Carcinoid tumor of the middle ear.

The patient was a 32 year-old man who was first seen in 2003 for 2 years hearing loss. On otoscopic examination, a whitish mass could be observed through the intact tympanic membrane. High resolution computed tomography showed a tumor like lesion in the middle ear with no evidence of bone destruction. A tympanomastoidectomy was performed. Light microscopy showed fragments of cellular tissue in which both glandular and trabecular growth pattern could be identified Immunohistochemical examinations showed positive staining of the tumor cells for cytokeratin and chromogranin. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is uncommon.

Carcinoma of the external auditory canal.

Carcinoma of the external auditory canal is one of the most inaccessible areas of the body. It is a rare malignant neoplasm with an aggressive nature and an overall poor prognosis. In a ten year period, 16 patients were treated in King Chulalongkorn Memorial Hospital. From TNM staging proposed by the University of Pittsburgh, the authors found T1 = 1, T2 = 6, T3 = 5, T4 = 4 cases. In 14 patients who were operated on (radical mastoidectomy in 8, lateral temporal bone resection in 5, sleeve resection in 1), 7 had cured (50%), 7 were recurrence. 6 cases of recurrence developed in patients with radical mastoidectomy, 1 case with lateral temporal bone resection. The overall cure rate in stage I-II = 85.71% (6/7) but only 11.11% (1/9) in the advanced stages (III-IV). The present data suggest that in early cancer (stage I-II) the lateral temporal bone resection with postoperative radiation is better than radical mastoidectomy with postoperative radiation.

The pectoralis major myocutaneous flap: applications and complications in head and neck reconstruction.

Ninety-six pectoralis major myocutaneous flaps were used in the head and neck reconstruction of 93 patients who underwent extirpation of cancer. The utilization of the pectoralis major myocutaneous flap included 50 tongue replacements, 19 hypopharynx and pharyngoesophageal closure, 11 oral mucosal closure and external skin replacement, 7 soft tissue coverage of the reconstruction plate, 3 soft tissue protection of the great vessels at the neck and 6 correction of the wound breakdown from failure of the other flap reconstruction. The major complication, which included total flap loss, partial skin paddle loss, orocutaneous fistula, dehiscence and plate exposure, was 17.7%. The overall complication rate was 54.2% and most of them were healed by conservative management. The pectoralis major myocutaneous flap is feasible and reliable for immediate reconstruction of various defects in the head and neck area. The pectoralis major myocutaneous flap should be the suitable flap for the advanced-staged cancer patient with a limited life expectancy.

Eosinophilic mucin rhinosinusitis: terminology and clinicopathological presentation.

Many terms related to allergic fungal rhinosinusitis (AFRS) such as eosinophilic mucin rhinosinusitis (EMRS), eosinophilic fungal rhinosinusitis (EFRS), and AFRS-like syndrome have been proposed. The authors define EMRS as patients with rhinosinusitis who demonstrate eosinophilic mucin on histopathological examination. EMRS patients who demonstrate fungal hyphae within the mucin are diagnosed as having EFRS and those who cannot demonstrate fungal hyphae within the mucin are diagnosed as having EFRS-like syndrome. EFRS patients who demonstrate an allergic response to the fungi are diagnosed as having AFRS and those who cannot demonstrate any allergic responses to the fungi are diagnosed as having non-allergic fungal rhinosinusitis (NAFRS). In the United States, the prevalence of AFRS in chronic rhinosinusitis patients who require surgery is 5-10 per cent. However, the prevalence of AFRS in Thailand is not known because AFRS has never been reported and studied in Thailand. This study shows the clinical and pathological entities of patients with EMRS in King Chulalongkorn Memorial Hospital from July 2001 to July 2002. From a total of two hundred and fourteen rhinosinusitis patients who required surgery, six were diagnosed as having EMRS. Two of six EMRS patients were diagnosed as having EFRS (both of them were also diagnosed as having AFRS) and four patients were diagnosed as having EFRS-like syndrome. In this study, the prevalence of AFRS is much less than in the United States because of the limited understanding of this disease, the lack of commercially available antigens for dematiaceous fungi, and the lack of awareness and knowledge of pathologists to diagnose eosinophilic mucin and fungi within the mucin. The terms related to AFRS are also discussed in this study.