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Objective:To evaluate the CT characteristics of ossifying foci in sinonasal inverted papilloma (IP) and to compare with the tumor root shown intraoperatively.Methods:The clinical and CT imaging data of 127 patients with IP, which were proved by histopathology, were reviewed retrospectively from Beijing Tongren Hospital, Capital Medical University, during the period from January 2012 to December 2018. The number, location, shape, density of ossifying foci in sinonasal IP and the relationship with the wall of sinus were observed. The sites of ossification on CT scans were compared with the root of the tumors described in the corresponding patient′s operative records.Results:In 127 IP patients, 51 (40.2%) patients showed the ossification in the tumor on CT. Single ossifying foci were found in 35 cases and multiple in 16 cases. The ossification affected single site of the sinonasal tract ( n=16) or distributed diffusely ( n=35). In the 50 cases, the ossifying foci extended along the long axis of the affected sinus appearing as branched ( n=19), striped ( n=16), linear ( n=7), lumpy ( n=2) or mixed type ( n=6), and 1 case was located at the edge of the maxillary sinus. Totally 66.7% (34/51) of the ossifying focis contained peripherally hyperdense bone tissue and centrally hypodense adipose tissue, which corresponded to bone cortices and fatty marrow of the trabecular bone. And 96.1% (49/51) of the ossifying focis were attached to the adjacent bone of the sinus, and the sites of attachment were concordant with the actual origin of tumor confirmed in operation . Conclusions:Ossification can be seen in some sinonasal IPs. Tracing along ossifying focus to the site of attachment with sinus might facilitate preoperative prediction of the originating site of tumor.
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Objective:To investigate the CT and MRI features of sinonasal lymphoepithelial carcinoma (LEC) and to compare functional MRI index of LEC with olfactory neuroblastoma (ONB) in this area.Methods:The clinical data, CT and MRI conventional findings of 7 patients were retrospectively reviewed . All of the patients, 5 males and 2 females, with age of 35-58 (45±9) years old, were histologically diagnosed as LEC of sinonasal tract at Beijing Tongren Hospital, Capital Medical University from February 2014 to November 2019. The semi-quantitative DCE-MRI parameters and ADC value were measured and compared with 18 cases of ONB which were collected during the same period. Independent sample t test or corrected t test, Fisher′s exact test were performed to compare the differences between the two groups. Results:In all of the 7 LEC patients, 6 lesions were located in naso-ethmoid area, 1 lesion was located in naso-orbital area. Six lesions were on the left side, and another one was sitted on both sides. All tumors manifested irregular soft tissue density with bony destruction, 3 of them showed bony sclerosis. All lesions showed homogeneous density or signal and obvious enhancement in solid portion accompanied with varying degrees of local invasion. Morphologically, two forms were observed: localized soft tissue mass and diffuse infiltration along mucosa. There were polypoid strips ( n=3), spherical masses ( n=3), and diffuse thickening of nasal cavity and turbinate mucosa ( n=1). DCE-MRI examinations were performed in six LEC patients. Maximum contrast enhancement index (CI max) was 1.51±0.46, wash out ratio (WR) was 14.26%±6.24%. Time intensity curve (TIC) showed a plateau pattern (type Ⅱ) in 4 cases and a washout pattern (type Ⅲ) in 2 cases. Time to peak (T peak) were (40.09±4.59)s, showing a rapid peak performance. Diffusion weighted imaging was performed in six LEC patients, and the ADC value was (0.80±0.14)×10 -3 mm 2/s. There were statistical differences in WR and ADC values between sinonasal LEC and ONB ( t=4.873, P=0.020 and t=3.255, P=0.025). Conclusion:The radiological manifestations of LEC have certain characteristics. The characteristics of conventional imaging findings and functional MRI index combined with clinical data are helpful in making differential diagnosis between LEC and other sinonasal malignant tumors.
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<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics of IgG4-related sialodacryoadenitis and chronic rhinosinusitis (CRS).</p><p><b>METHODS</b>A total of 13 patients (patient group) were evaluated clinically and biopsy specimens from the lacrimal/salivary glands (n=12) and nasal mucosa (n=8) were reviewed and immunohistochemistry was performed to assess IgG-and IgG4-positive cells. Similarly, nine patients with IgG4-related sialodacryoadenitis without CRS and 10 patients with common CRS were included as controls.</p><p><b>RESULTS</b>There were 8 male patients and 5 female patients. The age of patients ranged from 32 to 71 years (mean 50.2 years). The patient group had higher serum IgG4 concentration than that of the control group (P<0.05). Lymphoplasmacytic infiltration, lymphoid follicle formation and sclerosis were prominent in lacrimal/salivary glands in both groups; however the magnitude of IgG4-positive plasmacytic infiltration in the patient group was significantly higher than that of the control group (P<0.05). Similarly, evaluation of nasal mucosa revealed greater lymphocytic and plasmacytic infiltration, and lymphoid follicle formation, together with significantly higher amount of IgG4-positive plasma cell infiltration in the patient group compared to the common CRS group (P<0.05).</p><p><b>CONCLUSIONS</b>IgG4-related disease (IgG4-RD) simultaneously involving lacrimal/salivary glands and nasal cavity/paranasal sinuses is rare and characterized by a combination of IgG4-positive plasma cell infiltration involving lacrimal/salivary glands and nasal mucosa along with an increased serum level of IgG4. As a systemic disease, early and accurate diagnosis is therefore of great importance, and unnecessary surgery should be avoided.</p>