Challenges in the topic diagnosis of cerebrospinal leak rhinorrhea. Case report

Introduction: The leak of cerebrospinal fluid in the nose and paranasal cavities is a pathological condition, associated with defects in the skull base. The rhinoliquorrhea may occur spontaneously and may be hidden for a long time, wrongly treated due to the complexity and difficulty of diagnosis. This condition may be linked to serious life treating illnesses, with ascending bacterial infections from the non-sterile nasal cavity to the subarachnoid space – meningitis, meningoencephalitis, brain abscess, etc. The topical diagnosis of rhinoliquorrhea is truly important for the surgeon, because it defines the operative approach and the technic that will be used.Materials and methods: Seven cases of rhinoliquorrhea where diagnosedand treated from 2015 to 2017 in the ENT department in University Hospital St George, Plovdiv. Laboratory tests such as glucose test of the nasal secretion and beta 2 transferrin were made. Computer tomography (CT), Magnetic resonance (MRI) and cisternopgraphy were also performed. In one of the cases we localized endoscopically the CSF defect without imaging preoperative confirmation.Results: In six of the patients preoperatively was confirmed the presence and the localization of the defect. In one of the cases the topical diagnosis of the rhinoliquorrhea with positive beta 2 transferrin test wasn’t possible. A defect in the area of the olfactory rhyme was localized intra-operatively, via an endoscopic approach. The postoperative period lasted for 5 days without complications. In all of the patients an endoscopic repair of the defect was applied.Conclusion: The topical diagnostics of rhinoliquorrhea is a challenge. When the defects of rhino base are bigger, the timely diagnosis is of utmost importance given the risk of fatal consequences. The incorrect localization of the defect of the rhino base may cause difficulties for the surgeon when using endoscopic approach, given the complex anatomy of the nose and the sinuses, as well the complex structural communication and delicate sights(cribriform plate, the spheno-palatines arteries, the anterior etmoidals arteries, the carotid artery, optical nerv, etc). The diagnosis of a present rhynoliquorrhea and the topic of the defect are of utmost importance giving the fact of possible complications that may occur such as infections of central nerve system, disturbance in consciousness, persistant headache and it is also related to the precise surgical repair to the skull base

Carcinosarcoma of the palatine tonsil – diagnostic and therapeutic approach. Literature review. Clinical case

Introduction: Carcinosarcoma of the head and neck is an very rare pathology < 1%. This is a mixed tumor with epithelial and mesenchymal components. It is characterized by high recurrence, metastasis, and mortality rates.Aim: The sporadic nature of carcinosarcomas of the oral cavity, sinonasal tract, larynx, and hypopharynx causes difficulties with the diagnostic and therapeutic approach. Our clinical case is an example of a rare localization of carcinosarcoma, which allows for a detailed examination thereof.Materials and methods: We present a clinical case of a 67 year-old male, admitted to the Otorhinolaryngology Clinic of University Hospital „Sv. Georgi“ EAD – Plovdiv, presenting with difficulty swallowing and a lump on the right side of the neck for several months. Computer tomography was performed and a tumor found involving the right palatine tonsil. The tonsil was surgically removed. The histopathological result showed a biphase tumor with epithelial and mesenchymal components – carcinosarcoma.Results: Following the monotonsillectomy, the patient was referred to radiotherapy. The local status does not indicate any progression and infiltration into soft tissue.Conclusion: Carcinosarcoma is a malignant mixed tumor with high recurrence, metastasis, and mortality rates. It is difficult to diagnose due to the non-typical location and the need for immunohistochemistry testing, which is not always possible. The therapy for carcinosarcoma of the head and neck is delivered under a squamous cell carcinoma protocol due to the lack of a specific one