Atypical Lipomatous Tumor Originating From the Nasopharynx in a Patient with Chronic Lymphocytic Leukemia.

Atypical lipomatous tumor, also known as well-differentiated liposarcoma, is rare in the head and neck region. The primary and most effective option in the treatment of this malignancy with a good prognosis is excision with clean surgical margins. Therefore, it is important to distinguish this malignancy from lesions that require more aggressive treatment. In this article, we present the case of an atypical lipomatous tumor originating from the nasopharynx and almost completely obstructing the oropharynx in a 38-year-old male patient with chronic lymphocytic leukemia. To the best of our knowledge, this is the first report in the literature of an atypical lipomatous tumor case originating from the nasopharynx.

Coexistence of Adenoid Cystic Carcinoma and Sialolithiasis in Submandibular Gland: Case Report.

Sialolithiasis is the primary cause of swelling in the major salivary glands. The etiopathogenesis is not clear. Adenoid cystic carcinoma is a slow-growing salivary gland malignancy with a poor prognosis. There are only a few cases in the literature reporting the coexistence of sialolithiasis and adenoid cystic carcinoma. In this report, we present a case that was thought to have sialolithiasis in the foreground because of the calcified image on computed tomography, but was diagnosed with adenoid cystic carcinoma after excision, together with a discussion of the relationship between sialolithiasis and carcinogenesis.

Angiotensin-converting enzyme insertion/deletion gene polymorphism in patients with laryngeal cancer.

Objectives: The aim of this study was to compare the distribution of the angiotensin-converting enzyme (ACE) I/D polymorphism between patients with laryngeal cancer (LC) and a control group and to examine the distribution of this polymorphism with clinical parameters related to LC. Methods: We enrolled 44 LC patients and 61 healthy controls. The ACE I/D polymorphism was genotyped with the PCR-RFLP method. The distribution of ACE genotypes (II, ID, and DD) and alleles (I or D) was evaluated with Pearson's chi-square test, and logistic regression analysis was performed for statistically significant parameters. Results: There was no significant difference in ACE genotypes and alleles between LC patients and controls (p = 0.079 and p = 0.068, respectively). Among clinical parameters related to LC (extension of tumour, node metastasis, tumour stage and tumour location), only the presence of node metastasis was found to be significant in terms of ACE DD genotype (p = 0.137, p = 0.031, p = 0.147, p = 0.321 respectively). In the logistic regression analysis, the ACE DD genotype was increased 8.3 fold in nodal metastases. Conclusions: The findings of the study suggest that ACE genotypes and alleles do not affect the prevalence of LC, but the DD genotype of ACE polymorphism may increase the risk of lymph node metastasis in LC patients.

Frozen Section Evaluation for Surgical Margins in Laryngeal Squamous Cell Carcinoma: Is it a Reliable Method for Partial and Total Laryngectomies?

BACKGROUND: In this study, we aimed to compare the accuracy of frozen section evaluation in partial and total laryngectomies performed to treat laryngeal squamous cell carcinoma . METHODS: A retrospective study was conducted to evaluate the efficacy and accuracy of frozen section analysis for laryngeal squamous cell carcinoma of 65 patients, operated at a tertiary hospital. Two groups were recruited according to the surgical procedure. RESULTS: The sensitivity and specificity of frozen section diagnosis in laryngeal cancer were 20% and 99.73%, respectively. For partial laryngectomy, the sensitivity was 16.66% and specificity was 100%. For total laryngectomy, sensitivity was 22.2% and specificity 99.13%. Discordances between the initial frozen section diagnosis and the subsequent permanent section diagnosis were found in 13 (3.35%) pairs (3.37% partial laryngectomy and 3.33% total laryngectomy). CONCLUSION: Our study shows that the surgical method applied has no effect on discordances. However, sampling errors are likely to be more common in partial laryngectomy procedures. It should be kept in mind that the sensitivity of frozen section evaluation is low.

Evaluation of Anxiety Sensitivity, Anxiety, Depression, and Attention Deficit Hyperactivity Disorder in Patients with Tinnitus.

Context: There may be a connection between tinnitus, a common disease in society, and psychiatric disorders. When the literature is reviewed, it has been realized that more data are needed to elucidate this issue. Aims: The aim of this study is to compare the symptoms of anxiety sensitivity, anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) symptoms in patients with tinnitus with healthy individuals and to investigate the relationship between tinnitus and psychiatric disorder symptoms. Settings and design: This study was designed as a case-control study. Materials and methods: Fifty-one patients with tinnitus and 51 healthy controls were enrolled in this study. Clinical severity of the psychiatric variables were evaluated by Beck depression inventory, Beck anxiety inventory (BAI), anxiety sensitivity index-3, and adult ADHD self-report scale (ASRS) in patient and control groups. Statistical analysis used: Variables are presented as either a number, a percentage, a mean ± standard deviation, or frequency. Chi-squared, Student t tests, and logistic regression analysis were used to examine the relationship between variables. Results: Logistic regression analysis results indicated that a significant predictive power of BAI for the presence of tinnitus. Based on a backward-elimination regression analysis, ASRSs (inattention subscale scores) were considered to predict a higher tinnitus handicap inventory score. Conclusion: These findings provide additional evidence that anxiety and attention-deficit (inattentive) symptoms could contribute to the pathophysiology of tinnitus.

Assessment of hearing loss in patients with rosacea.

OBJECTIVES/AIMS: Rosacea is not only a skin condition but a systemic inflammatory disease that includes chronic inflammation, vascular alterations, and autoimmunity in pathogenesis. We aimed to evaluate the presence of a sensorineural hearing loss in the patients with rosacea in comparison with the healthy control group and, also to compare the audiometric results according to the severity of disease among the patient group. METHODS: Fifty-three patients with erythematelangiectatic or papulopustular type of rosacea and 105 age- and sex-matched healthy controls were included. Each participant had audiometric measurements after a complete ear-nose-throat examination by the same otorhinolaryngologist. RESULTS: The results of air and bone conduction thresholds showed statistically significant differences in particularly high frequencies between the groups in both the right and left ear (for all p < 0.05), but there was no correlation between audiometric measurements and the severity or the type of rosacea (p > 0.05). CONCLUSIONS: Regardless of disease severity or type, rosacea patients are likely to have sensorineural hearing loss, and it is important to refer these patients in the early period.

Expression of prostate-specific membrane antigen in the neovasculature of primary tumors and lymph node metastasis of laryngeal squamous cell carcinomas.

BACKGROUND: Prostate-specific membrane antigen (PSMA) expression is encountered in tumor-associated neovascularization. METHODS: PSMA-antibody was applied to the paraffin blocks of 51 patients who were diagnosed with squamous cell carcinoma of the larynx and underwent laryngectomy and one who underwent lymph node dissection. The percentage of vascular expression in tumoral and extratumoral stroma and lymph nodes and intensity score in tumoral epithelium were evaluated and divided into groups according to the level of PSMA expression. Final PSMA expression was determined by multiplying intensity and percentage scores. RESULTS: The mean age was 61±10 years. Patients with perineural invasion, cartilage invasion, and local invasion exhibited higher PSMA expression scores. Age, tumor differentiation, tumor diameter, perineural invasion, tumor localization, capsular invasion, depth of invasion, surgical margin status, local invasion, nodal metastasis, TNM classification, and stage were similar in high and low PSMA expression groups. There was no PSMA expression in extratumoral vascular stroma. Significantly higher PSMA expression was observed in the vascular endothelium of metastatic lymph nodes compared with reactive lymph nodes. Patients with advanced-stage disease exhibited higher PSMA vascular expression scores compared to those with earlier stages (p<.001). PSMA expression was not correlated with overall survival, disease-specific survival, or disease-free survival (p>.05). CONCLUSIONS: Our study suggests that higher PSMA expression is associated with cartilage invasion, local invasion, and advanced-stage of disease. PSMA expression can be utilized for detection of lymph node metastasis and has some predictive role in cases of neck metastasis.

The role of raftlin in the pathogenesis of chronic rhinosinusitis with nasal polyps.

PURPOSE: The aim of this study was to investigate the possible role of raftlin (RFTN) in chronic rhinosinusitis with nasal polyps (CRSwNP). There is no study in the literature investigating the role of RFTN in the pathogenesis of CRSwNP. METHODS: The present study was designed as a case-control study and conducted between 25.09.2020 and 01.01.2022. CRSwNP and control groups were formed in the study. Serum and tissue samples were taken from each patient in the study and their RFTN levels were measured. While nasal polyps were used for tissue samples in the CRSwNP group, middle meatus mucosa obtained during concha bullosa surgery was used in the control group. RESULTS: The control group included 31 patients (8 female, 23 male) and the CRSwNP group included 49 patients (14 female, 35 male). The mean age of the control group was 40.42 ± 9.99 years, while the mean age of the CRSwNP group was 43.47 ± 10.19 years. When the groups are compared in terms of gender and age, there were no statistically significant differences (p = 0.78, p = 0.19, respectively). The serum RFTN levels in the control and CRSwNP groups were 7.85 ± 10.87 ng/ml, and 7.02 ± 8.59 ng/ml, respectively (p = 0.45). The tissue RFTN levels in the control group and CRSwNP group were 87.15 ± 69.91 ng/ml, and 66.50 ± 17.10 ng/ml, respectively (p = 0.04, statistically significant). CONCLUSION: RFTN deficiency in nasal polyp tissue may be one of the reasons for the development of CRSwNP. Further studies are needed to elucidate the role of RFTN in CRSwNP.

The Importance of Prostate-Specific Membrane Antigen Expression in Salivary Gland Tumors.

Objective: Prostate-specific membrane antigen (PSMA) is a cell membrane protein expressed by prostate tissues. It is not prostate specific and is also expressed by some non-prostatic solid neoplasms. Our study aimed to investigate the potential role of PSMA in salivary gland tumors. Methods: The present study was designed to retrospectively analyze our cases that presented with salivary gland tumors. The files of 105 patients were reviewed and their paraffin embedded blocks were retrieved from the pathology department. Immunohistochemical examination and staining were done using PSMA antibody. Tumor tissue PSMA immunohistochemical staining was scored semi-quantitatively with the modified quartile approach. Negative staining was scored 0, >0% and ≤25% tissue expression was considered weak (score 1), >25% and ≤50% tissue expression was considered mild (score 2), >50% and ≤75% tissue expression was considered moderate (score 3), and >75% tissue expression was considered strong (score 4). Results: Eighty-eight patients (55 males, 33 females) were included in the study. Forty-eight patients had pleomorphic adenoma (PA), 35 had Warthin's tumor (WT), two had mucoepidermoid carcinoma, two had adenoid cystic carcinoma, and one had squamous cell carcinoma. There was statistically significant difference in terms of PSMA expression between PA and WT (p=0.003). PSMA expression was high in PA and absent in WT. Conclusion: PSMA is a potential source of inspiration for future studies on the development of novel diagnostic and theranostic investigations of salivary gland tumors. Prospective studies targeting intratumoral PSMA in salivary gland tumors should be planned.

A Rare Incidental Diagnosis After Adenoidectomy: Sarcoidosis.

Sarcoidosis is a systemic disease of unknown etiology. It is characterized by non-caseating granulomatous inflammation. It most commonly affects the pulmonary and intrathoracic lymph nodes. Isolated nasopharyngeal involvement is very rare. Pediatric sarcoidosis and isolated nasopharyngeal involvement are rare entities. Symptoms of nasopharyngeal involvement can mimic adenoid hypertrophy. In this case report, we present a nine-year-old female who was diagnosed coincidentally with sarcoidosis with the adenoidectomy specimen.

The Importance of Prostate-Specific Membrane Antigen Expression in Carotid Body Paragangliomas.

OBJECTIVE: Prostate-specific membrane antigen (PSMA) is a transmembrane protein expressed in prostate cancer. It is, however, also expressed in the neovasculature of some non-prostatic solid tumors. Carotid body paragangliomas (CBPs) are highly vascular neoplasms. In this study, we aimed to investigate the possible role of PSMA expression in CBPs. There are no studies in the literature that report to have investigated the relationship between PSMA and CBPs. METHODS: This study is a retrospective analysis of cases diagnosed with CBP based on their demographic, clinical, radiological, surgical and immunohistochemical findings. Immunohistochemical examination results of Ki-67, S100, synaptophysin, chromogranin were retrieved from patient files. Then, the paraffin blocks of CBPs specimens, stained by PSMA-antibody by immunohistochemical methods were examined histopathologically. RESULTS: The number of patients operated on for CBP was 12 (four men and eight women). Ten out of 12 specimens were suitable for staining and histopathological examination. Capsular and/or vascular invasions of tumors were seen in complicated cases. Intratumoral vascular PSMA expression was seen in all specimens except one. Extratumoral vascular PSMA expression was not detected in any of the cases. Tumoral cell PSMA staining was seen in six of ten cases. CONCLUSION: We found higher intratumoral vascular expressions of PSMA nearly in all CBPs, but we could not assess the statistical significance because of the small number of specimens. These data might be a guide for future studies that are planned for either diagnostic or therapeutic approaches to CBPs.

A Giant Diving Ranula Extending to the Skull Base in Pediatric Age.

ABSTRACT: Ranula is a retention cyst that develops from the salivary glands. It has 2 subtypes, oral and diving. There are differences in the clinical features of ranula subtypes. In particular, diving ranula is more prone to extend in the neck spaces than oral ranula. The enlargement of the diving ranula is generally downward in the neck. If the opposite occurs, we may encounter very interesting and difficult cases. Diving ranula should be kept in mind in the differential diagnosis of cystic neck masses in the pediatric age group and its treatment should be done surgically.A 15-year-old girl admitted to our clinic with the complaint of swelling in the floor of the mouth and neck. In physical examination of the patient, a mass with cystic content was observed adjacent to the left Wharton canal. In addition, a 4 × 3 cm, soft, fluctuant, nonfixed, painless mass was palpated in the left submandibular area. Magnetic resonance imaging revealed that the neck mass was a diving ranula extending from the parapharyngeal space to the skull base. In the surgery, submandibular and sublingual salivary glands were removed together with the diving ranula. We observed no complications in the postoperative period.Magnetic resonance imaging should be used to confirm the diagnosis of diving ranula. In the treatment of diving ranula, excision of the ranula alone is not enough surgically. We also recommend excision of the submandibular and/or sublingual salivary glands associated with ranula to reduce the recurrence rate.

Can the systemic immune inflammation index preoperatively predict nasal polyp subtypes?

PURPOSE: Chronic rhinosinusitis with nasal polyps can be classified as eosinophilic or neutrophilic based on the major inflammatory cell type in the tissue. There is a need for predictive parameters to enable rhinologists to identify the type of nasal polyp in a patient without surgery. The aim of the present study was to test the predictive value of the markers of inflammation to estimate eosinophilic nasal polyps. METHODS: The study analyzed 299 patients who underwent sinus surgery for nasal polyps from 2012 to 2019. Patients were divided into two groups according to pathology results (eosinophilic polyps = group 1, neutrophilic polyps = group 2). The values of preoperative complete blood count, systemic immune inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared. RESULTS: In our series, results of ROC analyses for both mean eosinophil count and systemic immune inflammation index were statistically significant. For the eosinophil count (AUC = 0.681, p < 0.001) and systemic immune inflammation index (AUC = 0.621, p = 0.001). Patients with an eosinophil cut-off value of 0.25 cells × 109/L had ORs of 49.27 (95% CI 11.68-207.81) and sensitivity: 0.69, specificity: 0.64. Patients with a systemic immune inflammation index cut-off value of 332.39 had ORs of 1.003 (95% CI 1.002-1.004) and sensitivity: 0.84, specificity: 0.39. CONCLUSION: The systemic immune inflammation index and absolute blood eosinophil count could be used to predict nasal polyp subtypes before surgery. We believe that systemic immune inflammation index should also be studied to estimate postoperative recurrence.

Cartilaginous choristomas in tonsillectomy specimen: A prospective analysis.

OBJECTIVE: Cartilaginous Choristomas (CC) are rare benign lesion in the head and neck. In our study, we aimed to share the findings we have observed in CC cases in tonsillectomy specimens in daily practice. MATERIALS AND METHODS: This is a prospective analysis done at Department of Pathology, Süleyman Demirel University Faculty of Medicine between 2002 and 2018. All of the tonsillectomy materials fixed in 10% formaldehyde were followed up by sampling one side of the cross-sections if no macroscopically specific pathology was observed routinely. All the specimens were processed and embedded in paraffin. The paraffin sections are stained with hematoxylin and eosin and examined under microscope. RESULTS: Tonsils of 141 patients among 2355 tonsillectomy patients had CC in their specimens. A total of 155 (3.68%) CC were detected because they were seen in bilaterally in 14 patients. More than one CC was observed in 20 patients. Two of the CC was observed calcification and one have ossification. No salivary gland was observed adjecent to the choristomas in 29 patients. Significant fibrosis was more frequent in patients 15 years of age and older. CONCLUSION: The presence of hyaline cartilage in the tonsil is hamartomatous development. The CC observed in the tonsil is non fibrotic and not related to age. They can be unilateral, multifocal or bilateral in tonsil. None of the cases we have seen with the CC found a primary malignancy associated with tonsillitis. The incidence of ectopic cartilage in tonsillectomy specimen is %5.99.