal obstruction, purulent rhinorrhea and severe headaches for 6 months. A gray-white, smooth-surfaced, gigantic firm mass occupying the right nostril was found in physical examination. Sinus computed tomography revealed 4 x 3 x 3 cm soft-tissue-density mass in the right nasal cavity and right maxillary sinusitis. The huge sinonasal fibroma measuring 4.5 x 3 x 3-cm in the right posterior ethmoid sinus, which was successfully endoscopically resected. The final diagnosis of fibroma was made histologically, according to light microscopy and immunohistochemical stain examinations, which were important for determining the patient's treatment. After endoscopic resection, her initial signs and symptoms were relieved and no recurrence was noted after 2 years of follow up.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. Cemento-ossifying fibroma of the ethmoidal sinus in a child presenting with isolated pain in the nasal region.The authors present a case of a previously healthy 8-year-old girl who presented with pain on the right side of the nose (bony part) radiating to the frontal and temporal regions. physical examination was normal, whereas magnetic resonance imaging (MRI) of the facial region revealed a tumor limited to the right ethmoidal sinus with a small extension to the medial wall and the upper part of the nasal septum. The tumor was removed by using a 5-degree nasoscope and sent for pathologic examination, which revealed a cemento-ossifying fibroma of the ethmoidal sinus. This is a rare condition, and MRI is a valuable tool in its detection because results of physical examination may be normal in patients reporting nasal pain. According to the world health organization classification, this tumor is a variant of cementifying fibromas, which represent a subgroup of cementomas, fibro-osseous lesions containing cementum. Cementifying fibromas are rare tumors. They are usually small, asymptomatic lesions, but although benign, they can develop into aggressive, expansible masses.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. Misdiagnosis of olfactory neuroblastoma.OBJECT: Olfactory neuroblastoma (ON) is a rare neoplasm arising from the olfactory epithelium and found in the upper nasal cavity. The authors studied the frequency with which ON is misdiagnosed with other tumors of the paranasal sinuses such as neuroendocrine carcinoma (NEC), pituitary adenoma, melanoma, lymphoma, and sinonasal undifferentiated carcinoma (SNUC). Based on the belief that misdiagnosis commonly occurs, they emphasized the importance of establishing the correct diagnosis, because the treatment regimens and prognosis of these tumor types are often significantly different. methods: Twelve consecutive patients in whom ON was diagnosed were referred to the Department of neurosurgery at the M. D. Anderson Cancer Center between January 1998 and March 2000. Demographic data were collected, physical findings and mode of treatments were documented, and neuroimaging studies were assessed. Pathologists at the authors' institute reviewed the histological specimens. Only in two of 12 patients was the diagnosis of ON confirmed. Lesions in 10 patients were misdiagnosed; there were two cases of melanoma, three cases of NEC, three cases of pituitary adenoma, and two cases of SNUC. Eight of 10 patients in whom lesions were misdiagnosed required significant alteration in the initially proposed treatment plan. CONCLUSIONS: Neurosurgeons should be acutely aware of the variety of neoplasms that occur in the paranasal region. The correct diagnosis should be ensured before initiating treatment to provide the optimum therapy and spare the patients from needless and potentially toxic treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Primary extracranial meningioma of the sinonasal tract.Meningiomas occurring outside the cerebrospinal axis can be primary at an extracranial site (nasal cavity, paranasal sinuses, and nasopharynx) or secondary extending from an intracranial lesion. magnetic resonance imaging findings of an 8-year-old child with primary meningioma before and after surgery have been reviewed and compared to computed tomography and histological evaluation. The child had difficulty breathing through the left nostril and tearing of the left eye. After physical and radiological examination, a tumor comprising the left lower, middle turbinate, and ethmoidal cells was found and radically extirpated. On histological examination, the tumor was identified as meningothelial meningioma. On the basis of the clinical, radiological, and histological features, the tumor was diagnosed as extracranial meningioma of the sinonasal tract. A follow-up examination 6 months later revealed no evidence of recurrence of the tumor.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. Malignant neoplasms of the paranasal sinuses involving the skin.Malignant neoplasms of the mucosa and minor salivary glands of the paranasal sinuses may involve the skin by direct extension. When a tumor appears on the overlying skin, these sinuses should be considered as a possible site of origin. Adenoid cystic carcinoma of the paranasal sinuses arise from minor salivary glands. They can infiltrate overlying skin and easily be confused with a primary cutaneous adenoid cystic carcinoma. Malignant melanomas of the paranasal sinuses are clinically very aggressive. They are often amelanotic, and this may lead to an incorrect histopathologic diagnosis. Hence, physical and radiological examination of the nose, mouth, and paranasal sinuses should be performed whenever a tumor appears in the overlying skin that does not have a clear cutaneous origin or whenever the primary site of a metastatic malignant melanoma is unknown.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. cerebrospinal fluid rhinorrhea as a complication of malignant lymphoma.A 53-year-old woman with a three-year history of recurrent stage IV diffuse aggressive lymphoma involving the nasopharynx presented with fever, chills, and the sudden onset of drainage of clear, colorless fluid from the left nostril. This woman had no history of trauma or physical activity that might increase intracranial pressure. Subarachnoid instillation of 111indium resulted in the accumulation of radioactivity in a cotton stint placed in the left nares, documenting cerebrospinal fluid rhinorrhea. Computed tomography of the head revealed bony erosion of the cribriform plate by lymphoma. Defervescence occurred in the patient 48 hours after treatment with antibiotics was begun, and systemic chemotherapy directed against the lymphoma resulted in resolution of the cerebrospinal fluid rhinorrhea within a month without surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |