Nasal Endoscopy and Computed Tomography for Epistaxis of Clinically Inapparent Aetiology.

Epistaxis is one of the common otorhinolaryngological emergencies that are encountered in daily practice. Aetiology of epistaxis may range from benign conditions like septal spur, infected nasal polyps etc to serious causes like malignancies. Many a times, the cause for epistaxis is not found on anterior and posterior rhinoscopy. We wanted to assess the role of nasal endoscopy and computed tomography of paranasal sinuses (CT scan of PNS) among patients with epistaxis in whom the cause is not evident after history taking and clinical examination. MethodsThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. For patients included in the study, diagnostic nasal endoscopy under local anaesthesia was done and findings were noted. If any bleeding point was visualised on endoscopy, it was cauterised. In selected cases, endoscopic biopsy from nasal mass was done, and sent for histopathological examination. CT scan of PNS was done and findings were noted. ResultsIn the evaluation of patients with epistaxis of inapparent aetiology, nasal endoscopy could aid the diagnosis in 61.8% of patients, and CT scan of PNS in 81.8 % of patients. Statistical comparison of measure of agreement between nasal endoscopy and CT scan of PNS for diagnosis of epistaxis of clinically inapparent aetiology yielded a kappa value of 0.187 which can be interpreted as slight agreement. Sensitivity of nasal endoscopy and CT scan for diagnosing sinonasal neoplasms as compared to histopathological examination (gold standard) was 83.3% and 100% respectively. Both had an accuracy of 66.7% as compared to histopathological examination. Statistical comparison of measure of agreement between nasal endoscopy and CT PNS for diagnosing sinonasal inflammation yielded a kappa value of 0.391 which can be interpreted as fair agreement. ConclusionsFor evaluation of sinonasal neoplasm causing epistaxis, CT scan of PNS has higher sensitivity than nasal endoscopy. Subclinical sinonasal infection could be a triggering factor for epistaxis in older patients. Nasal endoscopy and CT scan of paranasal sinuses are important and complementary tools in the evaluation of epistaxis.

Sinonasal neoplasms in 49 dogs: clinical, macroscopic, and histopathological aspects / Neoplasmas nasossinusais em 49 cães: aspectos clínicos, macroscópicos e histopatológicos

This study aimed to quantify nasosinusal neoplasms diagnosed in dogs in 20 years (2000-2019) and characterize the main clinical, macroscopic, and histological aspects of these neoplasms. The sex, breed, age, skull conformation, the main clinical signs, and the anatomopathological characteristics (distribution, macroscopy, and histology) were computed. During this period, 49 dogs were affected by neoplasms in these regions, totaling 50 neoplasms (one dog had two neoplasms of different locations and histogenetic origins). Similar amounts of mixed-breed dogs (25/49) and purebred dogs (24/49) were affected, these distributed in 16 breeds. Among purebreds, it was noted that dogs with mesocephalic cranial conformation (12/24) were the most affected, followed by dolichocephalic (10/24) and brachycephalic (2/24). There were 22 cases in males and 27 in females, making a proportion of 1:1.23. There was an age variation from 11 months to 16 years old. The epithelial neoplasms have occurred in older dogs compared to those of other histogenic origins (mesenchymal and other origins/round cells). The main clinical signs were similar between the histogenetic categories, related to the involvement of the upper respiratory tract, sometimes accompanied by nervous signs (when there was brain invasion of nasal neoplasms or vice versa). The possible origin site was mostly in the nasal cavity concerning the paranasal sinuses (and other locations). Invasions occurred in different tissues adjacent to the nasal cavity and paranasal sinuses, resulting in cranial and facial deformities (21/49). The frequency was 48% of epithelial neoplasms, 32% of mesenchymal neoplasms, and 10% of neoplasms with other origins and round cells. The neoplasms most frequently observed, in decreasing order of frequency, were: adenocarcinoma (9/50), squamous cell carcinoma (9/50), transmissible venereal tumor (5/50), osteosarcoma (5/50), chondrosarcoma (4/50), and undifferentiated sarcoma (4/50). Through this study, it was possible to establish the frequency of these neoplasms in 20 years and their clinical, macroscopic, and histological characteristics.(AU)

Este estudo teve como objetivo quantificar os neoplasmas nasossinusais diagnosticados em cães em 20 anos (2000-2019) e caracterizar os principais aspectos clínicos, macroscópicos e histológicos desses neoplasmas. Foram computados sexo, raça, idade, conformação do crânio, principais sinais clínicos e características anatomopatológicas (distribuição, macroscopia e histologia). Nesse período, 49 cães foram acometidos por neoplasmas nessas regiões, totalizando 50 neoplasmas (um cão tinha dois neoplasmas de localização e origens histogenéticas distintas). Foram acometidas quantidades semelhantes de cães sem raça definida (25/49) e de cães com raça definida (24/49), estes distribuídos em 16 raças. Entre os cães com raça definida, notou-se que os cães com conformação craniana mesocefálica (12/24) foram os mais acometidos, seguidos pelos dolicocefálicos (10/24) e braquicefálicos (2/24). Foram observados 22 casos em machos e 27 em fêmeas, perfazendo a relação de 1:1,23. Ocorreu uma variação de idade de 11 meses a 16 anos; tendo os neoplasmas epiteliais ocorrido em cães mais velhos quando comparado aos de outras origens histogênicas (mesenquimais e outras origens/células redondas). Os principais sinais clínicos foram semelhantes entre as categorias histogenéticas, sendo relacionados ao comprometimento do trato respiratório superior, por vezes acompanhados de sinais nervosos (quando houve invasão encefálica de neoplasmas nasais ou vice-versa). O possível local de origem em sua maioria foi na cavidade nasal em relação aos seios nasais (e de outras localizações). Ocorreram invasões para diferentes tecidos adjacentes à cavidade nasal e seios paranasais, tendo como consequência deformidades cranianas e faciais (21/49). A frequência foi de 48% de neoplasmas epiteliais, 32% de neoplasmas mesenquimais e 10% de neoplasmas com outras origens e de células redondas. Os neoplasmas mais frequentemente observados, em ordem decrescente de frequência, foram: adenocarcinoma (9/50), carcinoma de células escamosas (9/50), tumor venéreo transmissível (5/50), osteossarcoma (5/50), condrossarcoma (4/50) e sarcoma indiferenciado (4/50). Com isso, pode-se estabelecer a frequência desses neoplasmas em 20 anos, bem como suas características clínicas, macroscópicas e histológicas.(AU)

Sinonasal mammary analogue secretory carcinoma: a clinicopathological analysis of 2 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathological features of sinonasal primary secretory carcinoma (SC) and its diagnosis, differential diagnosis. Methods Two cases of sin-nasal SC were analyzed by light microscopy with immunohisto-chemical staining (EnVision) for CK, vimentin, S-100 protein, SOX10, PAS, DPAS, Mamaglobin, Calponin, DOG1, p63 and molecular detection of ETV6 gene break. Results Morphologically, SC revealed varying proportions of solid, tubular, acinar, microcystic, tubular growth patterns. All SC cases were cytological low grade with uniform cells, small-to medium-sizes nuclei, occasional small nucleoli, and abundant pink, bubbly cytoplasm. Mitotic figures were rarely encountered. Tumor cells secreted eosinophilic, colloid-like secretions that were PAS positive. There were no DPAS positive zymogen granules in cyto-plasm. This tumor cells were CK, vimentin, S-100, SOX10, PAS positive and Mamaglobin, Calponin and p63 negative. The ETV6 gene rearrangement was confirmed in all cases by fluorescence in situ hybridization (FISH). After excision, all two patients were survival without tumor recurrence for 41 months and53 months. Conclusion Sinonasal primary SC is a low grade malignant tumor. The histological features of SC are overlap with other salivary gland tumors. Immunohistochemical analysis and FISH are useful for the diagnosis and differential diagnosis.

Nasal Obstruction due to Fibrous Dysplasia Invading Inferior and Middle Turbinates: A Case Report and Literature Review / 대한이비인후과학회지

Fibrous dysplasia (FD) is a rare type of fibro-osseous lesion characterized by progressive replacement of normal bone with immature tissue. The involvement of craniofacial bones is reported in 10% of FD cases, while the involvement of sinonasal cavity is extremely rare. We report a unique case of FD in which the primary complaint was nasal obstruction. As FD cases involving the turbinate bones are very rare, we also reviewed all reported cases of FD involving the inferior or middle turbinates. Based on our experience and a review of the relevant literature, we conclude that inferior and/or middle turbinectomy via endoscopic approach and septoplasty can improve nasal symptoms.