Left Nasal Fossa Research Articles

LOW-GRADE SINONASAL FIBROSARCOMA : A CASE REPORT

Fibrosarcoma is a rare malignant tumor. The sinonasal localization is extremely uncommon.Theclinical presentation is similar to other neoplasms of this region, consisting of nonspecific symptoms such as epistaxis and nasal obstruction. Definitive diagnosis is obtained on the basis of histopathology and immunochemistry.This isthe case of a 40-year-old woman with a six months complaint of left nasal obstruction, recurrent epistaxis, hyposmia and cephalalgia. Nasal endoscopy revealed a regular pink soft-tissue mass filling the left nasal cavity. CT scan and MRI showed a well-defined, irregularly contoured tissue tumor,occupying the left nasal fossa, with matrix of calcifications within the tumor.A biopsy was performed, and the histopathological findings revealed a low-grade fibrosarcoma with spindle-shaped cells arranged in a herringbone pattern. The immunohistochemistry was positive for vimentin staining. The tumor was completely resected with free margins using the endoscopic endonasal approach. No adjuvant radiotherapy was prescribed.The patient is disease-free at a regular five-year postoperative follow-up.Only few cases of sinonasal fibrosarcoma has been reported in literature. There are no specific symptoms or imaging features. Still, this is the first case describing intra-tumoral calcifications. The mainstay of treatment is surgical excision with radical margins.Radiotherapy may be adjunctive in cases of positive margins or incomplete resection.

Safety and efficacy of remifentanil target-controlled infusion for conscious sedation in a pregnant woman: a case report

BackgroundEvery year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid.Case presentationWe present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion.Discussion and conclusionTo the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.

HPV-RELATED MULTIPHENOTYPIC SINONASAL CARCINOMA: AN AGGRESSIVE AND CHALLENGING CASE REPORT

A 54-year-old male patient complained of self-limited epistaxis for two years, the symptoms worsening one year ago. Systemic arterial hypertension for 14 years was reported in the anamnesis. Physical examination revealed an irregular nodule in the left nasal fossa with yellowish secretion, friable to aspiration. MRI revealed an expansile image in the left nasal cavity, measuring 8.3 × 4.3 × 2.8 cm, extending into the nasopharynx, ethmoid, right nasal cavity, and cortical bone of the hard palate. An incisional biopsy was performed. Morphologically, a malignant cellular proliferation with solid basaloid appearance admixed with adenoid cystic-like areas. IHC were positive for AE1/AE3, CK7, p63, and calponin, with focal labeling for CD117 and α-SMA. p16 had diffuse cytoplasmic and nuclear positivity. Ki-67 index was 80%. The morphological and immunohistochemical aspects were conclusive for HPV-related multiphenotypic sinonasal carcinoma. Already in stage IV, the tumor was considered unresectable, and the patient is under oncological treatment and follow-up with chemoradiotherapy. A 54-year-old male patient complained of self-limited epistaxis for two years, the symptoms worsening one year ago. Systemic arterial hypertension for 14 years was reported in the anamnesis. Physical examination revealed an irregular nodule in the left nasal fossa with yellowish secretion, friable to aspiration. MRI revealed an expansile image in the left nasal cavity, measuring 8.3 × 4.3 × 2.8 cm, extending into the nasopharynx, ethmoid, right nasal cavity, and cortical bone of the hard palate. An incisional biopsy was performed. Morphologically, a malignant cellular proliferation with solid basaloid appearance admixed with adenoid cystic-like areas. IHC were positive for AE1/AE3, CK7, p63, and calponin, with focal labeling for CD117 and α-SMA. p16 had diffuse cytoplasmic and nuclear positivity. Ki-67 index was 80%. The morphological and immunohistochemical aspects were conclusive for HPV-related multiphenotypic sinonasal carcinoma. Already in stage IV, the tumor was considered unresectable, and the patient is under oncological treatment and follow-up with chemoradiotherapy.

Voluminous Solitary Neurofibroma of the Nasosinus Cavities in an Undermedicalized Context: Reflection on a Case Collected in Bamako

Neurofibroma is a benign tumor of the connective tissue developed mainly at the expense of the endoneurium of the peripheral nerves. Histologically, there are two types of neurofibroma: plexiform and solitary. The objective of this work was to report a case of solitary nasosinusal neurofibroma in order to discuss diagnostic and therapeutic difficulties in a developing country. BA aged 17, with no known pathological history, was admitted to the service for a left nasal obstruction which had been evolving for about 4 years. The endonasal examination found a congestive mass, not bleeding on contact, filling the entire left nasal fossa pushing back the nasal septum on the right. Computed tomography showed a heterogeneous dense tissue process with cystic areas, filling the left nasal fossa with extension to the posterior sinuses, left maxilla. The patient was operated under general anesthesia via the left paralateronasal route. The tumor was difficult to cleave but not friable and not bleeding. The histological examination concludes to a neurofibroma. Conclusion: Solitary neurofibromas are uncommon and remain poorly understood. Literature data, rare, do not answer all the questions.

Diagnosis and treatment of congenital nasal glioma.

From the first days of life, a female newborn suffered from nasal congestion and a runny nose. The first MRI, at 42 days of life, revealed a solid and expansive mass of 1 cm in the left nasal fossa. The radiological examination repeated at 4 months of life showed an increase in volume, up to 2 cm (

Microvascular free flap in a pregnant patient after resection of a high-grade neuroendocrine carcinoma

Free flap reconstruction is seldom performed during pregnancy. Not only does the prolonged operative time pose a risk for the mother and the fetus, but also the hypercoagulable state of pregnancy predisposes the mother to a greater risk of complications in the transplanted tissue. We present a case of a 29-year-old patient in week 27 of gestation with a rapidly progressive neuroendocrine tumor in the left nasal fossa with involvement of the nasal sinus, pterygopalatine fossa, dura, and left orbit, associated with neurological symptoms and recurrent epistaxis. The aggressive and rapidly progressive character of the tumor made surgical excision by a multidisciplinary team as the first option. We performed immediate reconstruction with an anterolateral thigh free flap. Free tissue transfer was performed successfully, with satisfactory results on the mother and later delivery without complications.

An unusual collateral damage of COVID-19 pandemic

A 64-year-old man was admitted to the gastroenterology department after a nasopharyngeal swab broke inside his left nasal fossa during testing for SARS-CoV-2. The patient had no symptoms, and the physical examination was unremarkable.

Leiomiosarcoma de fosa nasal. A propósito de un caso

A 54-year-old female patient presented with a left nasal obstruction. On physical examination a pink delimited mass in the left nostril was observed. A cranial computed tomography scan revealed an expansive mass in the upper anterior third of the left nasal fossa, partially obstructing it. Endoscopic resection of the mass was performed. Histopathology revealed an atypical mesenchymal proliferation formed by cells disposed in disorganized and interconnected long bundles. Tumor cells had abundant eosinophilic cytoplasm and an oval, vesicular and hyperchromatic nucleus. Frequent mitotic figures were observed, many of them atypical. Necrosis was not observed. Immunohistochemistry showed tumor cells to be positive for calponin, muscle specific actin, caldesmon and smooth muscle specific myosin. Ki-67 index proliferation was 30%. A diagnosis of leiomyosarcoma of the nasal fossa was established.

Nasoangiofibroma Juvenil vs Hemangioma arteriovenoso, Reto diagnostico. Reporte de caso.

El nasoangiofibroma juvenil es un tumor vascular benigno, localmente agresivo pero poco común, representa tan solo el 0,05% de todos los tumores de cabeza y cuello, con una incidencia de aproximadamente 1:150.000. Por otra parte los hemangiomas son neoplasias benignas de las células endoteliales, representa el 7% de los tumores vasculares y son lesiones poco común de cabeza y cuello, pero ¿Son una misma entidad?, ¿Se puede trazar una línea clara para diferenciarlos?. El objetivo del presente articulo es proporcionar información acerca de estas dos entidades clínicas y responder las preguntas previamente formuladas. Este es el caso clínico de un paciente del género masculino de 19 años de edad, quien consultó por cefalea hemicraneana izquierda, otalgia y sensación de opresión ocular ipsilateral de 7 días de evolución. La tomografía axial computarizada de cráneo mostró una masa de densidad de tejidos blandos que ocupa la coana izquierda, infiltra parcialmente la región posterior de la fosa nasal izquierda, erosiona la apófisis pterigoides y el suelo de la celda esfenoidal izquierda. Se realizó biopsia por medio de nasofibrolaringoscopia en el consultorio, previa a infiltración con lidocaína, se toman dos muestras de lesión en coana izquierda sin sangrado significativo; el reporte patológico informa hemangioma arteriovenoso, por lo que se decidió realizar embolización pre quirúrgica; posteriormente es llevado a procedimiento quirúrgico sin complicaciones, finalmente la biopsia excisional reporta nasoangiofibroma juvenil con estudio de inmunohistoquimica CD31 y CD34 reactivo en pared de estructuras vasculares. El nasoangiofibroma juvenil es el tumor más común de la nasofaringe en hombres adolescente, la ausencia de epistaxis recurrente unilateral no debe descartar el diagnostico.

Mometasone furoate nasal spray in the treatment of nasal polyposis in Chinese patients: a double-blind, randomized, placebo-controlled trial.

Although mometasone furoate nasal spray (MFNS) has demonstrated efficacy in nasal polyposis (NP) in Western populations, data in Asian populations is limited. This randomized, double-blind study evaluated MFNS 200 μg twice per day (BID) vs placebo in Chinese adults with bilateral nasal polyps (graded as 1, 2, or 3 by the investigator). A 14-day placebo run-in period was followed by a 16-week treatment period with MFNS 200 μg BID vs placebo (1:1 ratio). The co-primary endpoints were change from baseline in nasal congestion/obstruction averaged over the first 4 weeks of treatment and change from baseline in the total polyp size score (sum of scores from the left and right nasal fossa) at week 16. Secondary endpoints included other sinonasal symptoms scores and safety outcomes such as monitoring laboratory measurements, vital signs, and adverse events (AEs). There were 748 patients randomized, 375 received MFNS 200 μg BID and 373 received placebo. The between-treatment difference in least squares (LS) mean change from baseline in nasal congestion/obstruction over 4 weeks of treatment was -0.14 (95% confidence interval [CI], -0.22 to -0.06) for MFNS vs placebo (p = 0.0007). The between-treatment difference in LS mean change from baseline in total polyp size score at week 16 was -0.30 (95% CI, -0.45 to -0.15) for MFNS vs placebo (p < 0.0001). Serious AEs were rare (0.5% and 0.8% in MFNS and placebo groups, respectively) and considered not drug-related. There were significantly more AEs of epistaxis with MFNS vs placebo (p = 0.009). This study demonstrated that MFNS was effective and well tolerated in this population of adult, Chinese patients with NP.

Diffuse Large B-Cell Lymphoma of the Nasal Cavity Presenting as Abducens Nerve Palsy

An 87-year-old man presented with a 1-week history of transient facial numbness, followed by the onset of left diplopia 1 month later. In the neurological examination, he was found to have left abducens nerve palsy. A brain MRI showed an infiltrative lesion invading the left posterior nasal cavity and pterygopalatine fossa, and extending into the left paracavernous region. The histological diagnosis was diffuse large B-cell lymphoma. We report an unusual case of diffuse large B-cell lymphoma occurring in the sinonasal tract with unilateral abducens nerve palsy presenting as an early feature.

Intraosseous adenoid cystic carcinoma of maxilla: A rare case report

Adenoid cystic carcinoma (ACC) accounts for approximately 6-10% of all salivary gland tumors. Palatal minor salivary glands, parotid, and sub-mandibular glands are usually affected. Rarely, these lesions arising intraosseously have been reported. Mandible is commonly involved than maxilla. The present case is a giant ACC involving the right maxilla. A thorough clinical and radiographic evaluation was performed to assess the involvement of surrounding vital structures along with a meticulous metastatic work-up. Computed tomography showed a giant lesion in maxilla encroaching the left nasal fossa, antrum, buccal space, and oral cavity. No metastasis was noted. Histological evaluation from multiple sites showed both cribriform and solid patterns. Radiotherapy was given as patient did not comply for surgery. Though central ACC is extremely rare, especially in maxilla, it should be included in the differentials for lesions in maxilla. A prompt diagnosis with treatment and long-term follow-up is advised in such cases.

Nasal cavity lobular capillary hemangioma due to insect sting

Lobular capillary hemangioma is a frequent benign vascular inflammatory lesion of the skin tissue. It rarely reaches the mucous membrane, and the nasal fossa involvement is exceptional. A 68-year-old woman presented with an ulcerous hemorrhagic mass blocking the left nasal fossa, which had appeared a few weeks after a wasp sting in the nose. The insect was evacuated only three weeks after the sting. The clinical and radiological data suggested malignancy. Biopsy under local anesthesia proved non-contributory and was complicated by 1 week's hospitalization for severe nosebleed. Surgical excision under video-endoscopy confirmed diagnosis. At 31 months' follow-up, the patient was free of recurrence. The pathogeny of lobular capillary hemangioma is uncertain. No previous cases affecting the mucous membrane after insect sting have been reported. Except in the typical contexts of long-term packing or pregnancy, diagnosis can be difficult and misleading. It can mimic a malignant pathology. Its rich vascularization requires caution during biopsy, and the risk of recurrence requires excision to be complete.

A Quantitative Study of Olfactory, Non-Olfactory, and Vomeronasal Epithelia in the Nasal Fossa of the Bat Megaderma lyra

In complexity, the mammalian nasal fossa is unparalleled among vertebrates. Although total nasal epithelial surface areas (SA) have been reported for numerous mammals, detailed quantitative reports on individual structures exist for few mammals. Here, we examine mucosal distribution in the nasal fossa of the greater false vampire bat, Megaderma lyra (Megadermatidae, Chiropera). The SA of the left nasal fossa of one adult Megaderma was measured in serial histological sections; the development of the nasal fossa was assessed using three fetal specimens. The nasal fossa of Megaderma has seven ethmoturbinals and multiple smaller interturbinals between them, all bearing olfactory mucosa. Nearly half of the total olfactory SA of the nasal fossa lines these turbinals; the remainder lines recesses and parts of the medial (septal) and lateral walls of the nasal fossa. The maxilloturbinal is diminutive, and the nasoturbinal is absent. Volumetric measurements of the fetal and adult vomeronasal organ suggest age-related reduction. Thirty-five percent of the nasal fossa is lined with olfactory mucosa, within the range reported previously for chiropterans. In Megaderma the frontal recess contributes little to total nasal SA (2% of all olfactory SA). This represents a significant departure in morphology compared to other mammals, including some bats, in which the frontal recess is much larger. The significance of the emphasis in olfactory SA distribution to central or more peripheral (paranasal) spaces could be investigated using a large sample of phylogenetically diverse mammals, such as bats. This study emphasizes the need for more histological detail to further such studies.

Primary sinonasal meningioma

Primary meningiomas of the sinonasal tract are rare tumors. Their positive diagnosis is difficult to establish. From one case observation, we report the clinical features, the diagnosis difficulties and the therapeutic modalities of primary meningioma of the sinonasal tract. A seventeen-year-old girl consulted for a left unilateral nasal obstruction with progressive evolution without episodes of epistaxis, smell disorder or headaches over a year. Physical examination revealed a grayish polypoid tumor in the left nasal fossa. CT scan evidenced an isodense lesion of the left nasal fossa slightly enhanced pushing back the lateral nasal wall without invasion or intracranial connection. Biopsy was in favour of an inverted papilloma. The tumor was resected via endoscopic approach. Pathological examination established the diagnosis of meningothelial menigioma. The prognosis was favourable without recurrence after a six-month follow-up. The positive diagnosis of primary sinonasal meningioma is difficult to establish because of their infrequent occurrence in this ectopic site and of their non-specific clinical appearance. The final diagnosis rests on the histological examination. Immunohistochemical studies are helpful to establish the accurate diagnosis. Imaging confirms the primitive nature of these tumors. Prognosis is excellent after complete surgical extirpation without the necessity of adjuvant therapy.

Sinonasal fibrosarcoma: a case report

Sinonasal fibrosarcoma (SFS) is an infrequent malignant neoplasm. It usually presents as other sarcomas in this region, with nasal obstruction and epistaxis. The final diagnosis is based on the histopathology and immunohistochemistry. We report the case of a 58-year-old man with an 8-month history of left proptosis, recurrent epistaxis and nasal obstruction. Nasal endoscopy confirmed a left nasal neoplasia. CT and MRI showed the extension of the neoplasia, occupying the left nasal fossa and ethmoid sinuses, and eroding the medial wall of the orbit. Complete removal was achieved through endoscopic sinus surgery, preserving the orbit. SFS was found on histopathologic examination. After 4 years of follow-up, nasal endoscopy, CT and MRI imaging show no sign of recurrence.

Unusual endocrine presentations of nasopharyngeal carcinoma

Nasopharyngeal carcinoma is endemic in Southern China and the majority of patients present with local symptoms due to the tumor. This report describes two unusual cases of occult nasopharyngeal carcinoma in which the patients initially presented with endocrine manifestations. The first patient presented with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) production. Nasolaryngoscopy showed a growth in the left nasal fossa and biopsy revealed a poorly differentiated nasopharyngeal carcinoma that exhibited positive immunostaining for ACTH. The second patient presented with a 10-month history of bone pain over both lower limbs. She was normocalcemic but her serum alkaline phosphatase was markedly elevated. A bone biopsy showed both osteoclastic and osteoblastic activity with widespread fibrosis suggestive of Paget's disease. Three months later, she developed third cranial nerve palsy. Computed tomography investigation revealed a soft tissue mass filling the sphenoid and ethmoid sinuses. Biopsy showed a poorly differentiated nasopharyngeal carcinoma. The bone biopsy was reviewed and immunohistochemistry demonstrated the presence of cells positive for the epithelial marker AE1/3 within the fibrous stroma. Radio-labeled in situ hybridization showed that Epstein-Barr virus early RNA was present in these tumor cells and the bone lesions were in fact metastases. Nasopharyngeal carcinoma can present with rather atypical symptoms that may lead to a delay in diagnosis. Therefore, in high risk populations, it is important to consider nasopharyngeal carcinoma as a possible primary tumor in patients with occult carcinomas.

In Vivo Localization of Staphylococcus aureus in Nasal Tissues of Healthy and Influenza A Virus-Infected Ferrets

An in vivo ferret model was used to study the association of Staphylococcus aureus with specific tissues of the nasal cavity in both control and influenza A virus-infected animals. Ferrets were inoculated intranasally with various doses of influenza A3/Hong Kong/1/68 virus. On Days 2, 5, 9 and 14, four or five virus-inoculated and two uninoculated controls were challenged intranasally with a 1-ml volume of radiolabeled S. aureus (3 mg dry wt), a clinical isolate of low passage history. Ferrets were allowed to clear the staphylococci in vivo for 60 to 90 min before sacrifice. The animals were anesthetized, exsanguinated, and decapitated, and the lower jaw was removed. The nasal fossae were exposed by dissection and turbinates from the left nasal fossa were used for virus isolation. The median septum and tissues from the right nasal fossa, which included vestibule and anterior and posterior turbinates, were harvested and processed for radioassay. The percentage of recoverable staphylococci from virus-infected ferrets (Days 2 and 5) was greater than or equal to 10-fold higher compared with controls and animals infected with suboptimal doses of virus; greater than or equal to 76% of the recoverable staphylococci, whether from controls or virus-infected animals, was associated with the anterior turbinates. Histologic examination of the anterior turbinates from virus-infected ferrets, particularly on Days 2 and 5 postexposure to virus, showed that the staphylococci were adhering to desquamating respiratory epithelial cells. In contrast, the anterior turbinates from control ferrets uninoculated with virus and posterior turbinates from both control and virus-infected animals showed no evidence of bacteria adhering to host cells; instead, the staphylococci were found in association with the mucus gel layer of respiratory mucosa. Examination of vestibular tissue showed staphylococci in association with cells of the stratum granulosum in both virus-infected and control animals. Results of this study suggest that the early events of S. aureus interaction with different sites of ferret nasal tissues are effected by different mechanisms, and that the interaction is significantly enhanced by virus-infection.

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<h3>PATHOLOGIC QUIZ CASE 1</h3><h3>Mark J. Shikowitz, MD, New Hyde Park, NY</h3> A 60-year-old woman complained of complete obstruction of the left nasal fossa and recurrent sinusitis of one year's duration. The patient gave a history of occasional left nasal epistaxis, constant postnasal drip, and a sense of left maxillary antrum fullness during this time. Paranasal sinus films disclosed a complete opacification of the left maxillary antrum. Left maxillary sinus irrigation was performed twice as an office procedure without relief of symptoms. A computed tomographic scan of the paranasal sinus demonstrated a soft-tissue density in the left maxillary antrum. The patient was admitted to the hospital for a left maxillary antrostomy, curettage, and biopsy. The tissue diagnosis at that time demonstrated antrum mucosa with chronic inflammation and small papillary projections without substantial changes. The patient's postoperative symptoms returned within the first month and progressed to complete left nasal obstruction. Physical

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<h3>PATHOLOGIC QUIZ CASE 1</h3><h3>Robert E. Fechner, MD, Charlottesville, Va</h3> A 36-year-old woman was admitted to the hospital with the complaint of nasal obstruction and an intermittent discharge. She also had a sense of fullness and discomfort in the region of her left maxillary sinus. A roentgenogram showed opacification of the sinus. On physical examination, the left nasal fossa was partially filled by a mass covered with purulent exudate. The mass originated from the lateral wall. The patient had had polyps removed from the nose on several occasions during the preceding eight to ten years. Seven months before hospital admission, nasal polyps had been excised, and a nasoantral window was created on the left side. At the conclusion of the procedure, sterile gauze impregnated with 3% tetracycline hydrochloride antibiotic ointment was placed into the wound. A review of the polyps removed previously, both from the nasal fossa and the left