Severe sinonasal epithelial dysplasia to malignancy

Right sinonasal non-keratinizing squamous cell carcinoma and hard palate, middle infraorbital area, middle cranial fossa space involvement were present in an 18-year-old male patient. The patient was admitted presenting: recurrent sinusitis, right sinonasal tumor and bilateral cervical lymph node involvement. The patient presented laterocervical bilateral metastatatic masses. Biopsy was performed and sent to the Pathology Service. Usual histological techniques were performed on the specimen. The polypoid lesion showing a connective tissue core with seromucous acini and moderate quantity of inflammatory cells (neutrophils, eosinophils, lymphocytes, histiocytes) was visible on hematoxylin eosin slides. The epithelium was pseudostratified, being composed of ciliated columnar cells and presenting areas of squamous metaplasia. A malignant tumor formed by epithelioid cells was visualised in these zones, with eosinophilic cytoplasm and vesicular nucleus containing prominent nucleolus. The cells were disposed in sheets, surrounded by fibrous connective stroma. Severe dysplasia was visible at the transition site between normal epithelium and malignant tumor, as precursor lesion. The complementary immunohistochemical tests were consistent with a non-keratinizing squamous carcinoma arising in a fibro-glandular polyp with concomitant severe epithelial dysplasia, as a starting lesion.After extensive radiochemotherapy the patient was sign and symptom free, at 12 months no recurrence was noted.Der Erstautor gibt keinen Interessenkonflikt an

Synchronic rhynopharyngeal and gingival carcinoma

We present a case of a 38-year-old male who presented recurrent otitis media, maxillary gingival ulceration and no lateral cervical lymph nodes. Admission signs and symptoms: right: mild conductive hearing loss, trigeminal V2 nerve anaesthesia, ear tinnitus, hypoglossal nerve paralysis, minor maxillary gingival ulceration, Claude Bernard Horner's syndrome. A non-homogenous mass of 4.5/5.3/5.6 cm from the level of the right rhinopharyngeal wall, extending in the right parapharyngeal space, invading the right middle cranial fossa was visible on cranial contrast enhanced CT scan. Contrast enhanced cranial MRI revealed a rhino- and parapharyngeal mass of 4.5/5.3/5.6 cm with intracerebral extension in the right cavernous sinus, right internal carotid artery engulfed by the tumor mass with partial compression. Lymph node masses of 0.7/1.2cm were also revealed.Rhinopharyngeal and gingival biopsy, right tympanotomy were performed.Routine histological technique was performed and subsequent immunohistochemical reactions for pan-cytokeratin AE1/AE3 and leucocytes common antigen were used, showing that malignant tumor cells had a syncytial pattern of growth in a background of small lymphocytes for the rhynopharyngeal biopsy. Cellular dysmorphias, well-differentiated stratified squamous epithelial cells with deep bulbous ridges and also parakeratin invaginations were visible on the gingival biopsy. The positivity of tumor cells for pan-cytokeratin established the final diagnosis of non-keratinizing undifferentiated carcinoma of the rhynopharinx and Keratins (10-16), MNP 2, 9; VEGF, KI67, P53 confirmed the verrucous cell carcinoma of the maxillary mucosa.The age of onset, the signs and symptoms and minimum lymph node involvement represent the particularities of this case.Der Erstautor gibt keinen Interessenkonflikt an

Laryngotracheobronchial foreign bodies - A 5 year retrospective study

Introduction: Laryngotracheobronchial foreign bodies are not uncommon in clinical practice and are often misdiagnosed and mistreated, leading to severe complications. Our studys objective was to raise awareness to the high incidence and importance of correct diagnosis and treatment.Methods: A five year retrospective study (2010-2015) was performed on all admitted foreign bodies regarding diagnosis and treatment procedures. A total of 52 patient were included in the study. All presented a foreign body in the laryngotracheobronchial tree, of different nature, and different localization. Correct diagnosis was obtained by clinical examination, Rx, and reconstructive bronchoscopy as well as rigid bronchoscopy. Results: Out of the 52 cases, 24 were between 1 and 3 years of age, 19 between 4 and 7 years of age, the rest were older than 7 years with one case of 44 years. The foreing bodies were organic - 41 cases and anorganic 11 cases. They were localized mainly in the right bronchia. Extraction was performed in all cases with a rigid bronchoscope with a 100% success rate. No postoperative complications were noted.Conclusions: Laryngotracheobronchial foreign bodies need special attention due to frequent misdiagnosis which may lead to severe complications. If diagnosed correctly and early rigid bronchoscopy is the election treatment.Der Erstautor gibt keinen Interessenkonflikt an

Bronchioalveolar carcinoma vs. head and neck squamous cell carcinoma - about 1 case with bilateral cervical metastases

Bronchioalveolar carcinoma vs. head and neck squamous cell carcinoma has been taken into consideration in one case with bilateral cervical metastases. Cancer of an unknown primary site is a clinical syndrome, accounting for 2%-5% of patients with cancer. The patient presented laterocervical bilateral metastatatic masses with unknown clinical, radiological or computer tomographical detected primary site of origin. The evolution was unfavorable, due to fast-growing bilateral tumor masses with involvement of other neck structures. The complementary immunohistochemical tests following surgery revealed an unexpected origin from the lung. Any other clinical signs or any detectable lung tumor mass by radiological or computer tomographic tests were absent.Unterstützt durch: Travelling GrantDer Erstautor gibt keinen Interessenkonflikt an

Upper aerodigestive tract carcinomas from diagnosis to treatment

Introduction: To assess the incidence and therapeutic alternatives for upper aerodigestive tract carcinomas in ENT Department Timisoara.Methods: Our study included 219 patients (11.08%) out of 1976 patients admitted in ENT Department from 01.01.2012 to 01.03.2013. The mean age was 59 years (43-79). The patients were assessed regarding onset signs and symptoms, histopathological exam, were staged and the therapeutic options were followed.Results: Out of 219 patients 121 (55.25%) presented the tumour localized in the larynx, 21 patients (9.58%) - hypopharyngeal carcinoma, 16 patients (7.3%) - metastatic carcinoma of unknown primary, 14 patients (6.39%) - oropharyngeal carcinoma (palatine tonsils and soft palate) and 7 patients (3.19%) (base of tongue carcinoma), 13 patients (5.93%) - rhinopharyngeal carcinoma, 10 patients (4.56%) - pharyngolaryngeal carcinoma, 8 patients (3.65%) - naso-sinusal carcinomas, 6 patients (2.73%) - auricular carcinoma, 1 patient (0.45%) with upper labial carcinoma, oesophageal carcinoma and thyroid cancer.The therapeutic options included: surgical treatment performed in 57 patients (26.02%), radio-chemotherapy in 83 patients (37.89%), surgical treatment followed by radio-chemotherapy in 66 patients (30.13%), palliative therapy in 4 patients (1.82%), while 9 patients (4.1%) refused any treatment modality.Conclusion: The incidence of upper aerodigestive tract carcinomas is as high as 11.08% of ENT Department admitted patients. The therapeutic options are variable (surgical treatment, radio-chemotherapy, surgery followed by radio-chemotherapy, palliative therapy).Unterstützt durch: Travelling GrantDer Erstautor gibt keinen Interessenkonflikt an

External ethmoidectomy for orbital complications of rhinosinusitis

Introduction: Acute rhinosinusitis is a very common disorder that at one time or another affects most people. In case of acute rhinosinusitis orbital complications an external ethmoidectomy represents an alternative approach.Case Report: A 22-year-old female patient addressed to the ENT Department presenting left acute pansinusitis, left subperiosteal abscess and left upper eyelid.ENT clinic and endoscopic 0º exam revealed middle meatus purulent material rhynopharynx with purulent secretions. A maxillary sinus lavage (+++) and silicon tube insertion was performed. The patient was addressed for a contrast enhancement CT exam. In the following day we performed left external ethmoidectomy, left subperiosteal and upper eyelid abscesses drainage. One week later the signs and symptoms were resolved. The evolution was favorable. The patient underwent a CT scan at 1 month after surgery, which revealed a normal aeration of the paranasal sinuses.Conclusion: Orbital and nasal signs and symptoms at one month after the surgical procedure were resolved, the patient presented a slight left proptosis.Der Erstautor gibt keinen Interessenkonflikt an

Tracheobronchial foreign body in children - 10 years experience

Introduction: Presentation of ENT Department - Timisoara 10 years experience of in the diagnosis and treatment of tracheobronchial foreign body in children. We studied 93 children, aged between 10 months and 8 years.Methods: The diagnosis of airways penetrating syndrome was established on history, clinical examination, cardiopulmonary X-ray, CT (virtual bronchoscopy) and rigid videotracheobronhoscopy. Foreign body removal was performed using pediatric Karl-Storz tracheobronhoscopy kit, under general anesthesia and video documentation.Results: The repartition of the cases according to age was: 76 cases were between 10 month and 3 years; 17 cases were between 3 and 8 years. Foreign body localization was: 53 cases in right bronchus, left bronchus 23 cases, 12 cases with bilateral localization, 4 cases in the trachea and 1 case with subglottic localization. In 72 cases there was an organic nature of the foreign body, while in 21 cases there was an anorganic nature. All other patients presented a good evolution, with no complication after extraction of the foreign body. Conclusions: Close cooperation between the ENT specialist, paediatrician, radiologist and anesthesiologist is necessary for the management of tracheobronchial foreign body.Supported by: ENT Department, University of Medicine and Pharmacy, "Victor Babes" TimisoaraDer Erstautor gibt keinen Interessenkonflikt an

Frontal sinus osteomas management

Introduction: Craniofacial osteomas are benign tumors of the skull-base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. Methods: Between the years 2003-2015, in the ENT Department Timisoara, 11 patients were treated for frontal sinus osteoma, 4 females and 7 males. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. In ENT Department Timisoara we used external approach in each case. Results: All 11 patients underwent surgery, the postoperative results were very good. Conclusions: Frontal sinus osteomas, skull base benign tumors, are very rare and the treatment is surgical by an external approach.Der Erstautor gibt keinen Interessenkonflikt an