A Case of Metastatic Renal Cell Carcinoma of Parotid Gland / 대한이비인후과학회지

Renal cell carcinoma (RCC) is known for its high propensity for early metastasis and one third of patients diagnosed with RCC present with metastatic disease at the time of diagnosis. RCC commonly metastasizes to the lung, bone, liver, brain, and skin by hematogenous spread, whereas metastasis to the head and neck region is rarer. In cases of head and neck metastasis, the thyroid accounts for a large percent. Parotid metastasis from renal cell carcinoma is an extremely rare finding. We recently encountered a 67-year-old man with left parotid mass and finally diagnosed as metastatic renal cell carcinoma. We report the rare case with a review of literature.

Giant Ancient Schwannoma of the Lateral Neck Presenting with Preoperative Horner's Syndrome / 대한이비인후과학회지

While ancient schwannoma (AS) from the cervical sympathetic chain is very rare. Preoperative Horner's syndrome resulting from cervical sympathetic chain schwannoma (CSCS) is extremely rare. A 58-year-old woman visited our clinic with a huge lateral neck mass that had been present for thirteen years. Ptosis and enophthalmos were observed on the left eye. After radiologic evaluation, we assessed the CSCS by performing surgical excision. Finally, pathologic examination revealed it to be AS. There has been no recurrence for 15 months after discharge, however Horner's syndrome has become more prominent. We report this unique case of ancient schwannoma with literature review.

A Case of Cervical Actinomycosis Misdiagnosed to Malignant Tumor / 대한이비인후과학회지

Actinomyces are gram positive anaerobes which exist as normal flora in the oral and digestive tract. Actinomycosis is a very rare subacute or chronic infectious disease that causes sinus fistula, tract or abscess due to the invasion of surrounding soft tissue when normal mucosa is damaged by inflammation. Clinically, it is categorized into cervicofacial, thorax, abdomen, pelvis, and systemic infection, in which cervicofacial infection accounts for 50% of all actinomycosis. With various nonspecific clinical manifestations and uncertain results of fine needle aspiration cytology and culture examination, treatment may be difficult since it may be misdiagnosed as malignancy or tuberculosis. Along with literature, we present a case of a 57-year old male patient with cervical actinomycosis in the submandibular mass, which was mistaken for malignancy.

The Usability of p16 Immunohistochemical Staining as a Screening Test of Human Papillomavirus Infection in Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although human papillomavirus (HPV) infection has been recognized as having an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC), there is no simple and reliable screening test of HPV infection in HNSCC to date. In the present study, we investigated the usability of p16 immunohistochemical staining as a screening test for HPV infection in HNSCC. SUBJECTS AND METHOD: Paraffin blocks were obtained from 45 tonsil SCC patients, who underwent surgery as an initial treatment between 1995 and 2004. Paraffin blocks were also obtained from 20 normal controls. Expression of p16 was investigated immunohistochemically and these results were compared with results of HPV genotyping and the real-time polymerase chain reaction (PCR) assay of viral oncoprotein to validate p16 staining as a reliable diagnostic tool of HPV infection. RESULTS: The expression of p16 was found to be significantly different between tonsil SCC (32/45, 71.1%) and normal control tissues (0/20, 0%)(p<0.05). Among the 45 patients, HPV genotyping and real-time PCR assay were performed in 21 of the 32 p16 (+) patients and in 6 patients of the 13 p16 (-) patients. HPV-16 was detected in 18 (85.7%) out of the 21 p16 (+) patients and in 2 (33.3%) out of the 6 p16 (-) patients. The p16 expression and HPV-16 status was significantly correlated (p<0.05). The two patients who had HPV-16 infection but did not have p16 expression showed an episomal infection or very low viral copy number each. CONCLUSION: The p16 expression may be an useful marker of HPV infection in HNSCC and may be used as a screening test for HPV infection in HNSCC.

A Case of Giant Neurofibroma Arising from the Scalp / 대한이비인후과학회지

Neurofibromatosis 1 (NF-1) is an inherited neurocutaneous disorder arising from the chromosome 17q with a prevalence of one in 4,000. Neurofibroma, Cafe-au-lait spots, freckles in axilla, Lisch nodule and bony dysplasia are features of NF-1. It is diagnosed preoperatively by history taking, physical examination, CT, MRI and intraoperatively by tissue biopsy. Scalp neurofibroma accompanying pain, motor disturbance, rapid growth, and suspicious of malignancy are indications for surgical removal. We present a case of NF-1 with two giant neurofibromas (15x7x4 cm, 3x5x2 cm) on the left scalp in a patient suffering from a head injury after falling down. The neurofibromas were successfully removed after diagnosed by MRI and histology.

A Case of Eustachian Tube Mature Teratoma in Neonate / 대한이비인후과학회지

Teratoma is a tumor derived from the three basic germ cell layers (ectoderm, mesoderm, endoderm) and is commonly found in the sacrococcygeal region. But teratomas of the head and neck are uncommon tumors which comprise between five and 15% of all teratomas. Of these, the Eustachian tube is an unusual site for this tumor. Patients with these tumors have symptoms related to difficulties with swallowing and respiration that could result in high degree of morbidity and mortality by virtue of size and location of the tumor. We present a case of eustachian teratoma in a female infant presenting dyspnea at birth with a review of the literature.

A Case of Sarcomatoid Carcinoma of Larynx / 대한이비인후과학회지

Sarcomatoid carcinoma is a rare type of head and neck cancer that presents both epithelial squamous cell carcinoma and sarcomatous features. There is much debate on pathogenesis, clinical behavior, therapeutic options and prognostic factors for this tumor. Treatment is similar for squamous cell carcinoma with respect to the state, location and size of the tumor. We report a case of sarcomatoid carcinoma on larynx, which was treated by surgical excision and postoperative radiotherapy. The relevant literature is briefly reviewed.

Combined Expression of COX-2, MMP-9, p53 and VEGF in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: COX-2, MMP-9, p53 and VEGF play an important role in the invasion and metastasis of tumor, and their roles are known to interact with each other. In this study, we investigated the relationship between gene protein expression and clinical parameters including synchronicity to the progression and metastasis in the head and neck squamous cell carcinoma. SUBJECTS AND METHOD: Tissue samples and clinical data were obtained from 69 head and neck squamous cell carcinoma patients who underwent surgery as initial treatment except nasopharngeal carcinoma from January 1999 to December 2003. Their primary sites were: oral cavity (12), pharynx (18) and larynx (39). Immunohistochemical stain was performed to evaluate the expression rate of COX-2, MMP-9, p53, VEGF and then expression patterns and clinical data were analysed. RESULTS: The expressions of COX-2, MMP-9, p53 and VEGF immunoreactivities were observed as 57.9%, 49.3%. 60.9% and 44.9%, respectively. MMP-9 was significantly correlated with T-stage (p=0.021) and COX-2 and p53 levels were significantly correlated with lymph node metastasis (p=0.019 and p=0.001, respectively). Multiple (2 kinds, 3 kinds, 4 kinds) expressions of gene protein were found in 31.9%, 21.7%, and 10.2%, respectively. There was a significant statistical difference between the multiple expression of gene protein to lymph node metastasis and a single expression of gene protein (p=0.030). CONCLUSION: These data suggested that COX-2, MMP-9 and p53 expression may play a role of tumor progression and metastasis in the head and neck squamous cell carcinoma. We may conclude that the synchronous gene protein expression was superior to the single gene expression in estimating progression and metastasis of the head and neck squamous cell carcinoma.

Treatment Effect of Intravenous Lasix-Vitamin-Dextran and Carbogen Inhalation Therapy Accompanying Oral Drug Therapy in the Patients with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is one of the most widespread and disturbing disorders of the auditory system. However, little is known about the physiological mechanism that causes tinnitus and there is no definite treatment. The aim of this study has been to evaluate the effect of Lasix-Vitamin and Carbogen inhalation therapy for tinnitus treatment and to determine their appropriate indications. SUBJECTS AND METHOD: From May 2004 through April 2005, 178 patients with subjective tinnitus were treated in two groups. One group was treated with Lasix-Vitamin and Carbogen inhalation therapy with oral Vitamin and Ginkgo biloba extract. The other group was treated with oral Vitamin and Ginkgo biloba extract at the Chung-Ang University Hospital. We compared the effectiveness of Lasix-Vitamin and Carbogen inhalation therapy for tinnitus on audiogram, tinnitogram, questionnare with that of other group. RESULTS: There was no difference between the oral Vitamin and Ginkgo biloba extract therapy group and Lasix-Vitamin and Carbogen inhalation therapy with oral Vitamin and Ginkgo biloba extract therapy group with respect to age, sex, initial Tinnitus handicap inventory score and tinnitus characteristics. Whereas tinnitus was improved in 25 (31.3%) of 80 patients who were treated with oral Vitamin and Ginkgo biloba extract, subjective tinnitus was improved in 69 (70.4%) of 98 patients who were treated with Lasix-Vitamin and Carbogen inhalation therapy in addition to oral Vitamin and Ginkgo biloba extract. The effect of each therapy was significantly different between two groups (p<0.05). CONCLUSION: We suggest that intravenous Lasix-Vitamin-Dextran and Carbogen inhalation therapy be used in addition to oral Vitamin and Ginkgo biloba extract as an effective treatment for subjective tinnitus.

A Case of Deep Neck Infection by Tuberculosis Destroying the Cervical Vertebrae / 대한이비인후과학회지

Deep neck infections affect fascial compartment of the head and neck, and their contents. Fever, pain, and swelling are the most common presenting symptoms. Also, the development of septic shock or mediastinitis depends on the degree of progression of the disease. The advent of antibiotics decreases the incidence and mortality of the deep neck infection. Antibiotics also alters the causation and management of this disease. In a recent report, mixed species with anaerobe were found in 50% of patients, whereas Staphylococci and Hemolytic streptococci were the leading causes of deep nect infections in the past. Also, in the case of immunocompromised host, deep neck infections caused by tuberculosis or fungus are not excluded. We experienced a 23 year old man with deep neck infection caused by tuberculosis presenting bone destruction of cervical spine. In this article, we reviewed the etiology, diagnosis, and treatment of this case, with a review of literatures.

The Effect of Polymeric Immunoglobulin Receptor on Eosinophil Degranulation in Respiratory Syncytial Virus Infection of Respiratory Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The presence of eosinophil-specific cytotoxic mediators in nasopharyngeal secretions of infants with more severe RSV infection in the respiratory tract suggests that eosinophils play a key role in the pathogenesis of RSV-induced airway inflammation and the associated epithelial damage. A recent report demonstrated that RSV-infected respiratory cells induce eosinophil degranulation by a CD11b/CD18-dependent, ICAM-1-independent mechanism. However, the molecule on the epithelial cell membrane involved in the receptor-mediated degranulation of eosinophils after RSV infection has not been clearly identified. MATERIALS AND METHOD: We investigated the effect of RSV infection on the expression of pIgR on A549 cells and blocking of the RSV-infected cell induced eosinophil degranulation with monoclonal antibodies of the pIgR. RESULTS: After 24h of RSV infection, A549 cells expressed pIgR remarkably whereas pIgR was hardly expressed by the uninfected cells in flow cytometry and in the semi-quantitative RT-PCR. CD11b/CD18 on eosinophils was highly expressed by the RSV conditioned media. Purified eosinophils cocultured with the RSV-infected A549 cells showed approximately eightfold increase in ECP in the isotype control, compared with the control and that was blocked by treatment of anti-pIgR monoclonal antibody. CONCLUSION: It is strongly suggested that pIgR expression in the epithelial cells may be a key factor for eosinophil degranulation via interaction with CD11b/CD18 in the RSV-infected epithelial cells.

Effects of Low-Dose Long-Term Macrolide Therapy on the Postoperative Symptom Change, Mucociliary Clearance and Polyp Regrowth

Low-dose long-term macrolide therapy (LDLMT) has been reported as an effective treatment in chronic respiratory tract diseases such as diffuse panbronchiolitis and chronic paranasal sinusitis. The mechanism of action of LDLMT is not fully revealed. The aim of this study was to evaluate the clinical effect of LDLMT on the postoperative patients of chronic sinusitis with polyp. Thirty eight control groups were defined empirically treated with antibiotics after endoscopic sinus surgery (ESS) and 62 experimental group were defined 8 weeks LDLMT (Clarithromycin 250 mg ) after postoperative 2 weeks in ESS patients. Preoperatively, we checked mucociliary clearance with saccharine test (MCT), symptom scores and sinus CT scan and total IgE, and allerg ic skin test were evaluated for allergy. After ESS, MCT and symptom scores were checked on postoperative patients at 2, 6 and 10 weeks, respectively. Recurrence of polyp was also evaluated with endoscopic examination. The improvement rate (IR) of MCT was s ignificantly higher in the experimental group than in the control group, but the IR of symptom scores was not significant statistically. High total IgE affected the IR of MCT and symptom scores in the experimental group. Allergy proven by allergic skin test also affected the IR of MCT, but the IR of symptom scores was not affected in the experimental group. The polyp recurrence rate was significantly higher in the control group compared to the experimental group. We can conclude that LDLMT has a beneficial affect on the postoperative treatment of sinusitis patients and high total IgE and allergy may affect the effect of LDLMT in postoperative patients who have undergone ESS.

Clinical and Histologic Features of Antrochoanal Polyps

Antrochoanal polyp (ACP) usually appears as a large, soft, gelatinous mass in the nasopharynx. Recently, ACP is considered as a separate entity among sinonasal polyps. Histologically, the antral part of the polyp can be cystic or polypoid with a fibrous and solid choanal part. However, the extent of inflammation of the paranasal sinuses has not well been demonstrated. In addition, pathologic patterns of ACP have not been well revealed. The aim of our study is to evaluate the disease patterns of ACPs by clinical and pathologic analysis. Thirty two patients with ACPs were evaluated by a retrospective study. We evaluated sinus involvement by operative findings and pathologic patterns were investigated in 28 cases by predominant infiltrating cells and types of polyp. In order to evaluate the histologic differences between the antral and choanal portion, each A CP was divided into proximal and distal portion. The involved sinuses were multiple and diverse and the most of them had a polyp. The most common pathologic type was chronic inflammatory polyp. Lymphocyte and neutrophil were visualized in many ACPs predominantly. The histologic differences between the proximal and distal portion was not observed significantly. Clinical analysis suggest that ACPs are not sole polyp but mixed disease with inflammation of the nose and sinuses in most cases. Histologic analysis suggest that ACPs are caused by chronic inflammation in many cases and each portion of ACPs is composed of the same histologic type.