Nasal gouty tophus

@#A 48-year-old, non-hypertensive, non diabetic man with uncontrolled gouty arthritis presented with a four-day swollen nasal mass. He was assessed to have a nasal abscess at the emergency room and was admitted for urgent management. Paranasal computed tomography (CT) scans showed a heterogeneously enhancing focus with areas of hypodensities in the nasal apex and dorsum extending into the right ala measuring 1.5 x 2.8 x 3.4 cm. with associated erosion of the cartilaginous part of the anterior nasal septum, soft tissue swelling and skin thickening in the nasal dorsum, nasal tip and right zygomatic region that was suspected to relate to an aggressive etiology. Tissue correlation was therefore recommended, and he underwent endoscopic-guided incision and drainage with biopsy and debridement of the nasal mass. The specimen submitted consisted of red to white, irregular, soft tissue fragments with an aggregate measurement of 1.5 x 1.5 x 0.5 cm. Microsections showed deposits of amorphous white to pink material with surrounding fibrosis and acute and chronic inflammatory cell infiltrates and foreign body giant cells. (Figures 1 and 2) Also seen in the background were fragments of sclerotic bone and bacterial colonies. These findings were consistent with gouty tophus with acute and chronic inflammation and bacterial colonization. The culture and sensitivity test of the nasal discharge showed growth of Enterobacter aerogenes (currently named Klebsiella aerogenes) which was identified by an automated mass spectrometry microbial identification system (VITEK® MS). Work-up also included uric acid levels which were within the reference interval at that time (6.57 mg/dL).

Nasal eosinophilic angiocentric fibrosis with IgG4-positive plasma cell infiltration

@#Introduction: Eosinophilic angiocentric fibrosis (EAF) is a rare lesion that predominantly affects the upper respiratory tract. Its etiology is unknown and it has been recently associated with the IgG4related disease (IgG4-RD) spectrum. To the author’s knowledge, this is the sixth case report of the relationship between EAF and IgG4-RD. Case Report: We report the case of a 37-year-old woman with nasal deformity and facial pain. The lesion was surgically excised. Histological examination revealed features of EAF with an IgG4/IgG plasma cell ratio >73% and 31 IgG4 stained cells per high power field. No clinical or radiological recurrence was detected during follow-up. Serum IgG4 quantification one year after surgery was within normal limits. Discussion: The relationship between both entities may have therapeutic impact because IgG4-RD of the head and neck has a high remission rate with corticosteroids and immunosuppressive therapy. Additional reports of this infrequent disease are necessary to elucidate appropriate treatment and prognosis.

A Clinicopathological Observational Study of Various Types of Masses at Nasal Cavity, Paranasal Sinuses and Nasopharynx.

Background: The nasal masses affect different age groups and have the aetiological factors, which are both congenital and acquired. In the present study we have observed Various Types of Masses at Nasal Cavity, Paranasal Sinuses and Nasopharynx. Methods: The present study was based on the observation of 100 patients of different age group having chief complaint of fleshy mass in the nasal cavity who were selected from outpatient department. Results: In the study of 100 patients, 49 were children and adolescent, 32 were adult, 17 were middle aged and remaining 2 were elderly. 83.9% of Antrochoanal polyp were found below 20 year age group and 90.9% of ethmoidal polyp were found in above 21 year age group and 9 out of 42 cases of polyp gave history of allergy and 6 (14.3%) cases out of 42 having DNS. Conclusion: Sinonasal polyposis is the most common pathological nasal mass and of these antrochoanal polyp is usually seen in children and adolescent and ethmoidal polyp is common in the middle age group.

Patología unilateral de senos paranasales con compromiso predominante de un seno: Descripción de serie de casos / Unilateral paranasal sinus disease with predominant commitment of one sinus: Case series description

Introducción: El velamiento de una cavidad paranasal representa un desafío diagnóstico y puede ser causado por diversas patologías. El examen clínico generalmente es insuficiente para orientar la conducta siendo necesario un estudio completo que incluya endoscopía, imágenes e histología para lograr un diagnóstico definitivo. Objetivo: Describir la impresión clínica, imagenológica, quirúrgica e histológica de pacientes con patología unilateral de senos paranasales. Material y método: Serie retrospectiva de 32 pacientes con patología sinusal unilateral operados en Hospital Clínico de la Universidad de Chile entre 2012 y 2014. Se consideró como criterio de inclusión el compromiso predominante de un seno paranasal en el estudio imagenológico. Se describen las variables: síntoma principal, impresión diagnóstica; clínica, imagenológica, quirúrgica, seno comprometido, entre otras. Resultados: El síntoma principal más frecuente fue obstrucción nasal (56%). Los diagnósticos más frecuentes fueron: patología inflamatoria (84%): pólipo antrocoanal (31%), mucocele (22%) y bola fúngica (22%) y patología tumoral benigna: papiloma invertido (16%), siendo el seno maxilar el más afectado (90%). La impresión diagnóstica quirúrgica fue más precisa que la imagenológica en determinar el diagnóstico definitivo, aunque esta diferencia no alcanzó significancia estadística. Discusión: Patología compleja que requiere estudio completo incluyendo endoscopía. Las imágenes son el segundo pilar en el diagnóstico y deben solicitarse de acuerdo a los hallazgos. El diagnóstico quirúrgico provee una mayor precisión diagnóstica. Conclusiones: Se incluyen varias patologías bajo este concepto, la patología inflamatoria predomina pero se debe tener alto índice de sospecha dado la relativa frecuencia de patología tumoral.

Introduction: Paranasal sinus opacity represents a diagnostic challenge and can be caused by diverse pathologies. Clinical examination is generally insufficient to achieve a definitive diagnosis and it is necessary a complete study including endoscopy, imaging and histology. Aim: To describe clinical, radiographical, surgical and histological diagnostic impressions of patients with unilateral sinus disease. Material and method: 32 retrospective serie with unilateral sinus disease treated at Hospital Clínico de la Universidad de Chile, between 2012 and 2014. The predominant commitment of one sinus on the tomography was considered as inclusion criterion. Principal symtom, clinical, radiographical and surgical diagnostic impressions, committed sinus, among others variables were studied. Results: The most frequent symtom was nasal obstruction (56%). The most frequent diagnoses were: inflammatory disease (84%): antrochoanal polyp (31%), mucocele (22%) and fungus ball (22%) and benign tumor: inverted papilloma (16%). The maxillary sinus was affected in 90%. Surgical diagnostic impression was more precise than radiographical impression in determining the definitive diagnosis, although this difference did not reach statistics significance. Discussion: Unilateral sinus disease is a complex pathology that requires comprehensive study including endoscopy. Images are the second pillar in the diagnosis and should be requested according to the findings. Surgical diagnostic impression provides greater diagnostic presicion. Conclusions: Several pathologies are included under this concept, inflammatory disease prevails but it is necessary to have high index of suspicion in view of the relative frequency of tumour pathology.

Histological correlation of nasal mass: a five year retrospective and prospective study.

Background: The presence of mass in the nose may seem to be a simple problem; however it raises several issues about the differential diagnosis. The aim of this study is to evaluate the histological profile of nasal masses in the environment. Methods: This is a retrospective and prospective study of nasal masses during a period of five years of patients presenting to the clinician in our hospital. Results: A total of 90 patients were analysed age ranging from 3 to 80 years. Majority of patients were in the second decade. Sex wise distribution showed a male to female ratio of 2.2:1. The main presenting symptom was nasal obstruction seen in 53.30% patients, while proptosis was seen only in malignant lesion. Among a total of 90 lesions in the nasal cavity 81.1% were benign, 15.5 % were malignant and 3.3% were inadequate sample The commonest non neoplastic lesion was nasal polyp which comprised about 83.33% followed by rhinoscleroma, while the commonest benign neoplastic lesion was papilloma and comprised about 42.10% and squamous cell carcinoma was the most common malignant neoplastic lesion in the nasal cavity and comprised about 42.85%. Most patients with benign lesion were in the second decade. Malignant lesions occurred mainly after fifth decade, while inadequacy of sample was seen in the second decade. Conclusion: Males are more commonly affected then females. Nasal obstruction is the commonest symptom Simple inflammatory nasal polyp is still the commonest histological pattern seen while papilloma being the most common benign lesion and squamous cell carcinoma the most common malignant lesion.

Old world leishmaniasis presenting as a nasal mass.

Mucosal leishmaniasis is a major problem in Latin America but has been rarely noticed in our region. Although there have been a few reports of mucosal involvement especially in the oral cavity from Southwest Iran, yet none have been presented from the Northeast where Leishmania tropica is the major concern. We report a patient with endonasal leishmaniasis due to L. tropica, an extremely rare entity in immunocompetent patients in our region. He presented with a mass in the left nasal vestibule causing a sense of obstruction on the same side, accompanied by occasional rhinorrhea and mild epistaxis. This case exemplifi es the need for considering leishmaniasis as a differential diagnosis for nasal obstruction in this endemic area.