Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: a case report.

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.

Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases.

BACKGROUND AND OBJECTIVES: The incidence of acquired laryngeal stenosis is increasing. This retrospective study aimed to assess the long term results of circumferential resection with end-to-end tracheal anastomosis for isolated post-intubation stenosis of the cervical trachea, and to review the relevant literature. METHODS: Twelve male and two female patients (aged 16-30 years, mean age 24 years) treated between February 2003 and December 2008 were included. Hospital and office records were reviewed and relevant surgical details recorded. RESULTS: Indications for tracheal resection anastomosis were post-intubation stenosis (78.57 per cent) and trauma (21.42 per cent). One to five tracheal rings were resected (i.e. 1-2.5 cm of cervical trachea). Tracheal anastomosis was considered successful if the patient remained asymptomatic for 24 months of close follow up (involving regular flexible bronchoscopy and neck X-ray). The anastomotic success rate was 92.85 per cent. CONCLUSION: Tracheal resection and end-to-end anastomosis is relatively safe and reliable for definitive treatment of benign tracheal stenosis in appropriate patients. Local application of mitomycin C prevents granulation and aids long term airway patency.

Rhinosporidiosis of the parotid duct cyst: cytomorphological diagnosis of an unusual extranasal presentation.

This cytology report highlights a case of rhinosporidiosis of the parotid duct cyst not associated with nasal manifestations. In an endemic area, one should be familiar with its morphologic features in fine-needle aspiration cytology even on scanty material, for it could be one of the investigations in the initial workup of a case.

Tonsillar lymphangiomatous polyp - a case report.

Tumors which are benign in origin in palatine tonsils are not uncommon. They may create anxiety in patients and pose difficulty in differentiating from malignancy. We report a case of tonsillar polyp of lymphangiomatous origin.