Inferior turbinate angiofibroma: an atypical presentation [correction of preservation].

Angiofibromas are nasopharyngeal tumours mostly seen in adolescent males. They usually present with nasal obstruction and epistaxis. They account for less than 0.5% of all head and neck tumours. Extranasopharyngeal angiofibromas although rare, have been reported (Ali et al., 1982). The most common extranasopharyngeal site is the maxillary sinus. We report a case of extranasopharyngeal angiofibroma arising from the inferior turbinate which had an unusual clinical presentation.

Intranasal glomangioma.

Glomangioma is a benign tumour of the glomus body. It is a relatively rare tumour in the head and neck region and even rarer in the nasal cavity. We present the 13th documented case of an intranasal glomangioma. A 56-year-old woman presented with a lesion on the nasal septum associated with intermittent nasal pain and epistaxis. Local surgical excision was not only diagnostic but therapeutic as it effected a cure. Intranasal glomangioma has no well-defined presenting features but must be borne in mind as a possible rare cause of nasal pain and epistaxis. We also briefly review the clinical presentation, histology and management of such a rare tumour.

The changing faces of a parotid mass.

The development of a neurofibroma in the temporal and parotid regions of the facial nerve is rare. We report a case occurring in a 32-year-old male, where the initial presentation was a parotid mass. Cytologically this was initially thought to be a pleomorphic adenoma. However, the diagnosis was then changed to a schwannoma and finally a neurofibroma after complete excision of the lesion. The case illustrates how fine needle aspiration cytology under ultrasound guidance, and even histological examination of an incision biopsy can sometimes fail to give the correct diagnosis. In this case magnetic resonance imaging was used to help plan definitive surgery.

Wegener's granulomatosis--a review of diagnosis and treatment in 53 subjects.

We reviewed 79 patients with clinically suspected Wegener's granulomatosis (WG) diagnosed in Nottingham between 1990 and 1997. Fifty-three patients were confirmed as having WG. We describe the symptoms and signs, features of diagnostic significance, ANCA results, biopsy sites, histology, treatment and outcome in this group. Nasal symptoms and signs had a positive predictive value of 63%, c-ANCA at presentation 100%, and positive nasal biopsy 100%. The negative predictive values were 41%; 79% and 74% respectively. From this study, we recommend that patients who have a negative ANCA and where there remains a clinical suspicion of WG, an ENT examination should be undertaken. Whilst a suspicious lesion should be biopsied and a positive histological picture has a 100% positive predictive value, a negative nasal biopsy does not exclude WG as 5 patients went on to develop a positive ANCA up to 4 years later. In 11 ANCA negative patients where there were signs of nasal mucosal disease, 6 had a positive biopsy and this highlights the importance of nasal biopsy. The c-ANCA should be repeated in patients with a negative c-ANCA and biopsy results at presentation, in whom there remains a clinical suspicion of WG.