Ewing Sarcoma of the Ethmoid Sinus in an Adult

Extraskeletal Ewing sarcoma (EES) is a relatively rare primary tumor of the soft tissues predominantly affecting men in the second and third decades of life. They are a less common form of the cancerous growth known as an Ewing sarcoma, which occurs in bones or soft tissue such as cartilage. Head and neck ESS can require intervention including endoscopic sinus surgery, septoplasty, inferior turbinectomy, and left internal nasal valve repairs with septal cartilage This is a case report on an unusual presentation of ESS in the sinonasal region.

Surgical Approach to Frontal and Ethmoid Sinus Osteomas: The Experience of 2 Metropolitan Italian Hospitals

OBJECTIVES

The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019.

METHODS

A retrospective chart review of cases of frontal and ethmoid osteomas from the Ca' Granda Niguarda Hospital of Milan and the Policlinico Umberto I University Hospital of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification.

RESULTS

A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up.

CONCLUSION

Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon's experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.

Osteoma of the ethmoid sinus in a pediatric patient - a case report

BACKGROUND

Osteomas of the paranasal sinuses occur rarely in the pediatric population, we find only a few reference of symptomatic osteomas in the literature. Opinions on the indication for surgical treatment are controversial.

CASE

The authors present a case of symptomatic osteoma of the right ethoimoidal sinus in a 12-year-old boy, who was treated surgically, with endoscopic endonasal approach. The symptomatology, diagnosis and therapy of these tumors in the pediatric patient are discussed.

CONCLUSION

Osteomas of the paranasal sinuses are slow-growing benign lesions. Symptomatic osteomas can grow expansively and cause serious complications. The treatment of osteoma is surgical and the endoscopic approach offers the possibility of removal with cosmetic benefits.

Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea

BACKGROUND

Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes.

METHODS

Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes.

RESULTS

In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [-0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) - 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed.

CONCLUSION

Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.

[Fibrous dysplasia of the frontal and ethmoid sinuses: a case report]

Fibrous dysplasia is a genetic and rare bone disorder affecting the young subject. Its pathophysiology involves genetic mutations leading to defective skeletal development with fibrous and medullary proliferations. Cephalic extremity is involved in one third of cases. We here report a case of surgically treated fibrous dysplasia of the frontal and ethmoid sinuses. The study involved a 31-year-old man presenting with chronic holocranial headaches. Computed tomography (CT) scan showed voluminous bilateral hyperdense expansive process in the frontal and ethmoid sinuses. Surgery was performed on the basis of functional signs and imaging data. Anatomopathological examination of bone fragments confirmed the diagnosis of fibrous dysplasia. Fibrous dysplasia is rare and characterized by slow disease progression. In the absence of a consensus on therapy, surgery remains the treatment of choice for unifocal forms.

Onodi cell mucocele causing isolated trochlear nerve palsy: A case report

RATIONALE

Acquired vertical diplopia is commonly observed in trochlear nerve palsy, often resulting from blunt head trauma or vascular problems. It is rarely caused by tumorous conditions or space occupying lesion. We report the first case of Onodi cell mucocele causing isolated trochlear nerve palsy.

PATIENT CONCERNS

A 62-year-old male noticed a double vision which worsened when looking down. On ophthalmologic examinations, the patient showed no abnormalities in visual acuity, intraocular pressure, and no swelling in optic disc. In ocular motility test, he was notable for 10° left hypertropia in primary position, 6° in right head tilt position, 14° in left head tilt position and this was aggravated in right and down gaze. Ostiomeatal complex CT depicted an expansile soft tissue density completely filling the left Onodi cell.

DIAGNOSES

He was diagnosed with a trochlear nerve palsy caused by an isolated mucocele in the left Onodi cell.

INTERVENTIONS

Three days after presentation, he underwent endoscopic sinus surgery for marsupialization of the mucocele in the left Onodi cell.

OUTCOMES

The mucocele was completely removed through the endoscopic endonasal approach. Within 4 months after surgery, his 4th nerve palsy had gradually and completely improved.

LESSONS

Onodi cell mucoceles that cause trochlear nerve palsy are extremely rare. Timely surgical decompression is essential to achieve optimal recovery of the neural function. Combined trochlear nerve palsy should be evaluated when Onodi cell mucocele involves the orbital apex from above.

Synovial sarcoma of the ethmoid sinus

INTRODUCTION

Synovial sarcoma is a malignant mesenchymal tumour typically occurring in the extremities. Its occurrence in the head and neck region, particularly in the paranasal sinuses is extremely rare.

CASE REPORT

Here, we report a case of primary synovial sarcoma of the ethmoid sinus in a 36-year-old female and review the literature of synovial sarcomas arising from the ethmoid sinus. Histopathology was essential in confirming the diagnosis. The patient underwent endoscopic excision of the tumour followed by postoperative radiotherapy.

DISCUSSION

As per our knowledge, only 2 cases of ethmoid sinus synovial sarcoma have been reported in the English literature till date. Although synovial sarcomas rarely involve the paranasal sinuses, they should be included in the differential diagnosis of paranasal sinus tumours. The accepted treatment modality is wide local excision followed by post operative radiotherapy.

Testicular Plasmacytoma in a Patient with the Acquired Immunodeficiency Syndrome

Clinical, laboratory, and pathologic findings from a case of primary extramedullary plasmacytoma of the testis and sinuses in a patient with acquired immunodeficiency syndrome (AIDS) are presented. To our knowledge this is the first case in the English literature of a primary testicular plasmacytoma in an HIV-infected patient. The findings in this report and those of others confirm the difference in the pattern of plasma cell tumor (PCT) presentation in patients infected with AIDS from those in non-infected individuals, suggesting that these tumors should be considered in the differential diagnosis of AIDS-associated malignancies.

A rare case of large sphenoethmoidal osteoma

Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach.

Endoscopic Resection of Giant Ethmoid Osteomas with the Assistance of an Image-guidance System

AIM

To investigate the minimally invasive ablation of giant osteoma of the ethmoid sinuses endonasally with the assistance of an image-guidance system.

PATIENTS AND METHODS

A retrospective analysis was carried out on 12 patients with osteomas of ethmoid sinuses treated by endoscopic surgery with the help of a navigation system from April 2005 to October 2013.

RESULTS

Osteomas in all 12 patients were giant and connected extensively with the anterior skull base, lamina papyracea, or orbital apex, and were removed successfully with the help of an endoscope and image navigation system under general anaesthesia. In two cases (one through superciliary arch incision and the other one through labiogingival incision), the procedure was combined with an external procedure to remove osteomas. All patients were followed-up for 8 to 64 months. No recurrences were found. All symptoms gradually vanished or reduced dramatically after surgery. One case of frontal mucocele was observed and was successfully removed 5 years after removal of the osteoma. Anosmia occurred in both patients who underwent crista galli resection, and no recovery was noted 9 and 26 months later. Cerebrospinal fluid rhinorrhea was found in one case during surgery and was repaired with mucosa of inferior nasal concha immediately, and primary healing was successful.

CONCLUSION

Endoscopic ablation of giant osteomas of the ethmoid sinuses with the guidance of a navigation system is an accurate, secure, minimally invasive procedure. A careful study of the preoperative computed tomographic scan is necessary for the success of the operation. If the lesion extensively affects the frontal sinus and maxillary sinus, a combination of superciliary arch incision and labiogingval groove incision is a simple, easy and elegant option.

Primary osteogenic osteosarcoma of the ethmoid sinus in an adolescent: case report

Osteosarcomas of the craniofacial bones account for fewer than 10% of all osteosarcomas. Primary osteosarcomas of the nasal cavity and paranasal sinus are rare (0.5-8.1% of the osteosarcomas occur in this location). Because of the rarity of this presentation, we report a case of osteogenic osteosarcoma arising de novo from the ethmoid bone in a 13 year old male who presented with discharge from the right eye and headaches. We describe the imaging features of this rare tumor and provide a brief review of the literature.

[Expression and clinical significance of Eotaxin-3 in chronic rhinosinusitis with and without nasal polyps]

OBJECTIVE

To investigate the expression and clinical significance of Eotaxin-3 in chronic rhinosinusitis with and without nasal polyps.

METHOD

The ethmoid inflammation mucosa of 15 cases diagnosed as chronic rhinosinusitis (sinusitis group), the nasal polyps in the middle meatus of 25 cases diagnosed as nasal polyps (nasal polyp group) and the ethmoid or uncinate process mucosa of 7 cases diagnosed as sinonasal non-inflamnatory diseases (control group), were collected as the research object. Eotaxin-3 expression was detected in the tissues by immunohistochemical SABC assay and the correlation between Eotaxin-3 and blood eosinophil counts was analyzed.

RESULT

Eotaxin-3 were detected both in sinusitis group and nasal polyp group, and the expression level in sinusitis group and nasal polyp group were higher than that in control group. The difference was statistically significant (P < 0.05). The Eotaxin-3 expression in nasal polyps group was higher than that in sinusitis group, and the difference was statistically significant (P < 0.05). The expression of Eotaxin-3 in nasal polyps group and sinusitis group were both significantly positively correlated with the eosinophil counts in the blood (P < 0.05).

CONCLUSION

Eotaxin-3 may be involved,in the pathogenesis of chronic rhinosinusitis with and without nasal polyps, and further research will help us to understand the pathophysiology of chronic rhinosinusitis with and without nasal polyps.

[One case report of nasal sinus ossification]

A 8-years-old male patient with a bulge of left eye ball for one mongth was hospitalized. The inspection of the patient showed the movement on the left side of the lateral nasal wall and a narrow nasal cavity. Orbital CT showed that the left orbital ethmoid sinus, maxillary sinus cyst, left orbital, sphenoid sinus, nasal cavity were damaged. A resection with the combination of approaches including the left maxillary sinus, the ethmoid sinus, and the sphenoid sinus osteofibroma was performed. 5 days after the operation, the nasal packing material was removed and 7 days after the operation the stiches were removed. The recovery of the patient was satisfied after the operation and no recurrence was observed during one and half years follow up.

[3.0 T MRI observe the ears and sinus damage degree of patients with acute carbon monoxide poisoning]

OBJECTIVE

Through 3.0 T MRI study the ear and sinus lesions of patients with acute carbon monoxide poisoning.

METHOD

From 2012 to 2015 collected the MRI images of the 45 patients with acute carbon monoxide poisoning, observe their changes of middle ear and mastoid and sinus imaging.

RESULT

The middle ear injury of mastoid 41 cases (91.1%), 22 cases (48.9%) of maxillary sinus injury, ethmoid sinus injury in 20 cases (44.4%), sphenoid sinus 9 cases (20.0%), 5 cases (11.1%) of frontal sinus injury. Carbon monoxide poisoning patients according to clinical symptoms can be divided into light, medium and heavy 3 groups, observing the ear sinus damage degree for comparison between groups, found to have significant differences (P < 0.05).

CONCLUSION

The patients with acute carbon monoxide poisoning ear and sinus injury should cause the attention of the medical staff, MRI can reflect people's ears from the details and the damage degree of the sinuses.

Nasal obstruction and recurrent sinusitis caused by bilateral pneumatized ethmoid bullae

The presentation of an enlarged pneumatized bulla ethmoidalis (BE) that obstructs the ethmoid infundibulum has not been previously reported. We report such a case in a 23-year-old woman who presented with recurrent acute rhinosinusitis and chronic rhinosinusitis. The obstruction had been caused by inferior and anterior pneumatization of the BE. Surgery was successful in alleviating all symptoms, and the patient remained symptom-free at 10 months of follow-up. We describe the radiologic and endoscopic findings in this case, and we discuss the possible mechanisms by which BE is involved in the pathogenesis of recurrent acute and chronic rhinosinusitis.

[Clinical analysis of fungal rhino-sinusitis in 189 cases]

OBJECTIVE

To investigate the clinical features of fungal rhino-sinusitis.

METHOD

Clinical data of 189 patients suffering from fungal rhino-sinusitis treated by functional endoscopic sinus surgery was analyzed retrospectively. The analyzed data included clinical type, age of onset, predilectionsite, reason, and surgical outcome.

RESULT

Among the 189 patients with fungal rhino-sinusitis,181 cases were fungal ball,6 cases were allergic fungal rhino-sinusitis, 1 case was acute invasive fungnal rhino-sinusitis, 1 case was chronic invasive fungnal rhino-sinusitis. One hundred and twenty-eight cases were in the maxillary sinus (123 cases were unilateral, 5 cases were bilateral). Nineteen cases were in the ethmoid sinus. 31 cases were in the sphenoid sinus. Two cases were both in the maxillary sinus and ethmoid sinus, 1 case was both in the maxillary sinus and sphenoid sinus. Two cases invasive fungnal rhino-sinusitis had diabetes history. All the patients treated by functional endoscopic sinus surgery, 184 cases without recurrence, 5 cases suffered re-operation.

CONCLUSION

The incidence of fungal rhinosinusitis is showing a rising trend, fungal ball is the highest. The sinusitis patients whom we highly doubt for fungal infection should be confirmed by using sinonasal secretion smear, cultivation and histopathological examination. Surgical treatment should completely remove the fungal masses, to avoid reoperation.

[Hemangiopericytoma in nasal cavity: a case report]

We report a case of a 46 year old female patient with nasal hemangiopericytoma. She complained of left nasal congestion, pus snot for 10 years, sometimes with left nasal bleeding. Physical examination: in the left nasal tract saw red soft neoplasm, roughness surface, easy bleeding when touched. Sinus CT shows: bilateral maxillary sinus, ethmoid sinus, sphenoid sinus and the left posterior nasal cavity lesions, considering inflammation with the formation of polyps, tumor not excluded. The left nasal cavity neoplasm biopsy shows: hemangioma of left nasal cavity. After admission in general anesthesia, we do transnasal endoscopic sinus openning operation and the left nasal cavity neoplasm resection. Postoperative pathological examination shows: the left nasal cavity hemangiopericytoma. Immunohistochemical showed: Vimentin(+), Smooth muscle actin(+), Desmin(-), endothelial cells CD31(-) and CD34(-). No postoperative radiotherapy or chemotherapy, no tumor recurrence. After one year of follow-up, the contact was lost.

Management for squamous cell carcinoma of the nasal cavity and ethmoid sinus: A single institution experience

OBJECTIVE

Here we report our experience of patients with squamous cell carcinoma (SCC) of the nasal cavity and ethmoid sinus (NC&ES) together with an analysis of treatment outcomes.

METHODS

A retrospective analysis was performed using data from 25 consecutive patients treated between 2000 and 2012. Four patients were diagnosed with T1, 3 with T2, 4 with T3, 7 with T4a, and 7 with T4b disease. No patient had lymph node metastasis.

RESULTS

Twelve patients were treated with surgery with/without radiotherapy and with/without chemotherapy. Of these, 4 underwent endoscopic surgery without an open approach and 3 required an anterior skull base approach. Thirteen were treated with radiotherapy; 1 with radiotherapy alone, and 4 and 8 with intravenous and intra-arterial chemotherapy, respectively. The 5-yr overall survival for T1-3, T4a, and T4b disease was 53.9%, 71.4%, and 29.0%, respectively. The 5-yr disease-specific survival for T1-3, T4a, and T4b disease was 74.1%, 71.4%, and 29.0%, respectively.

CONCLUSION

Our treatment policy for patients with SCC of NC&ES, which basically follows the NCCN guideline, was considered to be appropriate. However, several points in terms of surgery and non-surgical approach remain to be solved through further research.

Endoscopic management of pediatric sinonasal schwannoma: case report

OBJECTIVES

To describe an extremely rare pediatric sinonasal schwannoma, and to reviewmanagement strategies and relevant literature.

METHODS

Case report of pediatric sinonasal schwannoma, that was imaged with computed tomography and magnetic resonance imaging and managed endoscopically. Immunohistochemical analysis was performed to determine pathology.

RESULTS

A 12-year-old girl presented with a 2-month history of progressive left exophthalmos. Imaging studies showed a large heterogeneous tumour arising from the ethmoid sinus and extending to the base of the skull and to the orbital cavity. The lesion was removed with an endonasal radical excision. The final pathological diagnosis was schwannoma. There was no tumour recurrence or any major complication during the 2-year follow up.

CONCLUSION

Schwannoma should be considered in the differential diagnosis for pediatric patients with intranasal masses. Depending on the location and extent of the tumour, endonasal endoscopic excision could be a suitable management strategy.

[Mucocele of the ethmoid sinus revealed by an epiphora]

PURPOSE

To report a case of anterior ethmoid mucocele with atypical location and ophthalmic symptomatology.

CASE REPORT

A 18-year-old patient presented with epiphora and swelling of the left medial canthus; craniofacial scan revealed an ethmoid mucocele. We describe a surgical technique for the treatment of mucoceles, illustrated with CT and endoscopy images.

CONCLUSION

Mucoceles present with various clinical and radiological manifestations, and in particular may have an ophthalmologic impact. Treatment is surgical, with various techniques available. Epiphora may be an unusual presentation of an ethmoid mucocele, due to lacrimal duct compression.

Central giant cell reparative granuloma of the ethmoids with bilateral proptosis and intracranial extension

Central giant cell reparative granuloma is an infrequent, benign, proliferating lesion affecting the maxilla, mandible and, rarely, cranial bones. A 16-year-old girl presented with a 6-month history of recurrent nasal bleeding, a mass in the nose, difficulty in nasal breathing, a change in voice, and bilateral proptosis. Radiologically, an extensive ethmoidal mass was seen. Histologic examination revealed a central giant cell reparative granuloma. After endoscopic removal, the patient was symptom-free at the 12-month follow-up. The clinical picture of central giant cell reparative granuloma of the ethmoids is discussed, along with the differential diagnosis, histologic evaluation, appearance on computed tomography, and endoscopic management of this lesion.

Osteoblastoma of the ethmoid sinus

Osteoblastoma is a rare benign bone tumor that occurs unusually in the nasal sinuses. We report one case of sinonasal osteoblastoma in a 12-year-old girl who presented with nasal obstruction and telecanthus on the right side. Computed tomography revealed a lesion of the right ethmoid sinus with heterogenous bony density, which was displacing the orbital contents and the skull base. Biopsy caused significant bleeding. Magnetic resonance imaging showed intense homogeneous enhancement with typical flow-void areas due to large pathological vessels. This MRI feature must alert the clinician on the diagnosis before biopsy and surgical resection after embolization is performed. This case report describes the diagnostic and therapeutic difficulties of this rare tumor.

[Optical coherence tomography in monitoring of choroidal folds after surgical excision of ethmoidal myxoma]

PURPOSE

We describe a case of choroidal folds coexisting with ethmoidal myxoma and the evolution of folds after tumor excision. Choroidal folds can occure in the case of intraorbital pathology. Optical coherence tomography is usefull in diagnosis and monitoring of these folds.

MATERIAL AND METHODS

45 years old woman was reffered to our clinic because of visal disturbances in her right eye. Visual acuity of right eye was 0.5, of the left eye 1.0. Intraocular pressure of both eyes was within normal limits. Biomicroscopic evaluation of the right eye revealed no changes in anterior segment but choroidal folds in posterior segment were evident. The left eye was normal. Computer tomography of the orbit documented the presence of tumor within the right ethmoid. The tumor was excised surgically and its myxoidal nature was confirmed.

RESULTS

3 months after that intervention retinal profile in posterior pole in optical coherence tomography was normal and visual acuity of right eye improved by 1 line in Snellen chart.

CONCLUSIONS

Choroidal folds caused by ethmoidal myxoma can disapper after surgical excison of tumor. Optical coherence tomography is very useful in documentation of these changes.

Endoscopic repair of cerebrospinal fluid rhinorrhoea in a developing country

The objectives of the study was to determine the causes and outcome of endoscopic repair of cerebrospinal fluid (CSF) leak in a developing country. A total of five patients were recruited in the study. The age of patients ranged from 8 to 65 years. Four patients were male and one was female. In two cases of iatrogenic injury, the first was in the sphenoid sinus. The second was following functional endoscopic sinus surgery (FESS). Fascia lata was used to repair all cases. Beriplast was used as sealing agent in four cases and clotted blood was used in remaining case. Despite the small number, CSF rhinor rhoea was resolved in all cases. The patients were followed up for 2.5 to 6.5 years. Endoscopic repair is a viable option even in developing countries. It is cost effective and has a very low morbidity rate with no mortality at all.

Sinus mucocele: natural history and long-term recurrence rate

OBJECTIVE

To define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele.

PATIENTS AND METHOD

Retrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded.

RESULTS

The mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years.

CONCLUSION

This study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.

[Ethmoidal metastasis revealing lung adenocarcinoma]

OBJECTIVES

Ethmoidal cancers are rare and are mostly primitive adenocarcinomas. Sinuso-nasal metastases from adenocarcinoma occurring in other localisations are exceptional. We report a case of a patient presenting with an ethmoidal metastasis revealing a pulmonary adenocarcinoma.

CASE REPORT

A 57 years-old patient consulted for a right fronto-orbital pain which had appeared 3 weeks prior, associated with a central scotoma of the right eye and a third and fifth cranial nerve palsy. MR-imaging revealed a right ethmoidal tumour invading the orbit. Pathology results were in favour of a metastasis from a secondary adenocarcinoma. The CT-scan disclosed a pulmonary tumour of the right apex with liver and spleen metastasis.

CONCLUSION

Ethmoidal metastases are rare and often diagnosed in patients presenting with a previously known tumour. We report the first case of a pulmonary adenocarcinoma revealed by an ethmoidal metastasis. We emphasize the point that in ethmoidal tumours, pathological investigations are important for diagnosis.

Primary diffuse large B-cell lymphoma of the ethmoid sinus

Malignant lymphoma of the ethmoid sinus is very rare. A case of diffuse large B-cell lymphoma (DLBCL) of the left ethmoid sinus is presented here. A 79-year-old Japanese man was consulted to our hospital because of head ache and disturbance of left eye movement. Nasal endoscopy revealed a tumor, and imaging modalities including CT and MRI detected a tumor in the left ethmoid sinus. The tumor was invasive into left eye and left nose. A biopsy was performed via the nasal cavity. The biopsy revealed a diffuse proliferation of atypical lymphocytes. The atypical lymphocytes were large and had enlarged hyperchromatic nuclei. Mitotic figures were scattered. Hodgkin's cells were absent. Follicular structures were not seen. Immunohistochemically, the tumor cells were negative for cytokeratins (AE1/2, polyclonal, KL-1, and CAM5.2, Dako) and epithelial membrane antigen, CD3, CD15, CD30, CD45RO, and TdT. In contrast, the tumor cells were positive for CD20, CD45, CD79α, and p53. KI-67 labeling was 100%. Light chain restriction was present; there were numerous λ-chain-positive cells, while κ-chain-positive cells were scant. The pathological diagnosis was DLBCL of the left ethmoid sinus. Imaging of the whole body revealed no tumors and lymphadenopathy other than the ethmoid DLBCL. The patient was treated with chemoradiation, and is now alive 3 months after the presentation. In conclusion, a very rare case of DLBCL of the ethmoid sinus was reported.

Topographic gene expression in the sinonasal cavity of patients with chronic sinusitis with polyps

OBJECTIVE

To determine whether variations in gene expression exist at multiple subsites along the sinonasal tract in patients with chronic sinusitis with polyps and in healthy controls.

STUDY DESIGN

Prospective, controlled study.

SETTING

Academic medical center.

SUBJECTS AND METHODS

Tissue expression levels of 5 genes, previously found to be characteristic of ethmoid polyps, were measured using real-time quantitative polymerase chain reaction in 100 sinonasal tissue samples. Specimens harvested from 5 regions--the ethmoid sinus, septum, inferior turbinate, middle turbinate, and lateral nasal wall--in 10 patients with chronic sinusitis and ethmoid polyps were compared to tissue from similar regions in 10 control patients without sinusitis. Western blot analysis was performed to validate differential gene expression at the protein level.

RESULTS

Gene expression levels of ethmoid polyps differed significantly from those of healthy ethmoid mucosa, as well as tissue from 4 surrounding anatomical sites in both patients with chronic sinusitis and controls. Alterations specific to the polyp tissue included downregulated genes, prolactin-induced protein (fold change 377.2 ± 169.0, P < .0001), and zinc α2-glycoprotein (fold change 72.1 ± 26.5, P < .0001), as well as upregulated genes, met proto-oncogene (fold change 2.5 ± 0.7, P = .029), and periostin (fold change 7.5 ± 3.4, P = .003). No significant differences in gene expression was found for neurabin 2 (fold change 1.0, P = .99).

CONCLUSION

The transcriptional pattern of ethmoid polyps appears to be unique compared with other subsites in the sinonasal cavity of patients with chronic sinusitis. Care must be taken when collecting specimens for molecular studies of the sinonasal tract to differentiate polyp from nonpolyp tissue in chronic sinusitis.

[The observation of the inflamed cells in the mucosa at the medial site compare with that at the lateral site of the normal uncinate process]

OBJECTIVE

To determine the inflammatory cells in the mucosa at the medial aspect of the normal uncinate process compared with that on the protected lateral aspect of the normal uncinate process.

METHOD

The mucosa of 20 uncinate process from the nasal cavity of 17 patients with no evidence of sinus disease undergoing functional endoscopic sinus surgery were recruited for the study. The material was stained with HE, Chromotrope 2R, Alcian blue-periodic acid-schiff, Toluidine blue. Specimens were observed using an Olympus microscope.

RESULT

The number of mast cells and goblet cells were found to be higher on the lateral aspect of the normal uncinate process than on the medial aspect. The number of plasma cells was obviously different from that of lymphocytes. We did not found any eosinophils on either sides of uncinate process.

CONCLUSION

There are differences in the number of mast cells and goblet cells between the mucosa at the medial aspect of the normal uncinate process and the mucosa at the protected lateral aspect of the normal uncinate process.

Cemento-ossifying fibroma involving paranasal sinuses and skull base

INTRODUCTION

Ossifying fibroma is a rare benign fibro-osseous lesion that usually affects mandible and maxillary bone. Their localisation to paranasal sinus and skull base is uncommon.

MATERIAL AND METHOD

We report a huge recurrence of ossifying fibroma of the ethmoid paranasal sinus involving the skull base.

CASE REPORT

Ten years after the removal of ossifying of the ethmoid 34 year old man presented headache with diplopia. Computed tomography (CT) and magnetic resonance imagery (MRI) showed a recurrent tumour witch extended to the nasal cavity, the sphenoid and the posterior ethmoid sinuses, and the skull base. The tumour was totally removed using an anterior subcranial approach with removal of the orbital rim. Histopathology confirmed an ossifying fibroma. Two years later a subdural empyema with frontal suppuration necessited to remove the frontal bone flap, which was re-constructed 12 months later using a synthetic material.

CONCLUSION

Ossifying fibroma is a rare, benign tumour witch may recur if incomplete resection is performed. A long follow up with CT scan and MRI is required.

[Exophthalmos arising from paranasal sinuses]

INTRODUCTION

Proptosis due to intraorbital process is frequent and secondary to various aetiologies. Its findings in ENT practice is the sign of a serious complication. The purpose of this study is to review a series of patients who presented an exophtalmy.

MATERIAL AND METHODS

We conducted a retrospective analysis of 15 patients with exophthalmos complicating a rhinosinusal benign disease, diagnosed and treated in our department between January 2003 and December 2010. As their management is different, we excluded all cases of orbital cellulitis.

RESULTS

Average age of presentation was 38 years, without sex predominance. Exophthalmos was unilateral, non axial and irreductible in all cases. The average duration of symptoms installation was 18 months. The most common aetiology was fronto-ethmoidal osteomas (9 cases), followed by fronto-ethmoidal mucoceles (5 cases) and spheno-orbito-frontal fibrous dysplasia (1 case). The functional prognosis of the affected eye depended on the aetiology and the degree of ocular injury.

CONCLUSION

In our experience, sinusal causes of exophthalmos comprise osteomas and ethmoidal mucoceles. Medical history, clinical and radiological data as provide the diagnostic. In case of benign tumours, surgery is the curative treatment.

[Apathy or depression? Do you have a nose for it? Four case reports of paramedian frontal tumors]

We report four cases of patients with clinically isolated apathy which was mistaken for depression even though they were suffering from voluminous brain tumors. These cases remind us that rigorous clinical analysis is essential: searching for signs of organic origin or psychiatric etiology is fundamental to avoid an incorrect diagnosis. In particular, these four patients displayed anosmia, an uncommon symptom for patients suffering from depression. In addition, brain imaging is important to correctly identify the most prudent medical and/or surgical management strategy. In this short discussion, we propose an algorithm for the clinical diagnosis of apathy.

Primary tuberculosis of nose with intracranial extension: a rare presentation

Tuberculosis continues to be a major public health problem. This disease has varying presenting features. We here present a case of primary tuberculosis of the nose with intracranial extension, a very rare presenting feature of tuberculosis.

Spontaneous cerebrospinal fluid rhinorrhea: a clinical and anatomical study

OBJECTIVES/HYPOTHESIS

Spontaneous nasal cerebrospinal fluid (CSF) fistula represents a rare clinical entity. The possible etiology and the localization of the rhinorrhea remain an ongoing clinical challenge. The purpose of this study was to evaluate the localization of spontaneous CSF fistula and to correlate it with anatomical studies.

STUDY DESIGN

Retrospective clinical study, prospective anatomical study.

METHODS

Twenty-nine patients with spontaneous CSF rhinorrhea were retrospectively studied, 10 males and 19 females. Ages ranged from 10 to 92 years (mean, 50 years). In addition, 48 human skulls from newborns to adults were examined for the postnatal development of the anterior and middle cranial fossa.

RESULTS

In our study isolated cribriform plate defects were found in four patients. The lateral lamina of the ethmoid bone showed defects in three patients. In nine patients the bony defect could be found in the region of the fovea ethmoidalis. The bony defect between the extra- and intracranial space was found in the lateral recess of the sphenoid sinus in eight patients. Five patients had special sites (e.g., supraorbital recess and frontal recess).

CONCLUSIONS

This study supports the theory that bony dehiscence in the lateral lamina of the ethmoid bone can be congenital and can also be spontaneously acquired later. The bony dehiscence in the lateral wall of the sphenoid sinus can only develop during pneumatization.

Migration of regulatory T cells toward airway epithelial cells is impaired in chronic rhinosinusitis with nasal polyposis

The pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP) is still unclear. To evaluate the role of regulatory T cells (Treg) in the pathogenesis of nasal polyposis, we tested migration potential of Treg purified from subjects with CRSwNP, CRS without NP and controls. The nasal tissue expressions of FOXP3 were analyzed by means of RT-PCR and double immunohistochemistry. Chemotaxis assays were used to evaluate the migration potential of Treg onto bronchial epithelial cells and primary nasal epithelial cells, and toward chemokines. FOXP3(+)CD3(+) cells frequency and FOXP3 transcript expression in nasal tissue, and migration potentials of Treg toward airway epithelial cells and CCL1 were significantly lower in CRSwNP compared with other groups (P<0.05). These results indicate that migration potential of Treg is decreased in CRSwNP subjects, and this may be one of the reasons why tissue infiltration of Treg was decreased as seen in the immunohistochemistry of nasal polyps from CRSwNP subjects.

Ethmoid histopathology does not predict olfactory outcomes after endoscopic sinus surgery

BACKGROUND

Histological inflammation correlates with the degree of baseline olfactory dysfunction in patients with chronic rhinosinusitis (CRS); however, factors associated with improvement in olfactory status after endoscopic sinus surgery (ESS) remain elusive. Our purpose was to compare histopathological findings in CRS patients with olfactory loss and evaluate whether inflammatory markers can predict long-term olfactory improvement after ESS.

METHODS

Adult (> or = 18 years) patients with CRS were prospectively enrolled after electing ESS due to failed medical management. Mucosal tissue specimens were collected at the time of surgery and underwent pathological review in a blinded fashion. Subjects completed the 40-item Smell Identification Test (SIT) preoperatively and at least 6 months postoperatively. Multivariate logistic regression was used to identify histological factors associated with postoperative improvement in SIT score.

RESULTS

The final cohort was comprised of 101 patients with a mean follow-up of 16.7 +/- 6.0 months. Mean mucosal eosinophil count was higher in patients with hyposmia and anosmia (p < 0.001). Patients with preoperative anosmia were more likely to have greater severity of basement membrane (BM) thickening compared with subjects with hyposmia or normosmia (p = 0.021). In patients with olfactory dysfunction, 54.7% reported olfactory improvement of at least 4 points on postoperative SIT scores. After controlling for nasal polyposis, histological variables were not associated with postoperative improvement in olfaction.

CONCLUSION

Patients with severe olfactory dysfunction were more likely to have mucosal eosinophilia and BM thickening on ethmoid histopathological examination compared with normosmic patients. The presence of specific histological inflammatory findings did not, however, predict olfactory improvement after surgery.