Oncogenic osteomalacia caused by an occult paranasal sinus tumor.

Oncogenic osteomalacia (OOM) is a rare bone disease characterized by inadequate bone mineralization and is caused by a humoral factor mainly produced by benign mesenchymal tumors. We report a case of OOM caused by an occult phosphaturic mesenchymal tumor in the paranasal sinus. The causative tumor was small and localized in the ethmoid sinus, and the patient did not exhibit any nasal symptoms. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) depicted the location of the occult tumor, and systemic venous sampling followed by assessments of the samples' fibroblast growth factor 23 (FGF23) concentrations confirmed that the tumor secreted FGF23. The tumor was resected via an external surgical approach, resulting in the complete relief of the patient's symptoms. The combination of FDG-PET and systemic venous sampling to assess serum FGF23 levels is useful for identifying small asymptomatic OOM-associated tumors. Such tumors are rare, but a significant proportion of them develop in the head and neck region, and complete resection is the most effective treatment. It is important that ENT surgeons are aware of the characteristics of OOM.

Combined small cell carcinoma of the sinonasal tract associated with syndrome of inappropriate secretion of antidiuretic hormone: A case report.

Combined small cell carcinoma (SmCC) and squamous cell carcinoma (SqCC) is a rare malignant neoplasm in the head and neck. This study presents the first reported case of combined SmCC and SqCC originating from the sinonasal tract accompanied by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). An 80-year-old female presented with a four-week history of right nasal discharge, nasal obstruction and left neck swelling. Imaging studies revealed a tumorous lesion in the maxillary sinus encroaching upon the right nasal cavity and left cervical lymph node (LN) swelling. An incisional biopsy carried out from the right maxillary sinus and LNs resulted in a diagnosis of combined SmCC with SqCC, staged as T4aN2cM0. Clinical examination revealed a sustained increase of antidiuretic hormone, hyponatremia with urinary sodium increase, and serum hypo-osmosis, resulting in SIADH. Water restriction to <1,000 ml/day was effective in improving sodium and osmotic imbalance. Curative treatment for the tumor was not prescribed due to the poor condition of the patient. Palliative treatment was administered and the patient succumbed to cachexia five months after histological diagnosis. The presence of SIADH may have marked implications for the treatment and prognosis of this disease.

Development of a new method using narrow band imaging for taste assessment.

OBJECTIVES/HYPOTHESIS: The observation of fungiform papillae is a useful objective taste examination. The purpose of this study is to develop a new method using narrow band imaging for assessment of taste function. STUDY DESIGN: Using a narrow band imaging endoscope, we assessed the number and blood vessel morphology of fungiform papillae and compared with the gustatory threshold by the filter paper disc test. METHODS: The number of fungiform papillae was counted in 20 mm(2) , and blood vessels in fungiform papillae were evaluated morphologically by a five-point scoring system in 11 patients who had undergone middle ear surgery. The filter taste disc test was performed simultaneously to obtain the gustatory threshold and was compared with the number and blood vessel morphology of fungiform papillae. RESULTS: Using a narrow band imaging endoscope, we could clearly detect not only fungiform papillae but also blood vessel morphology. There was a significant correlation between the values of the number of papillae and blood vessel morphology. Moreover, these two parameters revealed a significant inverse correlation with gustatory function. As expected, both parameters on the affected side were significant lower than those on the unaffected side in patients. CONCLUSIONS: The assessment of fungiform papillae using narrow band imaging endoscopy is easy, highly sensitive, and reliable; therefore, it might be useful as an objective examination of taste function. LEVEL OF EVIDENCE: N/A.