Involvement Of Nasal Cavity Research Articles

Linfoma en fosa nasal encontrado durante una dacriocistorrinostomía

Malignant tumors in sinonasal areas constitute 3% – 5% of all malignant tumors, of which non–Hodgkin lymphomas developing from B cells are those most commonly found. Nasal cavity involvement is described between 1.5% and 15% and is usually found in patients who are in their seventies or eighties. It is more commonly found in women than in men and there is predisposition in Asians. Its histology has been found as non-primary epithelial tumors. Many patients in case series had been diagnosed with primary tumor in other places prior to the presentation of nasal symptoms such as nasal obstruction, epistaxis, edema, headache, and blurred vision. This article describes the case report of a male patient diagnosed with chronic lymphoid leukemia residing in Buenos Aires. While the patient was undergoing a dacryocystorhinostomy, a lymphoid tissue was found in the right nostril without previous presentation of nasal symptoms, palpable mass, or systemic symptoms.

MANAGEMENT OF JUVENILE NASOPHARYNGEAL CARCINOMA IN TUNISIA OVER TIME

AOBJECTIVFS: The aim of our study was to analyze the impact of the new imaging techniques as well as the combination of radiotherapy (RT) and chemotherapy (CT) on the diagnostic and therapeutic management of nasopharyngeal cancer (NPC) through a comparative study of epidemiologic, anatomoclinic, therapeutic and evolutive aspects of 316 juvenile NPC over two different periods. METHODES: We compared the results of two retrospective studies on patients younger than 25 years old treated at Salah Azaiz Institute for NPC over different periods: 1969-1979 and 1995-2005. Pretreatment evaluation included conventional X-ray examinations of the nasopharynx in the first study and CT-scan and/or MRI of the nasopharynx in the second study. In the two series, all patients received conventional 2D RT but using two different techniques. For patients treated between 1969 and 1979, CT was indicated only for metastatic or recurrent disease and for those treated between 1995 and 2005; CT was used also for non-metastatic but locally advanced disease. RESULTS: In the first series, 186 cases were registered against 130 in the second one with a male predominance in the two series. Lymph node involvement was frequent in the 2 series (92%) and supraclavicular lymph node, oropharynx and nasal cavity involvement were more common in the first period (1969-1979). According to the 1986 TNM staging system, the JNPC patients treated during the first period presented with less T3-T4 locally advanced tumors than did the JNPC patients treated during the second period (67.2% vs 96.1%). Initially metastatic forms were comparable in the 2 series (4 and 5%). All patients with no metastatic NPC of the first study have received exclusive RT regardless of the disease’s stage. Among the 125 patients with no metastatic NPC of the second study, 86.4% had neoadjuvant CT, 4% had concomitant RT-CT and 9.6% had an exclusive RT. After a complete curative treatment, patients treated between 1969 and 1979 had greater locoregional relapse and distant metastases rates than those treated between 1995 and 2005 (19 and 45% vs 8.8 and 15.2% respectively). The 5-year overall survival (OS) rate was better in the second series (79% vs 42%). CONCLUSION: This comparative study revealed that advances in imagery and radiology techniques as well as the combination of RT and CT have had a significant impact on the success ratio of JNPC treatment by reducing loco-regional and distant relapses over time.

CD56-negative extranodal NK/T cell lymphoma should be regarded as a distinct subtype with poor prognosis.

Previous results about the clinical and prognostic significance concerning CD56 expression status in extranodal NK/T cell lymphoma (ENKTL) are controversial due to a small sample size and the heterogeneity nature of this disease. The complete data of 288 patients with early-stage upper aerodigestive tract ENKTL were retrospectively reviewed. One hundred eighty-three patients (63.5 %) had stage I disease, and the primary tumor site of 204 patients (70.8 %) was in the nasal cavity. Sixty patients (20.8 %) were categorized to CD56-negative ENKTL group. The complete remission rate in CD56-positive ENKTL group was 80.6 %, significantly higher than that in CD56-negative ENKTL group (60.8 %, P = 0.005). At a median follow-up time of 69 months, the 5-year and 10-year progression-free survival (PFS) rate were 52 and 41 %, respectively, and the 5-year and 10-year overall survival (OS) rate were 69 % and 68 %, respectively. Patients with primary tumor site located in the nasal cavity or CD56-positive expression had significantly superior PFS and OS (P < 0.05). In multivariate Cox regression model that included age, Ann Arbor stage, lactate dehydrogenase (LDH) level, primary tumor site, chemotherapy regimens, and CD56 expression status, all these six factors remained to be independent prognostic factors for PFS, and the first five factors were independent prognostic factors for OS, while CD56 expression status had a trend to be independently correlated with OS (P = 0.084). In a subgroup analysis according to primary tumor site location, CD56 expression status significantly correlated with survival outcomes in patients with primary nasal cavity involvement (P < 0.05). In conclusion, in this large cohort of patients with early-stage ENKTL, we found that CD56-negative ENKTL had significantly inferior survival outcomes, indicating CD56-negative ENKTL should be regarded as a distinct phenotype, and optimal treatment strategies need to be evaluated further for this entity.

Lobular Capillary Hemangioma of Nasal Septum - A rare presentation

Lobular Capillary Hemangioma (LCH) is a benign, rapidly growing, vascular lesion of the skin and mucous membranes. It usually involves lips, gingiva, tongue and buccal mucosa. Involvement of nasal cavity is a rare presentation. In the nasal cavity, anterior part of nasal septum is the most frequently affected site. It commonly occurs in the third decade, and in females. The etiology until now remains obscure. The usual presenting symptoms are nasal obstruction and epistaxis. Endoscopic surgical excision is the preferred treatment of choice. In the present case, we describe a 14-year old male with left sided nasal obstruction due to a growing mass in the left nasal cavity. This case is reported for its rarity, and typical clinical and microscopic findings.

A single institution experience of extranodal natural killer/T cell lymphoma of nasal type

Extranodal natural killer/T cell lymphoma (ENKTL) nasal type is a rare form of non-Hodgkin lymphoma that is more commonly seen in Asia and Latin America than in North America or Europe. The purpose of this study was to determine the treatment outcomes with a combined modality approach and whether treatment outcomes varied according to ethnicity in patients with ENKTL, nasal type in Toronto, Canada. Patients presenting with ENKTL, nasal type, between 1994 and 2011 were retrospectively reviewed. Patient characteristics, including the patient's ethnic origin, treatment details and outcomes were recorded and analyzed for significant differences between Asian and Caucasian patients. A total of 34 patients were identified: 16 Asian, 16 Caucasian, one Aboriginal and one Hispanic. All patients had nasal cavity involvement. The majority had localized disease: stage I (n = 22), stage II (n = 6); and stage IV in six patients. Combined radiotherapy (RT) and chemotherapy was intended for 32 of the 34 patients, with two receiving RT alone. Median RT dose was 45 Gy (range: 35–50.4 Gy). Response to initial treatment was observed in 44% of patients. Two-year disease-free survival was 17.8% (Asian patients: 18.8%, Caucasians: 20%, p = 0.82), and overall survival 39.2% (Asian patients: 30%, Caucasians: 42%, p = 0.52). There were no significant differences in clinical outcomes in terms of patient ethnicity. A combined modality approach (with cyclophosphamide, doxorubicin, vincristine, prednisone [CHOP] chemotherapy administered initially) is of limited effectiveness. We have now adopted the use of RT as the initial treatment approach, followed by multiagent chemotherapy.

Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomical forms, namely, sino-nasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis, is frequently involved. The pathogenesis of URTA, in particular the relationship between the infecting isolate and outcome, is poorly understood. In this study, computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n = 7, SOA n = 9) where the infecting isolate had been identified by molecular testing.All cases had nasal cavity involvement except for one cat with SNA that had unilateral frontal sinus changes. There was a strong association between the infecting species and anatomic form (P = 0.005). A. fumigatus infections remained within the sino-nasal cavity, while cryptic species infections were associated with orbital and paranasal soft-tissue involvement and with orbital lysis. Cryptic species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA. These findings support the hypothesis that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.

Metachronous Nodal and Nasal Rosai-Dorfman Disease presenting with Chronic Renal Failure

ABSTRACT Rosai-Dorfman disease (RDD) is an uncommon non-neoplastic lymphoproliferative disorder. It usually manifests as bilateral, painless, massive cervical lymph node enlargement in children and young adults, hence the name sinus histiocytosis with massive lymphadenopathy. Extranodal involvement is observed in 25 to 40% of cases. Involvement of nasal cavity is rare and those presenting with renal failure are exceptional. We report a rare case of 16-year-old boy who was diagnosed as a case of RDD of cervical lymph node before 6 years, now presenting with nodular lesions in the nasal cavity and features of renal failure. The nasal lesion was confirmed to be RDD histologically. How to cite this article Bhat SP, Prasad HLK, Bhandary BSK, Baikunje S, Bhat V. Metachronous Nodal and Nasal Rosai Dorfman Disease presenting with Chronic Renal Failure. Clin Rhinol An Int J 2013;6(3):139-143.

English

Capillary haemangioma is a benign rapidly growing lesion characterized by a proliferation of capillaries arranged in lobules and separated by a loose connective tissue stroma, often infiltrated by inflammatory cells. Most mucosal capillary haemangioma of head and neck arise in the oral cavity, but the nasal cavity involvement is rare. The most common symptoms are unilateral epistaxis and nasal obstruction. The treatment of choice is surgery to remove the tumour even for large lesion.

Clinical Features, Treatment and Prognosis of Extranodal NK/T Cell Lymphoma, Nasal Type: A Retrospective Analysis of 88 Cases From a Single Institution in China

AbstractAbstract 4848 Background and Objective:Extranodal NK/T Cell Lymphoma, nasal type (NKTCL), a rare malignancy in western countries, behaves distinct clinicopathologic features. Patients are generally refractory to conventional chemotherapy. No standard therapy regimen has been established yet. Prognosis of this highly aggressive disease is usually dismal. As it is relatively prevalent in the southwest China, the analysis will provide useful information on the clinical characteristics, treatment options and survival. Methods:Hospitalized patients newly diagnosed as NKTCL according to the WHO classification in our institution from January 2000 to December 2010 were surveyed. 88 cases were retrospectively analyzed. Patients were treated by different regimens: chemotherapy-alone, radiotherapy-alone or radio-chemotherapy. All patients had thorough baseline and follow-up assessments. The median observation time was 28 months (range 3∼96). Results:1.Patients characteristics: median age 37 years old (range 12∼83), the M:F ratio is 2.7:1, including Ann Arbor stage I 33 cases (40.2%), stage II 12 cases (14.6%), stage III 10 cases (12.2%), stage IV 27cases (32.9%). Systemic symptoms were seen in 49 patients(59.8%). 55 patients(62.5%) present with nasal cavity or nasopharynx involvement. Lymphadenopathy, bone marrow infiltration and splenomegaly were observed in 34.2%, 12.2% and 17.1% of cases, respectively. 3 patients (3.7%) had haemophagocytic syndrome at diagnosis. 94.4% of patients showed a CD56+ phenotype. EBER-ISH was positive in 94.9% of patients with nasal presentation, comparing to 68.8% of those with lymphoma occurring outside the nasal cavity. All cases had CD45RO or CD3εexpression. Ki-67 was detected in 39 cases, which the median value was 53% (range 5∼90%), and 53.8% of the patients had a Ki-67 index more than 50%.2.65 patients were evaluable for response. The overall response rate was 88.9% for patients received radiotherapy alone (9 cases, 77.8% of them were stage I or II), 65.5% for those received chemotherapy alone (29 cases, 34.5% of them were stage I or II) and 85.2% for the radio-chemotherapy group (27cases, 74.1% of them were stage I or II). It indicated that chemotherapy alone produced a lower response rate compared to radiotherapy alone or combined radio-chemotherapy (P<0.05). There were no statistically significant differences in response among the various chemotherapy regimens, including CHOP-like, LVP, SMILE, GLIDE, ICE, etc.3.The median OS was 24 months in the whole group. OS at 1 year, 2 years and 5 years was 69.4%, 38.9% and 20.8%, respectively, and PFS was 59.7%, 37.5%, and 19.4%, respectively. Advanced stage, onset of extra-nasal involvement and bone marrow infiltration had been associated with poorer outcome (P<0.05). Respectively, OS at 1 year and 5 years was 43.3% and 6.7% in the radiotherapy-alone group, 77.8% and 22.2% in the chemotherapy-alone group, and 67.9% and 39.3% in the radio-chemotherapy group. No apparent differences were observed among chemotherapy regimens. Conclusions:NKTCL occurs most often in young or middle aged adults with a male predominance and has a strong association with Epstein-Barr virus (EBV) infection. Patients with advanced stage disease usually have a poor prognosis. Better response and higher survival chances are expected by radiotherapy or combined radio-chemotherapy. Disclosures:No relevant conflicts of interest to declare.

CT findings in two cases of lobular capillary haemangioma of the nasal cavity: focusing on the enhancement pattern

Lobular capillary haemangioma, known as pyogenic granuloma, is a relatively common benign vascular neoplasm that is composed of hyperplastic clusters of capillaries arranged in a lobular architectural pattern. Most mucosal lobular capillary haemangioma (LCH) of the head and neck arise in the oral cavity, but the nasal cavity involvement is rare. We report here on the CT imaging findings of two cases of LCH involving the nasal cavity, with an emphasis being placed on the different pattern of enhancement of the tumour on the enhanced CT scans.

Localized nasal cavity, sinus, and massive bilateral orbital involvement by human T cell leukemia virus 1 adult T cell lymphoma, with epidermal hypertrophy due to mite infestation

HTLV1 adult T cell lymphoma occurs tends to be widely disseminated and aggressive, with only brief responses to chemotherapy. Aside from cervical adenopathy, involvement of head and neck structures is uncommon and orbital involvement rare.We report a case of nasal cavity HTLV lymphoma with massive bilateral orbital involvement and proptosis, resulting in complete left and partial right eye amaurosis. No other sites of disease were found. Response to chemotherapy was rapid and complete, with almost complete restoration of vision and oculo-motor function; the patient has remained in remission for one year. An associated problem was striking bilateral hypertrophic, hyperkeratotic eyelid and breast lesions due to mite infestation.

Extranodal NK/T-Cell Lymphoma without Nasal Cavity Involvement Associated with Epstein-Barr Virus: A Multimodality-Based Diagnosis of Two Cases

We report two cases of extranodal NK/T-cell lymphoma, nasal type, in immunocompetent patients without nasal cavity involvement. In the two cases, the initial presumptive diagnosis was tuberculosis and there was a rapid dissemination of the tumor with short survival after the hospital admittance. An autopsy was performed showing infiltration in several organs including lymph nodes and mesenteric and retroperitoneal fat. Histological sections showed an angiocentric and angiodestructive growth pattern and the immunophenotype was CD45

Varied manifestations of Rosai-Dorfman disease and its management - a case report and review of literature.

Rosai Dorfman disease or sinus histiocytosis is a rare, idiopathic, benign and self-limiting histiocytic proliferative disorder, usually seen in younger patients. It most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes and classically presents with massive cervical lymhadenopathy. Extranodal disease occurs in about 43% of cases and produces different signs and symptoms depending upon its location. We report a case of this disorder in 22-year-old male with initial isolated involvement of bilateral nasal cavity and paranasal sinuses with subsequent involvement of cervical lymph nodes and skin. The clinical presentation, histologic characterstics, radiographic findings and treatment of the disease are discussed.

Retrospective study of feline and canine cryptococcosis in Australia from 1981 to 2001: 195 cases

A retrospective study of 155 cats and 40 dogs diagnosed with cryptococcosis between 1981 and 2001 was undertaken. Age, sex, breed, clinical findings, feline immunodeficiency virus and feline leukaemia virus status (in cats), species of Cryptococcus causing disease and region of domicile were recorded. Associations between variables were tested. Male and female cats were affected equally. Age ranged from 1 to 16 years, with a preponderance of cats aged between 2 and 3 years. Siamese, Himalayan and Ragdoll breeds were over-represented. Rural cats were more frequently infected with Cryptococcus gattii. Retroviral infection was not identified as a predisposing condition and was not correlated with either species of Cryptococcus or physical findings. Most cats had signs of nasal cavity infection, which was typically localised for a substantial period before invasion of adjacent structures or dissemination. Male and female dogs were affected equally. A marked preponderance of young, large breed dogs was noted. Border Collies, Boxers, Dalmatians, Dobermann Pinschers, Great Danes and German Shepherds were over-represented. Cryptococcus species involved was not affected by place of domicile. Although nasal cavity involvement was important, the canine cohort had a greater propensity to develop secondary central nervous system involvement and disseminated disease than feline cases. There were no clinical findings in either cats or dogs which could be reliably used to distinguish disease caused by Cryptococcus neoformans variety grubii from disease caused by Cryptococcus gattii. Both Cryptococcus species appear to be primary pathogens of cats and dogs, with the upper respiratory tract presumed to be the predominant primary site of inoculation in most but not all cases.

Computed tomographic findings in patients with invasive fungal sinusitis.

To determine the radiographic findings of computed tomographic (CT) imaging most suggestive of invasive fungal sinusitis (IFS) in an immunocompromised patient population. A retrospective review of patients with a diagnosis of IFS reached with CT and confirmed by histopathologic evaluation. An academic tertiary care hospital. Twenty-three immunocompromised patients with confirmed IFS and preoperative CT imaging. Controls were 10 patients with acute myelocytic leukemia and CT evidence of sinusitis but no history of IFS. The CT scans were reviewed to identify factors predictive of invasive fungal disease. Parameters evaluated were nasal cavity and sinus soft tissue thickening, the presence of air-fluid levels, bone erosion, extrasinus extension, and unilateral or bilateral nasal cavity and sinus involvement. The CT findings included severe soft tissue edema of the nasal cavity mucosa (turbinates, lateral nasal wall and floor, and septum) in 21 of the 23 patients, sinus mucoperiosteal thickening in 21, bone erosion in 8, orbital invasion in 6, facial soft tissue swelling in 5, and retroantral fat pad thickening in 2. Two patients had air-fluid levels. No patients had intracranial involvement. Unilateral involvement was found in 21 patients, and bilateral involvement in 2. Review of the control group revealed only mild soft tissue edema of the nasal cavity in 2 (P<.001), unilateral involvement in 2 (P<.001), and evidence of bone erosion or extrasinus soft tissue involvement in none. Most patients do not have classic CT findings of bone erosion or extrasinus extension in the early course of IFS. We found that severe unilateral thickening of the nasal cavity mucosa was the most consistent finding on CT suggestive of underlying IFS, occurring much more frequently in immunocompromised patients with IFS than without IFS. Even though severe nasal cavity soft tissue thickening is much more common in IFS, this is a nonspecific finding that can be seen, to a lesser degree, in all forms of rhinosinusitis. Therefore, the clinician cannot rely solely on CT imaging and must maintain a high index of suspicion when evaluating immunocompromised patients to establish a prompt diagnosis. Early nasal endoscopy with biopsy and initiation of appropriate therapy are necessary to improve prognosis.

Cystic schwannoma of the maxillary sinus

Objective: Although 25–45% of all schwannomas are reported to occur in the head and neck region, nasal cavity and paranasal sinus involvement is rare, with 32 such cases described till 1999. Of these cases, only three were cystic. Herein we present a cystic schwannoma of the maxillary sinus of a 66-year-old, otherwise healthy male patient. Methods: The tumor tissue was routinely processed, embedded in paraffin, and stained with H&E. Immunostaining was performed for S-100 protein, epithelial membrane antigen (EMA) and cytokeratin. Results: A mass with sudden enlargement, inhomogenous enhancement with cystic areas, S-100 positive membrane-like structures lining the cystic cavity of an otherwise classical schwannoma were the main features encountered in our case. Conclusion: We recommend that cystic schwannoma should be kept in mind in the differential diagnosis of cystic masses of the maxilla.

Computed tomography of Paget disease of the skull versus fibrous dysplasia.

Radiologists are often challenged to review CT examinations of the skull without pertinent clinical information or plain radiographs. Skull lesions of fibrous dysplasia (FD) may often be confused with Paget disease (PD). The purpose of this article is to evaluate radiographic similarities and to find the signs that can differentiate PD from FD of the skull on head CT and to describe the CT imaging features of PD and FD. CT scans of the skull in eight cases of PD, 18 cases of FD (13 cases of skull and facial bones, five cases of only facial bones) and 10 normals were studied retrospectively. Ten features were found to be similar in PD and FD and 10 other features were found to be dissimilar. The frequency of the 10 differentiating features was evaluated to determine their reliability in distinguishing one disorder from the other. The differentiating features in order of significance include: (1) "groundglass" appearance, (2) symmetry, (3) involvement of the paranasal sinuses, (4) thickness of the cranial cortices, (5) involvement of the sphenoid bone, (6) orbital involvement, (7) nasal cavity involvement, (8) presence of a soft tissue mass, (9) maxillary involvement, and (10) the presence of cyst-like changes. These 10 signs improve the radiologist's skill in differentiating FD and PD.

Resection of a recurrent nasal tumor via Le Fort I osteotomy approach

(Editorial Comment: The authors describe another approach to the nasal cavity. The Le Fort osteotomy is commonly used to expose the clivus on nasopharynx. The nasal cavity is most often exposed with either a lateral rhinotomy or midface degloving. Surgeons must consider the relative merits and difficulties inherent in selecting any surgical approach.) Pleomorphic adenoma most commonly affects the major salivary glands. The minor salivary glands are involved in only 8% of cases,l whereas most cases involve the palate. Nasal cavity involvement may be difficult to treat because of inadequate exposure that may lead to recurrence of the tumor. Compagno and Wang’ reviewed the files of the Armed Forces Institute of Pathology and found a 10% recurrence rate following conservative resection of

Osteoblastoma of the nasal cavity

The clinicopathological features of a rare case of osteoblastoma of the nasal cavity arising from the nasal turbinate are reported and compared with four reported cases of osteoblastoma with nasal cavity involvement. Two of the five tumours involved the nasal cavity and paranasal sinuses. The remaining three tumours were confined in the nasal cavity; one arose from nasal bone and two from nasal turbinate periosteum. Four tumours were successfully treated with local excision. One tumour recurred locally after excision; the recurrence was apparently controlled by further local excision.

Radiation therapy for juvenile angiofibroma: evaluation by CT and MRI, analysis of tumor regression, and selection of patients

Purpose : To provide an analysis of nine patients with juvenile angiofibroma treated with radiotherapy between June 1975 and June 1987. Methods and Materials : All patients had a minimum 3 years of follow-up; six of the patients had greater than 5 years and four had greater than 10 years of follow-up. Two patients received radiotherapy as primary therapy, and the remaining seven patients were treated with surgery initially, followed by irradiation for recurrent disease. Characteristic computed tomography (CT), magnetic resonance (MR), and angiography findings were identified. All nine patients had nasal cavity or nasopharyngeal involvement. Eight patients had involvement of the base of the skull, and seven had intracranial extension. Tumor regression during and after treatment was estimated clinically and from available imaging studies. Results : Tumor regression during treatment ranged from 25% to 100%, with most patients experiencing between 30% and 50% clinical decrease in the size of the tumor. Seven patients eventually showed complete regression by physical examination, but only two of seven patients evaluated by CT and/or MR showed complete regression. In five patients, follow-up imaging studies showed stable residual changes. Local control was achieved in all patients. No late complications were found. Conclusion : The initial treatment of early lesions is surgical. Low dose irradiation appears to be an effective alternative to extensive surgery in treating advanced juvenile angiofibroma. Morbidity has been minimal. Residual changes are seen in subsequent imaging studies but have remained stable with long follow-up.