[Primary tuberculosis of the cavum: An unusual diagnosis]

Primary tuberculosis of the cavum is a rare entity. It can occur at any age, especially between the second and ninth decade. We report the case of a 17-years-old patient with nasal obstruction and left laterocervical adenomegaly. A cervico-facial CT scan showed a suspicious looking tumor process of the nasopharynx. Histological analysis of the biopsies taken showed chronic granulomatous inflammation with necrosis and the absence of tuberculosis lesions in the usual sites, especially the lungs, led to the diagnosis of primary tuberculosis of the cavum. There was a good evolution on antituberculosis drugs. This unusual location can be a source of difficulties and delay in diagnosis, especially because of the clinical presentation, which suggests a nasopharyngeal tumour. In developing countries, where this disease remains relatively endemic, cross-sectional imaging techniques and histopathological analysis are of great interest for the management of patients.

Blastic plasmacytoid dendritic cell neoplasm with unusual extracutaneous manifestation: Two case reports and literature review

RATIONALE

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy. This disease almost always presents with cutaneous involvement.

PATIENT CONCERNS

The 1st patient was a 16-year-old girl who presented with recurrent epistaxis. The 2nd patient was a 17-year-old female who presented with nasal obstruction and voice change for a month.

DIAGNOSES

In the 1st patient, sinonasal computed tomography (CT) revealed a 2.9-cm sized, polypoid mass in the nasal cavity. In the 2nd patient, CT scans revealed a large enhancing nasopharyngeal mass involving adenoid and several small indeterminate lymph nodes at the neck. Cutaneous examination was unremarkable for either patient. Biopsy of these 2 masses and bone marrow biopsy were performed. Histologic diagnosis of the 2 cases was BPDCN.

INTERVENTIONS

Both patients were treated with induction chemotherapy and received allogenic peripheral blood stem-cell transplant.

OUTCOMES

No relapse was observed in the 2 patients for 14 and 11 months, respectively, after transplantation. Interestingly, they had no skin lesions at initial diagnosis or during the course of their illness.

LESSONS

We 1st identified nasal cavity as an unusual site of BPDCN. BPDCN should be considered in differential diagnosis of blastic leukemia with an undifferentiated and ambiguous immunophenotype despite the absence of skin lesions.

Encephalitis-Associated Human Metapneumovirus Pneumonia in Adult, Australia

Human metapneumovirus pneumonia, most commonly found in children, was diagnosed in an adult with encephalitis. This case suggests that testing for human metapneumovirus RNA in nasopharyngeal aspirate and cerebrospinal fluid samples should be considered in adults with encephalitis who have a preceding respiratory infection,

Necrotizing sialometaplasia of the nasopharynx with parapharyngeal extension: Case report and brief review of the literature

We report a rare case of necrotizing sialometaplasia of the right lateral nasopharynx with extension into the right parapharyngeal space in a 39-year-old man. Since this is a self-limiting condition, the patient began to improve spontaneously over the next few weeks, and he experienced a complete recovery. Necrotizing sialometaplasia is an uncommon condition that is known to involve the palate; nasopharyngeal involvement is very rare, and to the best of our knowledge, extension into the parapharyngeal area has not been previously reported in the English-language literature. This condition poses a diagnostic dilemma because it closely mimics a malignancy, and failure to recognize it can result in unnecessary investigations and extensive surgery. We also review the literature on necrotizing sialometaplasia of the oropharyngeal area.

Tuberculosis of nasopharynx masquerading as angiofibroma

Nasopharyngeal tuberculosis is a rare entity. We present a case of nasopharyngeal tuberculosis in an adolescent male which masqueraded as angiofibroma because of its clinical presentation and radiological features. Histopathology played a critical role in proper management of the case. We report this case because of its atypical presentation and clinical rarity.

[Primary nasopharyngeal tuberculosis presenting as durative aural fullness: one case report and literature review]

OBJECTIVE

To study the clinical features, diagnosis and treatments of primary nasopharyngeal tuberculosis.

METHOD

A case report was presented, and meanwhile etiopathogenesis and differential diagnosis were also reviewed.

RESULT

A biopsy was taken and the histopathological examination showed tuberculosis granuloma with caseous necrosis. After anti-tuberculosis therapy, the symptoms disappeared.

CONCLUSION

Not only otologic disorders but also nasopharyngeal diseases need to be considered when aural fullness exists. More importantly, primary nasopharyngeal tuberculosis should be taken as one of the differential diagnosis.

Image-guided transoral resection of recurrent parapharyngeal space glial heterotopia

Intranasal glial heterotopia is an uncommon congenital nasal lesion of neuroectoderm origin. Involvement of the parapharyngeal space is extremely rare. We present a case report of a newborn with life-threatening respiratory distress and feeding difficulty caused by a nasal glial heterotopia in a rare location involving the nasopharynx and parapharyngeal space. Surgical treatment was done in a staged fashion, involving image guidance for recurrence. Other diagnostic and treatment options are reviewed in the light of current literature.

Respiratory epithelial adenomatoid hamartoma (REAH) of the nasopharynx with high 18F-FDG uptake on PET/CT

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign non-neoplastic sinonasal lesion that usually presents in the nasal cavity, paranasal sinuses, or olfactory cleft. We report a case of nasopharynx REAH mimicking a malignant tumour with incidental high 18-FDG uptake in a patient with colon cancer. Less than five similar cases have been reported to date, and this is the first case of REAH to show high uptake on PET/CT scans. Although hamartoma arising from the nasopharynx region is very rare, it should be considered in the differential diagnosis because it is a benign lesion and complete surgical resection is curative.

A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy

OBJECTIVE

The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy.

METHODS

81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation.

RESULTS

Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02).

CONCLUSIONS

A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.

Nasopharyngeal tuberculosis: CT and MRI findings in thirty-six patients

PURPOSE

Tuberculosis is uncommon in the nasopharynx. The purpose of this study was to investigate the CT and MRI features of 36 cases of tuberculosis in this area.

MATERIALS AND METHODS

CT (n=15) and MRI (n=21) scans from 36 patients with histologically proved tuberculosis of the nasopharynx were reviewed by two experienced radiologists, paying particular attention to the lesions' distribution, location, extent, size, internal architecture, pattern, and degree of enhancement, and cervical lymphadenopathy.

RESULTS

Twenty-nine patients exhibited a polypoid mass pattern and seven had diffuse mucosal thickening. The roof of the nasopharynx was involved in all cases. The mean size of the lesions was 11.4mm. Striped pattern was detected in 19 cases. Adjacent muscle invasion or bone destruction was not detected. Heterogeneous enhancement was detected in all patients, and necrosis in the nasopharyngeal lesions was detected in 16 cases. Poor, moderate, and marked enhancement was detected in one, 27, and eight cases, respectively. Thirty-four patients had involvement of the cervical lymph nodes. Twenty-two and 28 cases were associated with bilateral lymphadenopathy or necrosis, respectively. The retropharyngeal lymph node was the most commonly involved site (94.1%).

CONCLUSION

The presence of necrosis and striped pattern in nasopharyngeal lesions, site predilection, no invasion of regional structures, and central necrosis with peripheral rim enhancement of cervical lymphadenopathy may suggest the diagnosis of nasopharyngeal tuberculosis.

[Primary nasopharyngeal tuberculosis]

A 59-year-old female was complaining of sore throat, right otorrhea, and hearing impairment. There were no abnormal findings suggestive of pulmonary tuberculosis on her chest XP and CT. Nasopharyngoscopic examination detected a lesion coated with white mass on her nasopharynx, and a biopsy-specimen from this lesion revealed histopathological findings compatible with tuberculosis and the presence of acid-fast bacilli. PCR was positive for Mycobacterium tuberculosis complex. Therefore, we diagnosed the case as primary nasopharyngeal tuberculosis and treated her by 4-drug combination regimen with daily isoniazid, rifampicin, ethambutol and pyrazinamide. Later, low degree of resistance was noticed, isoniazid was replaced by levofloxacin. After the anti-tuberculosis chemotherapy, her symptoms almost completely diminished and the mass in her nasopharynx disappeared. As far as we can search, 23 Japanese cases of primary nasopharyngeal tuberculosis, including this case, have been reported in the literatures. We summarized the clinical features of these cases in Table. Nasopharyngeal tuberculosis is a rather rare disease. But, recently, due to the advances in diagnostic technology, the number of the case-reports has been increasing. Difficulties in detecting tubercle bacilli in nasopharyngeal lesion sometimes delayed definite diagnosis and treatment. If a patient complains the symptoms compatible with this disease, such as sore throat, pharyngeal pain and otorrhea, which are refractory to the general antibiotic therapy, we should be aware of the existence of this disease and repeat bacteriological and/or molecular examinations to prove tubercle bacilli to be able to start timely anti-tuberculosis chemotherapy.

Nasopharyngeal encephalocele: a rare cause of upper airway obstruction

Nasopharyngeal encephalocele is a rare, benign congenital anomaly. It has the potential to be fatal due to airway obstruction. Here, we report on a 34-day-old infant with pneumonia who underwent mechanical ventilation. An upper airway evaluation was performed due to prolonged intubation, and revealed the presence of a nasopharyngeal encephalocele. The patient tolerated extubation and oral feeding after surgical resection of the lesion. Awareness of the condition can help clinicians arrive at an earlier diagnosis and enhance management.

[Pathogeny and treatment of 50 nasopharyngeal tuberculosis cases]

OBJECTIVE

To analyze the clinical characters and treatment of nasopharyngeal tuberculosis, and to provide a scientific basis for improving clinical diagnosis of nasopharyngeal tuberculosis.

METHOD

The clinical materials of 50 patients diagnosed as nasopharyngeal tuberculosis in Guangzhou Chest Hospital were reviewed and analyzed. All the 50 patients were given regular antituberculosis treatment with 3HRZS(E)/9HR(E) for one year, and were treated through nasal spray with combination medication of isoniazid, rifampicin and streptomycin injection solution for 3 months.

RESULT

All patients were cured through regular antituberculosis treatment for one year, and no recrudescence cases were found in 2 years of follow-up.

CONCLUSION

Nasopharyngeal tuberculosis is rare and the clinical manifestation is atypical. It is extremely easy to cause clinical misdiagnosis. A full understanding of the pathogenesis, timely clinical characters under nasopharyngoscope and histopathological examination results are the keys to diagnosis, and to giving regular antituberculosis treatment to obtain satisfactory curative effect.

Infectious mononucleosis mimicking malignant T-cell lymphoma in the nasopharynx: a case report and review of the literature

Infectious mononucleosis (IM) is Epstein-Barr virus-associated and self-limited lymphoproliferative disorder. The histopathologic features of the nasopharynx in IM are rarely described. In this report, we described a patient of IM with atypical T-cell proliferation in the nasopharynx. In-situ hybridization for EBV-encoded RNA with immunostaining against CD20 was used for evaluation of EBV infection. The histopathologic features of IM could mimic malignant T-cell lymphoma. It should be differentiate reactive T-cell lymphoproliferation from malignant lymphoma in the nasopharynx.

[Application of narrow band imaging endoscopy in the diagnosis of nasopharyngeal lesions]

OBJECTIVE

To evaluate the value of narrow band imaging (NBI) endoscopy in the diagnosis of nasopharyngeal lesions.

METHODS

Between December 2009 and April 2010, a total of 124 patients with nasopharyngeal lesions were examined with electronic nasopharyngolaryngoscope equipped with the white light mode and NBI mode. The biopsies of nasopharyngeal lesions were done in all patients. The characteristics of morphologies of mucosa and mucosal superficial vessels of each lesion under NBI mode were evaluated.

RESULTS

Of all cases, there were 1 of papilloma, 87 of lymphoid follicular hyperplasia and chronic inflammation, 11 of nasopharyngeal cysts, and 25 of nasopharyngeal carcinoma. According to the pathological results, the morphologies of nasopharyngeal lesions under NBI mode were quite different. The color depth of the mucosa could be divided into four types: light red (+), dark red (++), prunosus (+++), and blue or blue black (++++). Under NBI, the color depths were (+) in papilloma, (++) in nasopharyngeal cysts, and (+++) in lymphoid follicular hyperplasia and chronic inflammation, without abnormal vessels. The color depths were (+++)-(++++) in nasopharyngeal cancer, with abnormal vessels.

CONCLUSION

NBI has a potential ability to predict pathological results of nasopharyngeal lesions.

[Amyloidosis--diagnostic difficulties. A case report of localized amyloidosis]

Amyloidosis consists of a group of clinical disorders caused by extracellular deposition of insoluble protein fibrils which present beta pleated sheets configuration. Such structure makes fibrils resistant to proteolysis. Amyloidosis can be of acquired or hereditary origin. Amyloid deposits can accumulate in locally (localized amyloidosis) or simultaneously in many organs (systemic amyloidosis). Unclear pathogenesis and varied etiology result in particular diagnostic difficulties. Current article attempts to discuss this problem. Presented clinical case of a patient with the amyloid tumor in nosopharynx and positive staining for amyloid in abdominal fat tissue biopsy serves as an example of the diagnostical proceedings in amyloidosis. Congo red staining and red-green birefringence under cross--polarized light of histological specimens still remains a standard procedure in amyloidosis diagnostics. Such methods, however, do not allow to determine the type of the precursor protein, and thus the type of amyloidosis. Thus immunohistochemical tests constitute the next diagnostic phase. Currently, expanded diagnostic capabilities of SAP scintigraphy and of DNA sequencing (establishing transthyretin and apolipoprotein mutations) are also available. Research is carried out on the usefulness of fluorescence spectroscopy in the diagnosis of secondary amyloidosis. Mass spectrometry is used in combination with two-dimensional gel electrophoresis techique for the analysis of protein profiles.

Survey of nasopharyngoscope decontamination methods in Canada

BACKGROUND

nasopharyngoscopes are essential tools in modern otolaryngology practice. Owing to their frequent and diverse use, it is important to ensure that they can be efficiently and thoroughly cleaned. To date, there are no official national guidelines provided by the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) for decontamination of nasopharyngoscopes.

OBJECTIVE

to compare flexible nasopharyngoscope decontamination practices across Canada.

METHODS

a questionnaire regarding nasopharyngoscope cleaning procedures was distributed online to all otolaryngologists registered with the CSOHNS. The survey was anonymous. Topics addressed province, practice type, maintenance, operations, ventilation, and process development.

RESULTS

thirty-five percent of the 505 Canadian otolaryngologists contacted participated in the survey. Automated sterilization of nasopharyngoscopes is employed by 16% of participants, of which the majority of this use is in hospital settings. Over 61.3% of participants use a multistep decontaminating soak for cleaning. Decontamination procedures were created within the department in 59% of cases, and over 28.3% of participants are unsure as to whether their procedures adhere to infectious disease and industry standards.

CONCLUSION

various procedures are employed throughout Canada owing to a lack of standardization. Survey responses indicate that Canadian otolaryngologists would appreciate a national standard for the cleaning of flexible nasopharyngoscopes, particularly for nonhospital practices.

Localized nasopharyngeal amyloidosis

A mass in the nasopharynx often implies a malignancy in adults, particularly in the endemic areas of Epstein-Barr virus-associated undifferentiated carcinoma. We report an 86-year-old male patient who presented to our rhinologic outpatient department with postnasal drip for several years, with no other associated nasal symptoms. Physical examination with nasal endoscopy found a prominent bulge in the nasopharynx. Pathological examination of the biopsied specimens identified features consistent with amyloidosis. Magnetic resonance imaging demonstrated an enhanced soft-tissue mass localized to the nasopharyngeal region. We excluded the possibility of a partial representation of a potential systemic amyloidosis. Regular follow-up including nasal endoscopy was undertaken. Over 3 years of observation, the disease process remained silent. Here, the clinical presentation, diagnosis and treatment options of this rare entity are discussed.

[Endoscopic approach in patients with choanal polyps]

OBJECTIVES

We evaluated the results of endoscopic treatment for choanal polyps.

PATIENTS AND METHODS

Twelve patients (5 females, 7 males; mean age 25 years; range 10 to 49 years) underwent endoscopic surgery for choanal polyps. Preoperatively, all the patients were evaluated with endoscopic nasal cavity and nasopharyngeal examination and computed tomography of the paranasal sinuses. In addition, serum total and specific IgE levels were measured and prick test was performed. There were seven antrochoanal (58%), two ethmochoanal (17%), two sphenochoanal polyps, and one patient (8%) had a chonchachoanal polyp. Anterior ethmoidectomy and intranasal polypectomy were performed for ethmochoanal and sphenochoanal polyps, respectively. Two patients in whom antral part of the mucosa could not be clearly determined underwent transcanine sinoscopy. In all the patients, the mucosa giving rise to polyps was removed. Evaluations were made at one and six months and at the end of a year.

RESULTS

The most common symptoms were nasal obstruction (70%) and nasal discharge (52%). Allergic tests were positive in two patients with antrochoanal polyps. The only complication was mild bleeding in two patients. No recurrences were encountered within a year follow-up.

CONCLUSION

Endoscopic approach for choanal polyps can be applied at all ages and it is associated with low morbidity.

[Therapeutic and diagnostic criteria of choice of treatment methods in adenoid vegetations as a focus of chronic infection in childhood]

Clinical, laboratory and device methods were used in examinations of 175 children. Basing on the results of the above examinations, therapeutic and diagnostic criteria of choice of a method of treating adenoid vegetations in children were proposed.

Nasopharyngeal tuberculosis: an unusual cause of nasal obstruction and snoring

OBJECTIVE

To report an extremely rare case of nasopharyngeal tuberculosis.

CASE REPORT

A 35-year-old male patient presented with nasal obstruction and snoring. Nasal endoscopic examination with a rigid endoscope revealed a large mass on the posterior wall and roof of the nasopharynx. A computed tomography scan of the nasopharynx revealed a polypoid mass in the posterior nasopharyngeal wall. Histopathological examination of a biopsy taken from the posterior nasopharyngeal wall revealed granulomatous lesions with caseation necrosis. Treatment was decided after histopathological examination and intradermal positive reaction to tuberculin test, and started a week later. The patient was treated with antituberculosis drugs including isoniazid, rifampicin, pyrazinamide, and ethambutol. After six months, the nasopharyngeal examination was absolutely normal, and the patient was also symptom free.

CONCLUSION

This case highlights that nasopharyngeal tuberculosis should be considered in the differential diagnosis of a nasopharyngeal mass, especially in patients from regions of the world where tuberculosis is endemic.

Extramedullary plasmacytomas of the larynx and parapharyngeal space: imaging and pathologic features

Extramedullary plasmacytoma is a rare plasma cell neoplasm that can occur in the head and neck. In this article we describe a case of multiple synchronous extramedullary plasmacytomas involving the upper airway, pharynx, and larynx. The clinical, imaging, and pathologic features of this neoplasm are discussed, together with potential treatment options.

Stenotic nasopharyngeal dysgenesis in the dachshund: seven cases (2002-2004)

Medical records of seven dachshunds with congenital nasopharyngeal stenosis from abnormally thickened palatopharyngeal muscles were reviewed. The intrapharyngeal ostium in all cases consisted of only a narrow slit. Dogs were presented with various clinical signs--the most common being dyspnea, expiratory cheek puff, salivation, pharyngeal dysphagia, oral dysphagia (to a lesser extent), and macroglossia. Diagnostic procedures included direct pharyngeal inspection, pharyngeal and thoracic radiography, fluoroscopy, lingual ultrasonography, biopsies in two dogs, and a postmortem examination in one dog. Diagnoses were readily made with radiographs and visual examinations. Macroglossia was confirmed with transcutaneous ultrasonography or a transmandibular finger test.

[Nasopharyngeal tonsillolith: a report of 31 cases]

OBJECTIVE

Nasopharyngeal tonsilloliths are less well known to radiologists than palatine tonsil lithiases. The possibility of routinely available fine slices during CT scans of the head and neck prompted a retrospective study on the causes and radiological signs and patterns of nasopharyngeal tonsilloliths.

MATERIAL AND METHODS

A total of 515 CT scans were retrospectively re-examined looking for calcifications of the posterior wall of the nasopharynx. One patient with this type of calcification underwent a cerebral MRI as part of the etiological workup of his faintness, which also provided a study of the nasopharyngeal wall. The size, density, and position of these calcium concretions were analyzed with CT in all cases.

RESULTS

In 31 patients (18 men, 13 women), we discovered one or several calcifications in the pharyngeal mucous area, between 2 and 5.5 mm in size, with a median density of 202 HU. In two cases, we observed that these calcifications adhered to an adenoid cyst, whereas in three cases, the patients had both palatine tonsil and nasopharyngeal calcifications. None of the 31 patients had previously had an adenoidectomy. Sagittal CT and MRI images clearly localized all these calcifications before the pharyngobasilar fascia.

DISCUSSION

The position of these nasopharyngeal calcifications in front of the pharyngobasilar fascia means that a calcified vestige of the notochord can be ruled out. Moreover, the simultaneous presence of nasopharyngeal tonsil and palatine tonsil calcifications in three patients is an additional argument for considering these calcifications of the posterior wall of the nasopharynx as tonsilloliths, all of which, representing 6% of the CTs in our series, were asymptomatic.

CONCLUSION

The nasopharyngeal tonsilloliths are stones less than 1 cm in size lodged in the pharyngeal tonsils that are frequently detected on CT when there are no clinical symptoms.

Tornwaldt's cyst: incidence and a case report

Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 cm3) and 28 on MRI (0.13%; mean size: 0.58 cm3). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.

Cutaneous rhinosporidiosis

Rhinosporidiosis is a chronic granulomatous disease of the mucocutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of cutaneous rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 65-year-old male patient. He presented with dysphagia for solid foods and skin growth on the left side of jaw of 2 years duration. Histopathology of cutaneous and nasopharyngeal lesions revealed numerous thick walled sporangia in a vascular connective tissue along with a granulomatous inflammation confirming the diagnosis of cutaneous and nasopharyngeal rhinosporidiosis. Endoscopic removal of nasopharyngeal polyp was done and he was started on dapsone therapy.

Diagnosis and surgical treatment of a nasopharyngeal cyst in a dog

A 21-month-old boxer dog was presented with clinical signs caused by nasopharyngeal obstruction. A mineralised mass in the nasopharynx was identified by radiography. Computed tomography allowed accurate anatomical localisation of the cystic lesion and identification of an ossified wall. Surgical removal of the mass by a ventral approach resulted in complete resolution of clinical signs. Histopathological examination strongly suggested that the cyst was derived from remnants of Rathke's pouch.

Heterotopic neuroglial tissue causing upper airway obstruction in a newborn

Heterotopic neuroglial tissue, composed of differentiated neuroectodermal tissue, represents developmental heterotopia of neuroglial tissue rather than true neoplasm. Herein, we present a patient with nasopharyngeal heterotopic neuroglial tissue who presented with respiratory distress and feeding difficulty in early days after birth. Magnetic resonance imaging showed a cystic lesion measuring about 3 x 1.5 cm in the nasopharynx near the uvula. The lesion was resected and confirmed histologically as a heterotopic neuroglial tissue.

Huge Thornwaldt's Cyst: A Case Report

Thornwaldt's bursa, also known as nasopharyngeal bursa, is a recess in the midline of the nasopharynx that is produced by persistent notochord remnants. If its opening becomes obstructed, possibly due to infection or a complication from adenoidectomy, a Thornwaldt's cyst might develop. Here, we present a 53-year-old man who complained of nasal obstruction that had progressed for 1 year. Nasopharyngoscopy showed a huge nasopharyngeal mass. Thornwaldt's cyst was suspected. Magnetic resonance imaging showed a lesion measuring 3.6 x 3.4 cm, intermediate on T1-weighted and high signal intensity on T2-weighted imaging, neither bony destruction nor connection to the brain. The patient underwent endoscopic surgery for this huge mass. Afterwards, his symptoms improved significantly. We present the treatment and differential diagnosis of a nasopharyngeal cyst.

Tolerability and pharmacokinetics of inhaled bimosiamose disodium in healthy males

AIMS

The aim of these first-in-human studies was to investigate the tolerability and the pharmacokinetics of bimosiamose disodium (TBC1269Z) administered by inhalation.

METHODS

Two randomized, double-blind, placebo-controlled Phase I trials were performed in healthy males. In a single-dose escalating study 48 subjects received doses of 2-140 mg bimosiamose disodium by inhalation and in a multiple-dose study 32 subjects received 8-70 mg bimosiamose disodium twice daily. In both studies 4 ml of the drug solution was administered via nebulizer over 15 min. Adverse events, vital signs, ECG, clinical laboratory parameters and forced expiratory volume in 1 s (FEV(1)) data were recorded and nasopharyngeal examinations were performed to address the safety and tolerability. Blood was collected for the determination of plasma concentrations of bimosiamose.

RESULTS

All subjects completed the study. No deaths or severe adverse events occurred. Eleven mild adverse events occurred in the dose-escalation study and 34 in the multiple-dose study after inhalation of bimosiamose disodium. Adverse events were more frequent at the highest dose (140 mg) of the dose-escalation study. For placebo treatment one moderate adverse event was observed in the dose-escalation study after placebo treatment, eight mild and three moderate adverse events occurred in the multiple-dose study. Bimosiamose was detected in plasma (maximum concentration 64 ng ml(-1)) only at doses > or =50 mg given twice daily and 105 mg once daily. For the highest dose a median value of 5746 h ng ml(-1) was determined for the AUC over the entire period of treatment of the multiple-dose study.

CONCLUSION

The results suggest that single and multiple inhalation of bimosiamose disodium up to 70 mg is well tolerated in healthy males. Systemic bioavailability after inhalation is low.

Imaging of nasopharyngeal cysts and bursae

Cysts and bursae of the nasopharynx are uncommon and seldom symptomatic when compared with malignant tumors of this region. However, it is noteworthy that in the presence of symptoms, a good knowledge of their radiological appearance is useful to establish the correct diagnosis. Cysts of Rathke's pouch, pharyngeal bursa of Luschka, Tornwaldt's cysts, retentional cysts of the seromucinous glands, oncocytic cysts, intra-adenoid cysts, branchial cysts, prevertebral or retropharyngeal abscess and pseudocysts of the nasopharynx will be discussed in this paper.

Nasopharyngeal hamartoma: importance of routine complete nasal examination

The authors report clinical experience in managing an 82-year-old female presenting with long-standing bilateral nasal obstruction resulting from a nasopharyngeal mass. The patient had undergone a number of treatments including surgery. The previous examinations, investigations and treatment had all been performed within the previous 10 years and although examination had been documented there was no evidence on review of the notes that the nasopharynx had been inspected either by nasendoscopy or indirectly. The mass was removed via a combined nasal and oral approach. Histopathological examination of the specimen was consistent with mesenchymal hamartoma. In addition to describing a rare presentation the authors believe this case highlights the importance of complete examination in all patients with nasal symptoms

Respiratory epithelial adenomatoid hamartoma in the nasopharynx

We present a case report of a female patient with complaints of single-sided nasal obstruction. A polypoid structure was seen in the nasopharynx. Histologic examination showed a respiratory epithelial adenomatoid hamartoma – a rare, benign lesion. Therapy consisted of complete excision. In line with previous reports, the lesion did not recur during 13 months of follow up. The clinical and pathological features of this abnormality are discussed.

Total nasopharyngeal stenosis: treatment with laser excision, nasopharyngeal obturators, and topical mitomycin-c

OBJECTIVE

Severe nasopharyngeal stenosis after uvulopalatopharyngoplasty (UPPP) is a dreaded complication. Very little has been written about successful treatment because attempts at correction frequently fail. Severe stenosis of the nasopharynx drastically worsens speech, swallowing, and obstructive sleep apnea (OSA). We present our successful experience with severe stenosis focusing on a simple functional repair using topical mitomycin-c as well as differing daytime and nighttime palatal obturators.

METHODS

Three adults with total or near-total nasopharyngeal stenosis secondary to UPPP were referred to our institution after multiple failed attempts at repair. Each presented with significant OSA on polysomnogram (PSG), with excessive daytime somnolence and voice and swallowing complaints. Under general anesthesia, a CO2 laser is used to create an opening in the nasopharynx. Removable and adjustable palatal obturators are fashioned to keep the nasopharynx open with a daytime insert piece with a small obturator hole for diminished velopharyngeal insufficiency and a nighttime piece without an insert to maximize recumbent airflow. Obturators are removed 6 months later with topical application of mitomycin-c as a fibroblast inhibitor. All patients were followed clinically for at least 1 year and received posttreatment PSG.

RESULTS

All patients experienced resolution of their stenoses. Swallowing and voice complaints resolved. Either OSA was eliminated or any residual OSA was successfully treated with nasal continuous positive airway pressure. Serial videoendoscopic images throughout the treatment phase demonstrate the effectiveness of this new technique.

CONCLUSIONS

Severe nasopharyngeal stenosis is a rare but devastating complication of UPPP. We introduce a simple technique that uses functional palatal obturators and topical mitomycin-c and describe our success with this treatment algorithm.