Myeloid sarcoma presenting as nasopharyngeal mass: A rare clinicopathological scenario

Myeloid sarcoma (MS) is considered as an extramedullary manifestation of acute myeloid leukemia (AML) with or without concurrent AML. It can present at any age and any site, however, nasopharynx being an extremely rare site of manifestation. MS may precede AML by weeks, months or years, thereby necessitating an early diagnosis and timely intervention and treatment. We report a case of MS in a young female who presented with nasal obstruction and epistaxis for 3 months. The present case also highlights the significance of judicious use of immunohistochemistry panel while dealing with a hematolymphoid neoplasm devoid of expression of B-cell or T cell specific markers in head and neck region.

New Nasopharyngeal Flap for Posterior Skull-base Reconstruction: The Upper-Tongue Flap

Abstract Introduction Reconstructions of clival resection are still challenging, and additional reconstructive methods may be necessary to achieve full coverage of the skull-base defect in patients with middle- and lower-clivus disease. Objective To describe a new nasopharyngeal flap for the middle and lower clivus. Methods Using nasal endoscopy in a cadaver dissection, we demonstrated a new nasopharygeal flap to cover the lower and middle clival resection. Results We described a new nasopharyngeal flap capable of covering the lower and middle portion of the clivus. Discussion The new nasopharyngeal flap, called the upper-tongue flap, is particularly adequate as an alternative for the reconstruction of middle and lower clivus defects, and it is better used in association with a nasalseptal flap in cases in which the nasalseptal flap alone does not provide enough mucosal coverage. Conclusion The new nasopharyngeal flap can be used in the reconstruction of clival resection.

Lymphoepithelial carcinoma of the maxillary sinus: A case report

Lymphoepithelioma-like carcinoma or lymphoepithelial carcinoma (LEC) of the maxillary sinus is an extremely rare malignancy. It is a rare type of undifferentiated carcinoma, consisting of atypical epithelial cells surrounded by reactive lymphoplasmacytic infiltrate. The paper reports the case of a 76-year-old male patient, with complain of swelling on the hard palate and epistaxis. Biopsy from the hard palate mass showed features consistent with LEC, with contrast-enhanced computed tomography nasopharynx and neck showing soft-tissue lesion in the right maxillary sinus. The patient is currently under treatment with external beam radiotherapy.

Identification of the nasopharyngeal carriage of Neisseria meningitidis by 16S rRNA Gene sequencing in asymptomatic adolescents and young adults in Cartagena, Colombia (2019-2020)

Abstract The bacterium Neisseria meningitidis, a strictly human pathogen, can cause meningitis, meningococcemia, sepsis, and death; repeatedly it scause outbreaks around the world. The frequency of asymptomatic carriage is often high in adolescents and young adults, increasing the invasive meningococcal disease risk and likelihood of transmission. However, detailed analyses of meningococcal carriage in this population in Colombia, particularly in coastal areas, are lacking. In this study, the prevalence and characteristics of Neisseria meningitidis carriage were evaluated in asymptomatic adolescents and young adults (11-25 years old) in Cartagena, Colombia. Oropharynx samples were collected from participants between August and December 2019. The phenotypic identification of bacteria was performed by conventional methods and biochemical testing. Molecular identification to the species level was performed by 16S rRNA gene sequencing. In total, 12 of 648 samples were positive for Neisseria meningitidis by 16S rRNA sequencing, indicating a prevalence of 1.9%. Isolates were classified into four invasive serogroups (A, B, C, and W) by a comparative sequence analysis of the ribosomal gene. Despite the occurrence of meningococcal disease in Cartagena city in the last several years, the frequency of oropharyngeal carriage in adolescents and young adults was low. Serogroup A had not been previously reported in nasopharyngeal samples in Colombia. This is the first report of Neisseria meningitidis on the Colombian Caribbean coast based on 16S rRNA sequencing and is expected to guide the development of vaccination and follow-up strategies.

Clinical characteristics and nasopharyngeal bacteria profiles in children with respiratory syncytial virus bronchiolitis / 中华实用儿科临床杂志

Objective:To explore the detection of potentially pathogenic bacteria (PPB) in the nasopharynx of children with respiratory syncytial virus (RSV) bronchiolitis and the influence of PPB types on disease severity.Methods:In this retrospective cohort study, clinical data of patients hospitalized for RSV bronchiolitis at Department of Respiratory Medicine, Children′s Hospital of Soochow University between January 1, 2017 and December 31, 2019 were retrospectively analyzed.The virus, Mycoplasma pneumoniae and bacteria in nasopharyngeal secretion of children were detected.They were classified into <3 months group, 3-<6 months group, 6 months-<1 year group and 1-2 years group based on the age.In addition, they were further classified into RSV infection group, RSV+ G + group, RSV+ G - group and RSV+ G + + G - group based on detected PPB in the nasopharynx.Comparison of RSV + PPB frequency between groups was performed by Chi- squared test, clinical characteristics were compared by using Mann- Whitney U test. Results:A total of 280 patients with RSV bronchiolitis were included in the study, involving 113 cases (40.4%) with PPB in the nasopharynx.The most-common detection bacterium was Streptococcus pneumoniae.The detection rate of Streptococcus pneumoniae increased with age ( χ2=12.609, P=0.005), while that of Staphylococcus aureus decreased with age ( χ2=8.387, P=0.034). Compared with RSV group, patients in RSV+ G - group had a longer length of stay, higher rate of fever and shortness of breath, higher oxygen supplement and higher C-reactive protein (CRP) (all P<0.05). Compared with RSV group, patients in RSV+ G + group were older, and they had higher rate of fever, higher percentage of neutrophil, lower percentage of lymphocyte and higher CRP (all P<0.05). Conclusions:PPB in nasopharynx can be detected in about 40% of children hospitalized with RSV bronchiolitis, and nasopharynx complicated with PPB infection may affect the severity of RSV bronchiolitis.

Value of 18F-FDG PET/CT in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma / 中华核医学与分子影像杂志

Objective:To explore the value of 18F-FDG PET/CT in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Methods:A retrospective analysis including 100 patients (77 males, 23 females, age (51.0±12.4) years) with nasopharyngeal carcinoma and 107 patients(61 males, 46 females, age (52.3±18.2) years) with nasopharyngeal lymphoma after 18F-FDG PET/CT at Tianjin Medical University Cancer Institute and Hospital from October 2011 to December 2019 was performed. All patients were confirmed by pathology. Differences of clinical data, PET metabolic parameters and CT morphology between nasopharyngeal carcinoma group and nasopharyngeal lymphoma group were compared (independent-sample t test or Mann-Whitney U test). Multiple regression analysis and ROC curve analysis were used to evaluate the efficacy of the combined features in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Results:As for nasopharyngeal carcinoma group and nasopharyngeal lymphoma group, there were statistically significant differences in SUV max (10.86±3.99 vs 14.81±7.24; t=-4.90, P=0.001), peak of SUV (SUV peak; 7.84±3.13 vs 10.86±5.66; t=-4.79, P=0.001), and total lesion glycolysis (TLG; 39.00(19.98, 62.56) vs 56.75(33.02, 102.06) g; z=-3.24, P=0.001). However, the diagnostic efficiencies were low (AUCs: 0.657, 0.646, 0.636, respectively). Multiple regression model showed that SUV max combined with multiple morphological and clinical features (gender, lesion location, with or without involvement of surrounding structures, cervical lymph node metastasis, parapharyngeal involvement and spleen involvement) could improve the differential diagnosis efficiency significantly (AUC=0.900). Conclusion:18F-FDG PET/CT metabolic parameter SUV max combined with CT morphological and clinical features have high diagnostic efficiency in the differential diagnosis of nasopharyngeal malignant tumors.

Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer / Correlação dos achados de PET-CT, RM e histopatologia no seguimento de pacientes com carcinoma nasofaríngeo

Abstract Introduction: Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the postradiotherapy period is improved. Objective: The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. Methods: A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients' age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. Results: Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). Conclusions: Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Resumo Introdução: As opções de tratamento cirúrgico são limitadas para o carcinoma nasofaríngeo por várias razões, inclusive aspectos epidemiológicos e histológicos, proximidade de estruturas importantes, drenagem linfática carregada e dificuldade de garantir uma margem cirúrgica segura; portanto, o tratamento primário é geralmente radioterapia e quimioterapia. Com a tecnologia atual de radioterapia, o sucesso oncológico aumentou e a qualidade de vida dos pacientes durante o período pós-radioterapia é garantida. Objetivo: O papel da ressonância magnética e da tomografia computadorizada por emissão de pósitrons no seguimento de pacientes com carcinoma nasofaríngeo recorrente, inicialmente tratados com radioterapia, foi avaliado em relação aos achados histopatológicos. Método: Foram incluídos no estudo 110 pacientes com carcinoma nasofaríngeo que receberam radioterapia. Pacientes com suspeita de recorrência de acordo com o exame endoscópico nasofaríngeo e com achados de ressonância magnética foram solicitados a fazer tomografia computadorizada por emissão de pósitrons. Foram feitas biópsias de 40 pacientes com lesões suspeitas nas imagens de tomografia computadorizada por emissão de pósitrons. Os pacientes foram avaliados segundo idade, sexo, presença/ausência de realce por contraste na ressonância magnética, valores SUVmax de lesões nasofaríngeas e cervicais, estágios T/N no diagnóstico inicial, recorrência histopatológica e histórico de esvaziamento cervical. Resultados: A recorrência foi observada em 8 pacientes (20,0%). Entre esses, 4 (10,0%) apresentaram recorrência na nasofaringe e 4 (10,0%) no pescoço. Pacientes com recorrência eram do sexo masculino, apresentavam idade mais avançada, estágio avançado T/N, realce por contraste na ressonância magnética e maiores valores de SuvMax nasofaríngeo e cervical na tomografia computadorizada por emissão de pósitrons. Entretanto, essas diferenças não foram estatisticamente significantes. Apenas o histórico de esvaziamento cervical foi significantemente mais comum entre aqueles com recorrência (p < 0,001). No entanto, na análise multivariada, aqueles com um valor de SUVmax nasofaríngeo superior a 4,58 apresentaram um risco 7,667 vezes maior de recorrência (p = 0,036). Conclusão A ressonância magnética e a tomografia computadorizada por emissão de pósitrons devem ser avaliadas em conjunto no seguimento da doença. Pacientes com valor de SUVmax mínimo de 4,58 na tomografia computadorizada por emissão de pósitrons após realce com contraste na sequência T2 na ressonância magnética podem ser considerados mais adequados para biópsia. Biópsias em pacientes com um valor de SUVmax menor do que 4,58 podem ser evitadas. Dessa forma, podemos evitar o estresse cirúrgico para o paciente e custos desnecessários.

Current treatment of recurrent nasopharngeal carcinoma / 中华放射肿瘤学杂志

On the basis of intensity-modulated radiotherapy (IMRT)-based comprehensive treatment, the 5-year overall survival rate of initially-treated nasopharngeal carcinoma patients without recurrence and metastasis has reached 80%, local regional control rate has exceeded 90%, whereas approximately 10%-15% of patients will suffer from local and/or nodal recurrence after initial treatment. The factors affecting the decision-making of re-treatment mainly include the causes of local and/or nodal recurrence of nasopharngeal carcinoma after initial treatment, selection of re-treatment, side effects and efficacy after re-treatment. This article summarizes the recent progress on these issues above.

Caracterización clínica y epidemiológica del carcinoma nasofaríngeo y su relación con el virus Epstein-Barr / Nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, clinical and epidemiological description

RESUMEN Fundamento: El carcinoma nasofaríngeo es el tumor maligno más frecuente del cavum. Estos tumores se diferencian de otros carcinomas epidermoide de la cabeza y cuello por su histología característica y su relación con el virus de Epstein-Barr. Objetivo: Caracterizar clínica y epidemiológicamente el carcinoma de nasofaringe y su relación con el virus Epstein-Barr, en el Instituto Nacional de Oncología y Radiobiología, Ciudad de la Habana, en el período de enero a diciembre de 2012. Metodología: Se realizó un estudio retrospectivo; se trabajó con un total de 16 historias clínicas. Se observaron variables como edad, sexo, tipo histológico, estadiamiento clínico, presencia del virus Epstein-Barr en el tumor, tratamiento aplicado, respuesta al tratamiento, recaída y estado del paciente. Resultados: El 50 % tenían entre 45-55 años de edad, 75 % eran hombres, el 50 % diagnosticados con tipo 3, 100 % negativo a la inmunohistoquímica para virus Epstein-Barr, predominó la etapa III con 43.75 %, el 56.25 % de los casos se trataron con radio-quimioterapia más quimioterapia, el 50 % tuvo respuesta completa, la recaída fue de 37.50 % y el 68.75 % de los pacientes estaba vivo a los 60 meses. Conclusiones: En esta pequeña población con carcinoma nasofaríngeo, la totalidad de la población fue negativa a la presencia de virus Epstein-Barr por técnicas de inmunohistoquímica, por lo que su negatividad se hizo representativa en los tipo 3 y etapas avanzadas y no tuvo impacto en la respuesta al tratamiento y la supervivencia global.

ABSTRACT Background: Nasopharyngeal carcinoma is the most common malignant tumor of the cavum. These tumors differ from some other epidermoid carcinomas of the head and neck by their histology features and their Epstein-Barr virus relationship. Objective: To describe clinically and epidemiologically the nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, at the National Institute of Oncology and Radiobiology, Havana City, from January to December 2012. Methodology: A retrospective study was conducted; with a total of 16 medical records. Variables such as age, sex, histological type, clinical staging, and presence of Epstein - Barr virus in the tumor, applied treatment, response to treatment, relapse and patient status were observed. Results: 50 % were between 45-55 years old, 75 % were men, 50 % diagnosed with type 3, 100 % negative to Epstein-Barr virus immunohistochemistry, stage III predominated with 43.75 %, 56.25 % of the cases were treated with radio-chemotherapy plus chemotherapy, 50 % had a complete response, relapse was 37.50 % and at 60 months 68.75 % of the patients were still alive. Conclusions: In this small population with nasopharyngeal carcinoma, the entire population was negative to the presence of Epstein-Barr virus applying immunohistochemical techniques, so its negativity became representative in type 3 and advanced stages and had no impact on the treatment response and overall survival.

Determination of Biofilm-Forming Capacity of Otopathogens Isolated from Discharging Ears in Children with Chronic Otitis Media

Chronic otitis media is a common disease of the developing world with persistent ear discharge, leading to major complications. This study describes the microorganisms isolated from the middle ear and nasopharynx of children with chronically discharging ears. Middle ear and nasopharyngeal swabs from 89 children were studied, and the microorganisms isolated were assessed for biofilm-forming ability. Methicillin-susceptible Staphylococcus aureus was common in the nasopharynx, while the middle ear showed predominantly pseudomonas and Methicillin-resistant S. aureus. Pseudomonas aeruginosa showed strong biofilm formation, whereas Escherichia coli, Proteus sp. and Providentia sp. were weak biofilm producers. S. aureus isolates were negative for biofilm formation.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases / O papel do exame clínico e da biópsia de nasofaringe no diagnóstico de doenças malignas

Abstract Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001). Conclusion: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Resumo Introdução: Em proporção direta à taxa crescente de exames de nasofaringe que são feitos, o diagnóstico precoce e o tratamento de lesões nessa região têm sido possíveis. Nem sempre os achados clínicos e os resultados da primeira biópsia são consistentes, levando à necessidade de biópsias repetidas. Objetivos: Avaliar a distribuição dos resultados dos testes histopatológicos obtidos pela biópsia de nasofaringe, determinar quais métodos foram mais frequentemente usados na identificação e investigar os casos nos quais a biópsia precisou ser repetida. Método: O estudo incluiu 1.074 pacientes (500 mulheres, 574 homens) submetidos a biópsia de nasofaringe em nossa clínica entre junho de 2011 e junho de 2017. Os dados foram obtidos dos prontuários dos pacientes e incluíram idade, sexo, achados clínicos, achados de imagem e diagnóstico histopatológico. Os diagnósticos histopatológicos foram separados em três grupos principais como nasofaringite crônica, citologia benigna e citologia maligna. Resultados: Os exames resultaram em 996 casos laudados como nasofaringite crônica, 47 como citologia benigna e 31 como citologia maligna. Das 31 lesões malignas, o diagnóstico foi feito em 15 (48,4%) com uma única biópsia e em 16 (51,6%), quando duas ou mais biópsias foram feitas. Na comparação das lesões benignas e malignas em relação à necessidade de biópsias repetidas, os casos determinados como malignos mostraram uma taxa estatisticamente maior de biópsia repetida (p < 0,001). Conclusão: Em comparação com os casos de tumores benignos, um número estatisticamente maior de biópsias repetidas foi necessário em casos diagnosticados como tumores malignos, para confirmação do diagnóstico histopatológico ou na suspeita continuada de malignidade. Portanto, quando há suspeita clínica, mesmo que não haja achados de malignidade na primeira biópsia, ela deve ser repetida tão logo seja possível.

Assessment of nasopharyngeal airway volume in pediatric patients with adenoid hypertrophy by cone-beam computerized tomography / Volumen de la vía aérea nasofaríngea en pacientes pediátricos con hipertrofia adenoidea: evaluación por tomografía computarizada de haz cónico

Objective: Adenoid hypertrophy is a disease whose most serious effect is the obstruction of the nasopharyngeal airway, leading to severe dentoskeletal deformities. The aim of this study was to determine the volume of the nasopharynx in patients with different grades of adenoid hypertrophy. Materials and methods: A retrospective study was conducted. One hundred and twenty-five cone beam computed tomographies of 8 to 12-year-old pediatric patients, obtained from the 2014-2017 database of the School of Dentistry of Universidad de San Martin de Porres, were selected. Romexis 3.6.0 software (PlanMeca®, Finland) was used. In order to make a diagnosis and determine the grade of hypertrophy (Grade 1= healthy, Grade 2= mild, Grade 3= moderate and Grade 4= severe) quantitative and qualitative methods were used; grades 2, 3 and 4 were considered pathological. The same software was used to determine the volume of the nasopharynx. Results: Grade 1 hypertrophy was 44%, mild 36,8%, moderate 13,6% and severe 5,6%, accounting for a pathological adenoid hypertrophy prevalence of 56%. The mean volume of the nasopharynx was 4.985, 3.375, 2.154 and 0.944cm3 for grades 1, 2, 3 and 4, respectively. Conclusions: There is a high prevalence of pathological adenoid hypertrophy (56%). The volume of the nasopharynx decreases according to the severity of the adenoid hypertrophy.

Objetivo: La hipertrofia adenoidea es una patología cuya repercusión más severa es la obstrucción de la vía aérea nasofaríngea, con graves consecuencias de malformaciones dento-esqueléticas. El objetivo del estudio fue determinar el volumen de la vía aérea nasofaríngea en pacientes con diferentes grados de hipertrofia adenoidea. Material y método: Se realizó un estudio retrospectivo, se seleccionaron 125 tomografías computarizadas de haz cónico de pacientes pediátricos de 8 a 12 años de edad obtenidas en la base de datos del 2014 al 2017 de la Facultad de Odontología de la Universidad de San Martín de Porres. Se utilizó el software Romexis 3.6.0 (PlanMeca®, Finlandia); para realizar el diagnóstico y determinar el grado de hipertrofia (Grado 1= sano, Grado 2=leve, Grado 3=moderado y Grado 4= severo) se utilizaron dos métodos, uno de evaluación cualitativa y otra cuantitativa; los grados 2, 3 y 4 fueron considerados como patológicos; para determinar el volumen de la vía aérea nasofaríngea se utilizaron las herramientas del mismo software. Resultados: La hipertrofia grado 1 estuvo constituida por el 44%, leve en el 36.8%, moderado en el 13.6% y severo en el 5.6%; constituyendo finalmente una prevalencia de hipertrofia adenoidea patológica del 56%. Las medias de los volúmenes de la vía aérea nasofaríngea fueron de 4.985, 3.375, 2.154 y 0.944 cm3 para los grados 1, 2, 3 y 4 respectivamente. Conclusión: Existe una alta prevalencia de hipertrofia adenoidea patológica (56%), el volumen de la vía aérea nasofaríngea tiende a disminuir conforme a la severidad de la hipertrofia adenoidea.

Neoadjuvant Vs Concurrent Chemotherapy Addition to Radiotherapy in Locally Advanced Carcinoma Nasopharynx: Analysis of Survival & Failure Patterns

Locally advanced nasopharyngeal cancer necessitates the use of both chemotherapy and radiotherapy foroptimal benefit. The current recommendation is to treat patients with stage IIB-IVB disease with concurrentchemoradiotherapy. The purpose of this study was to evaluate the survival outcome difference betweenconcurrent chemoradiation and neoadjuvant chemotherapy. Between January 2000 and December 2007,45 patients of nasopharyngeal cancer (stage IIB-IVB) were treated with curative intent in the DepartmentofRadiotherapy. 23 patients receivedneoadjuvant chemotherapy followed by radical radiotherapy and 22patients received concurrent chemoradiotherapy. The study cohort included 35 males and 10 femalessuffering from locally advanced carcinoma nasopharynx. Median age of the group was 52 years (range19-76 years). 2-year failure free survival in the concurrent chemoradiotherapy arm was 62% versus 38%in the neoadjuvant group (log rank p=0.197). Statistically significant difference was not observed in termsof failure free survival between the concurrent and neoadjuvant group.

Morphometric Study Of Pharyngeal Orifice Of Auditory Tube In South Indian Population

Auditory tube extends from the anterior wall of middle ear to the lateral wall of the nasopharynx at the level ofinferior turbinate. It plays an important role in maintaining the equilibrium of air. In the patients suffering fromchronic otitis media, the auditory tube plays an very important landmark for the endoscopic evaluation and fortransnasal approach to the infratemporal fossa. The present study was aimed to locate the pharyngeal orifice ofthe auditory tube in relation to the important anatomical landmarks. The study was carried out on 50 sagittalhead and neck sections of formalin fixed cadavers. The pharyngeal opening of auditory tube was looked for itsshape, size and position. The anatomical landmarks with reference to the pharyngeal opening of auditory tubetaken were posterior end of inferior turbinate, perpendicular distance from the clivus, from the roof of nasopharynx,from the posterior end of hard palate and from the anterior arch of atlas. The distance from these anatomicallandmarks to the pharyngeal orifice of auditory tube were measured using digital vernier calipers. The mean andstandard deviations of the distances were calculated and tabulated. The measured distances were slightlyhigher on the right than the left side. These differences were not statistically significant. The present study isuseful for otorhinolaryngologists to locate the position of pharyngeal opening of auditory tube endoscopicallyand evaluate patients with diseases of middle ear.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction? / Medidas obtidas por tomografia computadorizada em 3D das vias aéreas superiores em crianças com respiração bucal estão de acordo com o diagnóstico clínico-otorrinolaringológico de obstrução?

Abstract Introduction: Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. Objective: The objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. Methods: This retrospective study included 25 mouth-breathing children aged 5-9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. Results: The intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p < 0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p < 0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. Conclusions: (1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.

Resumo Introdução: O exame clínico otorrinolaringológico da via aérea superior tem sido historicamente feito com a ajuda de imagens radiográficas para diagnosticar causas obstrutivas da respiração bucal. Objetivo: O objetivo deste estudo foi comparar as medidas volumétricas em 3D da cavidade nasal, nasofaringe e orofaringe entre crianças com respiração bucal e obstrução respiratória e crianças respiradoras bucais sem obstrução respiratória. Método: Estudo retrospectivo que inclui 25 crianças respiradoras bucais de 5 a 9 anos. As crianças foram avaliadas por exame clínico otorrinolaringológico, nasofibroscopia flexível e tomografia computadorizada multi-slice. Medidas volumétricas obtidas tomograficamente de três regiões anatômicas (cavidade nasal, nasofaringe e orofaringe) foram correlacionadas e comparadas com diagnóstico dicotômico otorrinolaringológico (obstruído vs. não obstruído). Um teste t de amostra independente foi usado para avaliar a associação entre as medidas em 3D das vias aéreas superiores e o diagnóstico otorrinolaringológico de obstrução nas três regiões anatômicas. Os coeficientes de correlação intraclasse inter e intraobservador foram usados para avaliar a confiabilidade das medidas em 3D. Resultados: O coeficiente de correlação intraclasse variou de 0,97 a 0,99. Uma associação foi encontrada entre a hipertrofia de conchas e a redução do volume da cavidade nasal (p < 0,05) e entre a hiperplasia de tonsila faríngea e a redução do volume da nasofaringe (p < 0,001). Não foi encontrada associação entre a hiperplasia da tonsila palatina e a redução do volume da orofaringe. Conclusões: 1) O volume da cavidade nasal estava reduzido nas crianças com diagnóstico de hipertrofia de conchas; 2) O volume da nasofaringe estava reduzido nas crianças com diagnóstico de hiperplasia de tonsila faríngea; e 3) O volume da orofaringe de crianças com respiração bucal e hiperplasia de tonsila palatina foi semelhante ao de crianças respiradoras bucais sem aumento da tonsila palatina. A adoção da mensuração anatômica dos vários compartimentos da via aérea superior complementa o método de avaliação.

Assessment of size of adenoid-comparison of adenoidal nasopharyngeal ratio and nasal endoscopy in children with chronic adenoiditis

Background: Adenoid hypertrophy (AH) is a common cause of upper airway obstruction in paediatric patients and can have a significant influence on the health of the child. Children who have hypertrophic adenoids often exhibit nasal obstruction, snoring, sleep apnea, otitis media with effusion and craniofacial abnormalities. The main objective of this study was to know the association between size of adenoids and occurrence of otitis media with effusion (OME) and to correlate the grades of AH by lateral nasopharyngeal radiograph and nasal endoscope.Methods: This was an observational cross-sectional study of 100 children who were diagnosed as chronic adenoiditis were studied clinically with relevant investigations. The digital X-ray nasopharynx lateral view and nasal endoscopic results of all the patients were analyzed and graded.Results: Mean Adenoidal-nasopharyngeal ratio for which OME was present was 0.72 which corresponds to X-ray grade 2. It was also found that 80.6% of X-ray grade 3 adenoids had OME and 100% of cases of endoscopic grade 4 adenoids had OME in either or both ears.  36 cases with grade 3 X-rays, 69% were in endoscopic grade 3 and 19.4% cases were shown to have complete choanal obstruction (grade 4).Conclusions: There is significant association between the size of adenoids and OME. The X-ray nasopharynx provides a more convenient method and nasal endoscopy is the gold standard method for determining whether the AH is clinically significant or not.

A mimic of nasopharynx carcinoma turned out to be primary nasopharynx tuberculosis

Nasopharyngeal tuberculosis is indeed a rare manifestation of extrapulmonary tuberculosis. The general symptoms of nasopharyngeal tuberculosis are nasal obstruction, neck mass, epitaxis, rhinorrhoea, otalgia and hearing loss. Constitutional symptoms may present in almost 12-30% of nasopharyngeal tuberculosis cases, hence it often disguise as nasopharyngeal carcinoma in patients. Apart from that, most cases of nasopharyngeal tuberculosis usually occur with combined active pulmonary tuberculosis or systemic infection. Hereby presenting a case of nasopharyngeal tuberculosis in a lady who is otherwise healthy presented with neck mass for duration of two months with no obstructive symptoms. Upon proceeding with rigid nasal endoscopy, obliteration of fossa of rossenmuller was noted and biopsy confirmed tuberculosis. Patient was immediately started on antituberculosis therapy. Upon subsequent follow ups, resolution of the neck mass was noted. Hence, it is crucial to have a high index of suspiciousness to rule out nasopharyngeal tuberculosis as this is a curable disease and failure to do so can pave way for the deathly pathogen to disseminate in its host and cause mortality.

Histopathological Study Of Non-neoplastic Lesions Of Nose, Paransal Sinuses And Nasopharynx

Background: The various lesions of the nose, paranasal sinuses and nasopharynx were subjected to histopathological evaluation over a period of 5 years (2010 to 2015) at the Department of Pathology, in a rural based hospital. Total 84 specimens were studied over the time of 5 years. Methodology: The formalin fixed specimens were received with complete clinical and radiological features. Routine gross examination and required number of sections were taken and stained with hematoxylin and eosin. Result: In the study, 84 cases were of Inflammatory and Non neoplastic le-sions. Nasal polyps were the most common lesions with 77 (91.67%) cases. Among the all Nasal polyps, 77 cases, 20 (25.97%) cases were of Allergic polyp, 50 (64.93%) cases were of inflammatory polyp, while 7 (9.09%) cases were of Antrochoanal polyp. 2 cases (2.38%) each of Sinusitis and Intradermal naevus. Rhinosporidiosis, Mucocele and Na-solabial cyst comprised of 1 (0.77%) case each respectively. Conclusion: In our study, most common lesions were Nasal Polyps. Most of the cases were presented in 2ndand3rddecade of life with Male preponderance. Nasal obstruction was the most common clinical presentation in the present study.

MRI features of retronasopharyngeal space / 中国医学影像技术

Objective: To investigate the value of MRI in displaying posterior wall of nasopharynx. Methods: Plain MR scanning were performed in volunteers without head and neck lesions, including axial T1W and high-resolution T2W, and MRI manifestations of the posterior wall of nasopharynx were observed. Five formalin-fixed head and neck of adult cadavers were first evaluated with MRI, and then were frozen, cut into cross-section and stained with HE. The manifestations of the posterior wall of nasopharynx were observed contrastively with MRI and microscopic examination. Results: At the upper level of nasopharynx, the posterior wall of nasopharynx consisted of nasopharyngeal mucosa, fascia, prevertebral muscle and clivus from the outside. The heterogeneous signal was detected in bilateral prevertebral muscle, which was unable to clearly distinguish the posterior boundary of bilateral prevertebral muscles from the basilar clivus. Bilateral anterior edge of the prevertebral muscle was smooth and continuous low signal fascia shadow by gross observation, which was the fascia layer that consisted of the pharyngobasilar fascia, buccopharyngeal fascia, alar fascia and prevertebral fascia at the microscopic level. At the lower 1/2 level of nasopharynx, homogeneous signal was detected in bilateral prevertebral muscles, and the anterior edge was smooth while the shadow of the fascia was ambiguous, where the fibrous membranes of the pharyngeal constrictor turned thin distinctly and the pharyngeal constrictor separated it from the posterior fascia (consisted of buccopharyngeal fascia, alar fascia and prevertebral fascia) at the microscopic level. Furthermore, there was a high signal of the fat strip between posterior edge of bilateral prevertebral muscles and the lower clivus. Conclusion: MRI can clearly show the structures of fascia, prevertebral muscles and fat space in the posterior wall of nasopharynx.

Primary localized amyloidosis in nasopharynx: A Case Report

@#Nasopharyngeal amyloidosis is an extremely rare benign tumour. It is divided into localized or systemic amyloidosis. It is more common in men. Clinical presentation includes nasal blockage, epistaxis and reduced hearing. Classical positive Congo red stain and appearance of apple green birefringence on polarized microscopy confirms the diagnosis of amyloidosis. We present a case of nasopharyngeal amyloidosis in a 44-year old lady who presented with acute hearing loss for 1 week with epistaxis mimicking nasopharyngeal carcinoma. Clinical examination showed a nasopharyngeal mass with biopsy proven AA amyloidosis. She is now cured of amyloidosis following endoscopic transnasal excision of tumour. We discuss on the similarity of presentation between nasopharyngeal carcinoma; the commonest malignant tumour in our region and the much rarer nasopharyngeal amyloidosis as well as highlighting the importance in early recognition of the latter in view of its known risk of systemic involvement.