Angiosarcoma de cavidad nasal: reporte de caso y revisión de literatura / Nasal cavity angiosarcoma: case report and literature review

Los tumores malignos de cavidad nasal y cavidades paranasales son poco frecuentes y sus síntomas de presentación suelen ser unilaterales e inespecíficos; éstos incluyen: epistaxis, rinorrea y obstrucción nasal. Encontramos una amplia variedad histológica de tumores, entre ellos tenemos el angiosarcoma nasal, que es considerado una rareza y el diagnóstico definitivo lo da la confirmación anatomopatológica complementado con estudios inmunohistoquímicos. Su modalidad de tratamiento incluye múltiples opciones, pero la cirugía radical temprana con márgenes negativos asociado a radioterapia adyuvante, ofrece el mejor pronóstico. Se presenta a un paciente adulto masculino con un angiosarcoma nasal izquierdo que fue detectado de forma precoz y se manejó con cirugía radical y radioterapia.

Malignant tumors of the nasal cavity and paranasal cavities are rare, while presenting symptoms are usually unilateral and nonspecific like, epistaxis, rhinorrhea, and nasal obstruction. There are many histological varieties of tumors, among them we have nasal angiosarcoma, which is considered a rarity pathology. The definitive diagnosis is given by biopsy confirmation complemented with immunohistochemical studies. Its treatment modality includes multiple options, but early radical surgery with negative margins associated with adjuvant radiotherapy offers the best prognosis. We present a male adult patient with a left nasal angiosarcoma that was detected early and managed with radical surgery and radiotherapy.

Sinonasal Mucormycosis in a Diabetic - Case Report

Background : Mucormycosis is one of the rapidly progressing and lethal form of fungal infection which involves the nose and paranasal sinuses of the head and the neck regions. It manifests as rhinocerebral, sinonasal, pulmonary, gastrointestinal, cutaneous or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes. Objective: To present and discuss the case of a diabetic patient with sinonasal mucormycosis presented with facial pain and discolouration of right side of nose and face due to mucormycosis. Case report: A 23 years old female patient presented to emergency with uncontrolled blood sugars, pain and swelling over right side of face and blackish discolouration of right side of nose. On examination, there was bluish black discolouration of skin over right side of dorsum of nose and right ala of nose and right nasal vestibule. Sinus CT scan showed features suggestive of fungal sinusitis. Mucormycosis was suspected, confirmed with biopsy and surgical debridement and medial maxillectomy done. Intravenous amphotericin B was administered for 21 days. The patient was followed up regularly, the disease appearing to be resolved. Conclusion: Mucormycosis is a rapidly progressive fatal infection mostly reported in immune-compromised individuals. Emergency multidisciplinary treatment for control of blood sugars, surgical debridement and effective antifungal medications gives better clinical outcome.

Oncocytic Schneiderian Papilloma: A Rare Sinonasal Papilloma Removed via Endoscopic Medial Maxillectomy

There are three types of papilloma which arises from the Schneiderian membrane namely inverted, fungiform and oncocytic. Oncocytic papilloma is the rarest type and occurs predominantly in the older age group. Clinically, its behaviour is similar to inverted papilloma in having both local recurrence and associated malignancy. We report a rare case of oncocytic papilloma arising from the maxillary sinus, extending into the nasal cavity and nasopharynx, in a 78-year-old lady. Despite the longstanding history there was no evidence of associated malignancy in this lesion. An endoscopic medial maxillectomy was successfully utilized for approach and complete tumour excision. In conclusion, oncocytic papilloma should be considered as a differential diagnosis in patients presenting with unilateral polypoid nasal lesions especially in the elderly. In addition, endoscopic medial maxillectomy can provide an adequate approach for complete tumour removal.

Epiphora after Medial Maxillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Medial maxillectomy is commonly performed for benign and low-grade malignancies involving the lateral wall of the nose. The most frequent complications are cavity crusting, epicanthal scarring and epiphora. Silicone stent, tube fixation in lacrimal sac have been used for prophylaxis of epiphora. Authors studied for the incidence of epiphora and necessity for prophylatic procedure of epiphora in patients who underwent medial maxillectomy. MATERIALS AND METHOD: This study was performed on 26 patients treated with medial maxillectomy without additional procedure for management of epi-phora. The minimal duration of follow-up was 6 months. RESULTS: Twenty one patients were treated with medial maxillectomy only and five patients were treated with medial maxillectomy combined with irradiation. Incidence of epiphora was about 7% (2/26). All patients who complained of epiphora had inverted papilloma and underwent medial maxillectomy without irradiation. No patients treated with combination of medial maxillectomy and irradiation complained epiphora. CONCLUSION: It is not necessary to do routine prophylatic procedures for epiphora at the initial procedure.

Inverted Papilloma of the Nose and Paranasal Sinuses: Treatment Outcomes of 76 Cases

To learn the long-term effects of surgical treatment for inverted papilloma, we retrospectively studied 76 patients who underwent surgery for inverted papilloma between March 1990 and June 1997 and who followed up for at least one year. The patient pool consisted of 65 males and 11 females, and their ages ranged from 29 years to 81 years (mean age : 52 years). Twenty-eight patients (37%) had a history of previous nasal surgery, performed to treat nasal polyps with or without sinusitis. Conservative surgery resulted in four recurrences (16%) out of 25 patients, while medial maxillectomy resulted in three recurrences (6%) out of 47 patients. Endoscopic removal was performed in eight patients and resulted in one recurrence. Due to complications related to a medial maxillectomy, seven cases developed epiphora caused by stenosis of the lacrimal opening in the nasal cavity. The overall recurrence rate was 9%. Tumors recurred in four (67%) out of the six patients with associated carcinoma, one (13%) out of the eight patients with atypia, and two (3%) out of the 62 patients with inverted papilloma only. In conclusion, a preoperative biopsy is recommended for any unilateral polypoid nasal mass developed in adults. Medial maxillectomy may reduce the recurrence of inverted papilloma in spite of its disadvantages, which include external scarring and epiphora. Patients, especially those with associated atypia or carcinoma, should be followed up regularly for several years because of the high recurrence rate.

A Clinical Study on the Surgical Treatment of Inverted Papilloma / 대한이비인후과학회지

BACKGROUND: Inverted papilloma is an uncommon benign tumor which is characterized by local aggressiveness, high recurrence rate, associated malignancy and tendency to multicentricity. Most authors advocate radical surgical removal of these tumors; however, conservative endoscopic surgery has been reported to be effective in selected cases. OBJECTIVES: To compare with operative methods of the inverted papilloma. MATERIAL AND METHODS: This study comprised 14 cases of inverted papilloma, which were divided into 3 groups. The first was lateral rhinotomy and traditional medial maxillectomy treated group with 7 cases. The second group was treated with conservative endoscopic intranasal resection of 4 cases and the third group was treated by endoscopic medial maxillectomy of 3 cases. RESULTS: The follow-up periods in average were 23 months, 19 months and 11 months in first, second and third groups respectively. All cases showed no recurrence. CONCLUSION: Although follow-up periods are insufficient, the endoscopic approaches are meaningful methods to treat inverted papilloma.

Treatment of Inverted Papilloma: A Comparision of Extranasal Operation and Conservative Surgery Using Nasal Endoscope / 대한이비인후과학회지

BACKGROUND: Inverted papilloma is a benign neoplastic lesion which shows high recurrence rate and possibility of association with malignancy. Medial maxillectomy has been preferred as a treatment of choice, for conservative treatments resulted in higher recurrence rate. However, introduction of nasal endoscope made more precise evaluation of intranasal lesion under brighter illumination. OBJECTIVES: Aim of this study was to compare the recurence rate between medial maxillectomy and conservative surgery using nasal endoscope. MATERIAL AND METHODS: Thirty one patients who underwent operation between 1980 and 1995 were retrospectively studied. RESULTS: Fifteen patients were treated via external approach and sixteen patients endoscopically. Inverted papilloma was recurred in two cases of endoscopic surgery group and one case of external surgery group. CONCLUSION: Endoscopic conservative surgery can be an alternative surgical modality in the selected cases.