A sinonasal yolk sac tumor in an adult

Yolk sac tumors (YSTs), which are also called endodermal sinus tumors, are malignant tumors of germ cell origin. These tumors usually occur in the gonads, but 20% of cases have been reported at extragonadal sites. The head and neck is a rarely affected region that accounts for just 1% of all malignant tumors of germ cell origin. In addition, YSTs arise mostly in childhood. We present a rare pathologically pure case of primary adult YST in the sinonasal area. A 45-year-old male patient presented with a rapidly growing mass in the nasal cavity, which caused nasal obstruction and bloody post-nasal drip. The histopathologic features indicated pure YST, and immunohistochemical analysis revealed positive reactivity for Sal-like protein 4 and alpha-fetoprotein. Herein, we discuss the clinical, radiologic, and histologic features of this YST and review other cases of sinonasal YST in adults.

Role of Natural Killer Cells in Airway Inflammation

Natural killer (NK) cells have an immune regulatory function as well as cytotoxicity against tumor or infected cells. In the airway, although NK cells constitute a small proportion of the resident lymphocytes, they play an important role in the pathogenesis of chronic inflammatory airway diseases by modulating immune responses. NK cells can promote allergic airway inflammation by increasing the production of type 2 cytokines and inducing eosinophil migration. The increased activity of NK cells can develop or aggravate the destruction of lung parenchymal cells. On the other hand, decreased apoptotic activity of NK cells in eosinophils can serve as an aggravating factor for allergic airway inflammation. The increase in interferon-γ-producing NK cells and the inhibition of type 2 immune response by NK cells can alleviate allergic airway inflammation. This review aims to define the roles of NK cells in chronic inflammatory diseases of lower and upper airways.

Sinonasal Undifferentiated Pleomorphic Sarcoma in Five Patient Cases

Undifferentiated pleomorphic sarcoma (UPS) is a rare soft tissue sarcoma of the sinonasal area. Here, we present two primary cases of UPS and three post-irradiation sinonasal UPS cases. Imaging findings were misinterpreted by radiologists as representing other malignant tumors or recurrence of the primary tumor. Our cases indicate that post-irradiation UPS can originate within any part of the radiation field. Treatment outcomes of primary sinonasal UPS seem to be favorable if the tumor is treated aggressively, but the outcomes of post-irradiation sinonasal UPS may be poor if appropriate surgical margins cannot be obtained.

Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.

Human Rhinovirus-induced Proinflammatory Cytokine and Interferon-beta Responses in Nasal Epithelial Cells From Chronic Rhinosinusitis Patients

PURPOSE: Asthma exacerbation from human rhinovirus (HRV) infection is associated with deficient antiviral interferon (IFN) secretion. Although chronic rhinosinusitis (CRS), an inflammatory upper airway disease, is closely linked to asthma, IFN-beta responses to HRV infections in human nasal epithelial cells (HNECs) from CRS patients remain to be studied. We evaluated inflammatory and antiviral responses to HRV infection in HNECs from CRS patients. METHODS: HNECs, isolated from turbinate tissue of 13 patients with CRS and 14 non-CRS controls, were infected with HRV16 for 4 hours. The HRV titer, LDH activity, production of proinflammatory cytokines and IFN-beta proteins, and expression levels of RIG-I and MDA5 mRNA were assessed at 8, 24, and 48 hours after HRV16 infection. RESULTS: The reduction in viral titer was slightly delayed in the CRS group compared to the non-CRS control group. IL-6 and IL-8 were significantly increased to a similar extent in both groups after HRV infection. In the control group, IFN-beta production and MDA5 mRNA expression were significantly increased at 8 and 24 hours after HRV16 infection, respectively. By contrast, in the CRS group, IFN-beta was not induced by HRV infection; however, HRV-induced MDA5 mRNA expression was increased, but the increase was slightly delayed compared to the non-CRS control group. The RIG-I mRNA level was not significantly increased by HRV16 infection in either group. CONCLUSIONS: HRV-induced secretion of proinflammatory cytokines in CRS patients was not different from that in the non-CRS controls. However, reductions in viral titer, IFN-beta secretion, and MDA5 mRNA expression in response to HRV infection in CRS patients were slightly impaired compared to those in the controls, suggesting that HRV clearance in CRS patients might be slightly deficient.

Analysis of Facial Deformities in Korean Leprosy

OBJECTIVES: The clinical features of various facial deformities in Korean leprosy patients were evaluated according to the type of leprosy. METHODS: One hundred ninety six patients with leprosy were examined for various facial deformities using a nasal speculum, endoscope, and digital camera. The frequency and severity of external nasal deformities and septal perforations were evaluated according to the type of leprosy. Eye deformities, ear deformities, and facial palsy were also assessed. RESULTS: Seventy-one patients (36.2%) displayed external nasal deformities: 28 minimal contractures, three cartilage contractures, two bony-cartilage contractures, and 38 skin defects. The external nasal deformity and severe form deformity in lepromatous types were more frequent compared to other types (P0.05 for each variable). Sixty-one patients (31.1%) had eye deformities and 19 patients (9.7%) had facial nerve palsy, common in the borderline type. No cases of ear deformities were observed. CONCLUSION: Korean patients had characteristic deformities according to the type of leprosy. They were different from those seen in the prior analyses of Caucasian populations.

The Treatment Outcomes of Primary Subglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Primary subglottic cancer is uncommon, so our understanding of primary subglottic cancer is limited. The purpose of this study is to review the clinical characteristics and treatment result of primary subglottic cancer from our experience. SUBJECTS AND METHOD: During the period from Nov. 1996 to Nov. 2010, patients with primary subglottic cancer were reviewed retrospectively. The mean follow up period was 46.1+/-40.9 months. We analyzed its clinical characteristics, stage, treatment results and survival rate. RESULTS: Of 824 patients with diagnosed laryngeal cancer, 8 (0.97%) had primary subglottic cancer and hoarseness (50.0%) is the most common initial presenting symptom. The symptom of dyspnea was found in 25.0% (2/8) of the patients and squamous cell carcinoma in 75% (6/8). At the time of diagnosis, the four clinical stages of TNM, T1, T2, T3 and T4, had 1 (12.5%), 2 (25.0%), 1 (12.5%) and 4 (50.0%) patients, respectively. There were two cases of cervical lymph node metastases, N1 and N2c. No distant metastasis was found. Two groups of patients comprising of two patients each received surgery alone or radiation alone as an initial treatment; another two groups of patients comprising of two patients each received concurrent chemoradiation or surgery plus radiation therapy alone. The overall 2-year survival rate was 80.0% and 2-year disease free survival rate was 51.7% in patients with squamous cell carcinoma. CONCLUSION: Despite the infrequency of primary subglottic cancer, it is important to understand its clinical characteristics and treatment results during the early diagnosis to make the prognosis better.

Clinical Features and Treatment Results of 64 Cases of Nasolabial Cyst

BACKGROUND AND OBJECTIVES: Nasolabial cysts are relatively rare and are sometimes confused with tumors due to progressive enlargement. Treatment of a nasolabial cyst consists of sublabial excision or endonasal endoscopic marsupialization (EEM). The purpose of this study was to investigate the clinical features of nasolabial cysts in order to provide a basis for correct diagnosis and treatment. MATERIALS AND METHODS: Sixty-four patients with a nasolabial cyst were surgically treated between December, 1989 and January, 2010 at the Department of Otolaryngology, Asan Medical Center. Their clinical features, radiologic and histopathologic findings, and treatment and outcomes were retrospectively analyzed. RESULTS: The patients comprised 51 (80%) women and 13 men (20%), with ages ranging from 16 to 69 years with a mean of 43 years. Swelling of the nasolabial fold was the most frequently experienced symptom. There was no right or left side preponderance. Sublabial excision was applied in 57 cases (89%), while seven cases (11%) were treated via the endonasal approach. There was no case of recurrence. CONCLUSION: Nasolabial cysts should be suspected in patients with swelling of the nasolabial area and nasal obstruction. Enhanced CT may be needed to differentiate from tumors, odontogenic cysts, or other inflammatory lesions. Nasolabial cysts can be successfully treated via sublabial or endonasal approaches. Postoperative complications or recurrence is very rare.

Excision of a Nasal Dermoid Sinus Cyst via Open Rhinoplasty Approach and Primary Reconstruction Using Tutoplast-Processed Fascia Lata

Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.

Clinical Outcome of Salvage Treatment for Recurrent Supraglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is difficult to treat recurred supraglottic cancer safely and preserve physiologic function of the larynx. This study was designed to review the clinical manifestations of recurrent supraglottic cancer and compare the results of each salvage treatments. SUBJECTS AND METHOD: During the period from Jan 2000 to Sep 2007, thirty recurrent supraglottic cancers were reviewed retrospectively. Their mean follow-up period was 30.8+/-20.1 months. We investigated initial treatment methods, stage, recurrent sites and salvage methods, and analyzed the oncological results including disease-specific survival and overall survival. RESULTS: Ninety-seven percent of all recurrence occurred within 3 years and 76.7% of all recurrence were diagnosed at stage III-IV when recurrence was detected. Five-year disease-specific survival rate was 28.4% and five-year overall survival rate was 73.4%. Recurrence at the primary site showed significantly better overall survival rate than that at the lymph node, primary and lymph node recurrence, or distant metastasis (p=0.008). Patients who were salvaged with total laryngectomy had significantly better disease-specific survival rate and overall survival rate (p< 0.001). CONCLUSION: With careful selection of salvage treatment for recurrent supraglottic cancer, acceptable oncological result can be achieved. Further study for laryngeal preservation for recurrent cases is necessary.

Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea

OBJECTIVES: Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. METHODS: We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. RESULTS: After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. CONCLUSION: The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.

Clinical Results of Atticoantrotomy with Attic Reconstruction or Attic Obliteration for Patients with an Attic Cholesteatoma

OBJECTIVES: We aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma. METHODS: Ninety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed. RESULTS: There were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2+/-13.5 dB and 25.0+/-15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5+/-9.7 dB and 15.23+/-14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients. CONCLUSION: Atticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.

Clinical Significance of Retropharyngeal Lymph Node Metastasis from Hypopharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Little information about the incidence of retropharyngeal adenopathy and its impact on prognosis has been published. The purpose of this study is to investigate the incidence and prognostic significance of metastatic retropharyngeal adenopathy in patients with squamous cell carcinoma of the hypopharynx. SUBJECTS AND METHOD: The pretreatment CT/MRI of 121 patients with squamous cell carcinoma of the hypopharynx were reviewed for the presence of metastatic retropharyngeal lymph nodes. All patients were treated between 1996 and 2005. The influence on recurrence (local and regional), distant metastasis, and survival was retrospectively analyzed. Mean follow-up was 28.3 months. RESULTS: Retropharyngeal node involvement was present in 21 (17.4%) patients. The clinical T staging was the most significant factor relating to the incidence of retropharyngeal adenopathy in multivariate analysis (p=0.006). The rates of regional recurrence and distant metastasis were significantly higher in patients with retropharyngeal adenopathy. Disease specific survival rate was significantly lower in the retropharyngeal node positive group (p=0.013). CONCLUSION: Retropharyngeal node involvement has a negative impact on the prognosis of squamous cell carcinoma of the hypopharynx. Patients are particularly at risk for distant metastasis, resulting in worse disease-specific survival. Retropharyngeal node involvement should be taken into account in designing the treatment plan for these patients.