Neoplasms of the nasal passages and paranasal sinuses in domesticated animals as reported by 13 veterinary colleges

Three hundred cases of primary neoplasms involving the nasal cavity or paranasal sinuses were found among the reports of 12,300 microscopically confirmed neoplasms. The multispecies data were compiled from abstracts of medical records by 13 colleges of veterinary medicine in the United States and Canada from 1964 to 1973. Significant numbers of neoplasms were observed in dogs, horses, and cats. Intranasal neoplasms were more frequent than those of the paranasal sinuses in dogs and cats. Only cats had a sex difference in the occurrence of nasal neoplasms, with a male predilection. The frequency of neoplasms of the nasal cavity and paranasal sinuses increased with age in all species examined. A clear relationship could not be established between nose length and of intranasal neoplasms. Of the tumors, 80% were malignant in dogs, 68% in horses, and 91% in cats. Detailed review of medical records in a subset of 49 dogs with neoplasms of the nasal passage and paranasal sinuses revealed major clinical signs of nasal and ocular discharge, facial deformity, and stertorous breathing. Median duration of signs prior to diagnosis was 3 months and 95% of the dogs had been given treatment prior to definitive diagnosis. All 49 tumors were malignant; 27 were classified histologically as carcinomas and 22 were sarcomas. Nineteen dogs were treated, using surgery alone or in combination with radiation therapy. Median survival duration was 5 months (mean 6.7 mo).     

Frontal sinus mucocele mimicking a metastasis of papillary thyroid carcinoma

Radioiodine scans are highly specific for detecting metastases of well-differentiated thyroid carcinomas. However, false-positive 131I whole-body scans may occur as illustrated in the following case report. In a 53-yr-old patient, abnormal 131I uptake was found in the right frontal skull 4 wk after total thyroidectomy and radioiodine therapy for papillary thyroid cancer. Bone scans and planar x-rays of the skull were unremarkable and the serum thyroglobulin level was within normal limits. X-ray CT revealed a small nodule in the right frontal sinus corresponding to the pathological focus of 131I uptake. Surgical removal and histopathological examination of this lesion yielded a mucocele, a slow-growing lesion of the paranasal sinuses accumulating mucous material. The postoperative 131I scan was unremarkable. The possibility of a false-positive finding on radioiodine scans should be considered, particularly when the serum thyroglobulin level is not elevated.     

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses

Small cell neuroendocrine carcinomas (SNECs) of the sinonasal tract are extremely uncommon tumors. We reviewed the clinicopathologic features of six cases of this neoplasm. There was no sex preponderance with three females and three males and a mean age at presentation of 51 years (range, 38 to 68). Two patients had disease limited to the nasal cavity, and in four the tumor involved the nasal cavity and maxillary or ethmoid sinuses. Involvement of the orbit was present in two patients. Surgery was the primary treatment. After a mean follow-up of 37 months, one patient died of local disease and liver metastases, four were alive with recurrent or metastatic disease, and one died of unrelated causes. The tumors were composed of sheets, nests, and trabeculae with extensive areas of necrosis and hemorrhage. The individual cells were small to intermediate in size and had scanty cytoplasm. The nuclei were oval or round and hyperchromatic with absent or inconspicuous nucleoli. Nuclear molding and crush artefact were present in five cases. All tumors had a high mitotic rate with frequent abnormal mitotic figures. All cases stained for Cam 5.2, neuron-specific enolase, and chromogranin. Five cases were positive for AE1:AE3, and four for synaptophysin. No case stained for S-100 protein, or neurofilaments. O-13 stained one case. No case contained EBV-RNA. SNECs of the nasal cavity and paranasal sinuses are aggressive tumors with pathological features similar to those of anaplastic small cell carcinomas of the lung. They exhibit morphological and immunophenotypic features different from olfactory neuroblastoma and should be distinguished from this tumor.     

Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses

Three adult horses underwent aggressive treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses, using course-fractionated cobalt 60 radiotherapy. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is not commonly diagnosed in horses. Historically, horses with this type of neoplasm have not been treated or have undergone some form of surgery. The prognosis for long-term survival or cure has been poor. Long-term results of cobalt 60 radiotherapy were good to excellent and exceeded those usually reported for horses treated surgically. On the basis of these results, use of radiotherapy for these neoplasms is recommended.     

Differential expression of costimulatory molecules in chronic inflammatory periodontal disease tissue

OBJECTIVES: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. STUDY DESIGN: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. METHODS: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. RESULTS: Twenty-six patients underwent oncologic resections, 22 patients had reduction of complex fronto-naso-orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontension pneumocephalus. The most common late complication in all three groups was anosmia. CONCLUSIONS: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.     

Correlation between the clinical and pathohistologic diagnosis in "small biopsies" of the lung

INTRODUCTION: During the last 20 years routine application of various methods of multiple "small biopsies" of the lungs such as forceps, transbronchial, trucut percutaneous and so on, has significantly increased the efficacy of diagnostics of bronchopulmonary and pleural diseases. Tissue samples, not bigger than 3-4 mm, in which diagnostic pathological changes are expected on the basis of previous clinical, radiological and bronchoscopic examinations, can be the basis for making a definite therapeutical decision only if a skillful surgeon has performed the biopsy by correct instruments and from the right place and sent it for histological analysis with other important clinical information. This study is a comment on quality, significance and possibilities of improving clinical-pathological cooperation in this field of clinical pathology. MATERIAL AND METHODS: By correlation of clinical and histological diagnoses we analyzed the diagnostic efficiency of microscopic examinations of "small biopsies" of the respiratory tract in 319 patients (175 bronchial forceps biopsies, 31 transbronchial biopsies, 22 percutaneous needle pleural biopsies and 91 combined forceps and transbronchial biopsies) in whom biopsies were performed during 1996 in the Specialized Hospital for Lung Diseases Brezovik. RESULTS: Overall concordance between the clinical and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out of 135 clinically "obvious" neoplasms, the histopathological examination confirmed existence of malignant tumor: squamous cell carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in 5.6% of patients. In other patients it was not possible to perform a more precise classification. Endoscopic specimens of 29 patients (9.1%) were not representative. CONCLUSION: The level of diagnostic efficiency (73.3%) of definitive histopathological verification of bronchopulmonary lesions, which have been clinically diagnosed as malignancies, is rather high, but the increase of diagnostic efficiency requires application of more sophisticated histological diagnostic methods (immunohistochemical) and more frequent utilization of bioptic procedures which are more convenient for detection of peripheral pulmonary lesions (transbronchial and percutaneous fine needle aspiration biopsies of the lungs).     

Solitary giant skull base schwannomas--report of four cases

BACKGROUND: Solitary intracranial schwannomas not related to major nerves or neurofibromatosis as well as paranasal schwannomas are rare. Schwannomas simultaneously involving the paranasal sinuses and intracranial cavity are even rarer. METHODS: We report four cases of schwannomas simultaneously involving the intracranial cavity and paranasal sinuses. They were successfully managed by surgery. The literature on such tumors is reviewed. RESULTS: All patients were young adults; the male to female ratio was 1:3. In two patients, the tumor was predominantly intracranial with extension into the sphenoid and ethmoid sinuses, whereas in the other patients, the tumor was located predominantly in the paranasal sinuses and nasopharynx with intracranial extension. Radiologically, bone destruction was seen in three cases. The tumors were totally removed piecemeal with repair of the basal dura. Histopathologic examination confirmed the diagnosis of schwannoma in all four cases. Three patients are alive and well; one of them was reoperated for a recurrence. CONCLUSIONS: These tumors should be excised completely if possible. Radiologically, bone erosion or destruction are suggestive of malignancy but histopathology clinches the diagnosis. Therefore, drastic surgery should be avoided in these cases. Surgery is generally curative in these massive schwannomas.     

Prevalence, follow-up and clinical significance of the anticardiolipin antibodies in normal subjects

We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma. Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses. An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates. A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected. Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding. There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.     

A modification of split-skin graft

Although acine cell neoplasms have for a long time been regarded as benign tumors, they are presently considered to represent the carcinomas. These rare tumors mainly affect the parotid glands, and only exceptionally involve other salivary glands. Clinically, acic cell carcinoma present as isolated tumors simulating a pleomorphic adenoma. The diagnosis is histopathological, and complete surgical removal of the tumor is the treatment of choice, with cervical lymphatic voiding and/or postoperative radiotherapy in selected cases. A prolonged patient follow-up is required, for the tumor may recur many years after surgery. We report a case of acinic cell carcinoma in submaxillary gland.     

Paranasal sinuses: only one of nature's games?

BACKGROUND: Many theories exist concerning the function of paranasal sinuses, but it is rather difficult to definitively name the right one. Despite the fact that many of them have been proved to be wrong, they are still used. THEORIES: Galen postulated 2000 years ago that they were "porous bones", which helped with weight reduction. Like Galen's theory, most of the others have been refuted as well. A list of these refuted theories covers a range of postulated functions including a relative warming or moistening of the breath, protection against high pressure in the nasal region when sneezing, paranasal sinuses as a place of efficient mucus production, or an aid for smelling, similar to the ethmoidal cells of the porcupine. Others include an isolated function for protection against cold climates and an aid for formulating sound by acting as a resonance chambers. CONCLUSIONS: Two theories still remain. One says that the paranasal sinuses are only the result of the evolutionary processes that have taken place in the skull during human development. The other theory explain that the form of the paranasal sinuses exists through the influence of the forces created during the act of chewing. Small cavities appear as a result of the minimal energy created, and these cavities can be found in the form of paranasal sinuses.     

Imaging of ORL diseases in acquired immunodeficiency syndrome

More than 50% of patients with acquired immunodeficiency syndrome (AIDS) present a lesion affecting parotid gland, lymph nodes, paranasal sinuses, pharyngo-larynx or temporal bone. In about 20% out of cases affected patients present different head and neck lesions at the time of evaluation. Most often, clinical examination and endoscopy are sufficient to perform diagnosis and to manage the disease. Imaging studies (CT or MRI) are indicated when the nature of the disease is unknown or when a map of the process is mandatory for therapeutic approach. Some imaging features are strongly suggestive of HIV infection: parotid cysts associated with hyperplasia of the nasopharynx and cervical lymph nodes enlargement; labyrinthitis and multinevritis; and head and neck squamous cell carcinomas in non alcoolo-tobacco addicted patients. Such diseases suggest the need for knowledge of the patient's seropositivity status.     

Thymic carcinomas, but not thymomas and carcinomas of other sites, show CD5 immunoreactivity

Thus far, there are no immunohistochemical markers that are specific for thymic epithelial neoplasms, although demonstration of immature T cells in an epithelial tumor can indirectly support a diagnosis of thymoma. In this study, the usefulness of a paraffin section-reactive CD5 antibody (clone CD5/54/B4) for supporting the thymic origin of an epithelial neoplasm was evaluated. Antigen retrieval was effected by microwaving in citrate buffer. Sixteen of 24 thymic carcinomas (67%) were immunoreactive for CD5, including nine of nine squamous cell, two of two undifferentiated, two of four lymphoepithelioma-like, and one case each of basolid carcinoma, clear cell carcinoma, and unclassified thymic carcinoma, but none of four thymic small cell carcinomas. None of 17 cases of benign thymoma and 21 cases of invasive thymoma (including six cases classifiable as well-differentiated thymic carcinoma using the Muller-Hermelink criteria) was immunoreactive for CD5, in the presence of CD5-positive lymphocytes as an internal positive control. Two of three thymic neoplasms with features borderline between thymic carcinoma and invasive thymoma were immunoreactive for CD5. In contrast, none of 61 cases of other malignant neoplasms with a tendency to involve the mediastinum was immunoreactive for CD5, including 40 nonthymic carcinomas and 13 malignant germ cell neoplasma. CD5 staining of thymic epithelial tumors correlated with the absence of tumor-associated CD99-positive thymocytes, as demonstrated in our previous studies. We conclude that CD5 is a useful marker of primary thymic carcinomas. Taken together, CD5 and CD99 (or other immature T-cell markers such as TdT and Cd1a) should be particularly useful in evaluating mediastinal and other biopsy samples of possible thymic epithelial neoplasms and in the subtyping of these tumors.     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.     

Inhibin immunohistochemistry applied to ovarian neoplasms: a novel, effective, diagnostic tool

Immunohistochemistry using monoclonal antibodies against human inhibin, a peptide hormone produced by ovarian granulosa cells to inhibit follicle-stimulating hormone (FSH), has been recently applied to diagnostic anatomic pathology. This investigation hypothesizes that inhibin immunohistochemistry will aid in the crucial clinical distinction between sex cord-stromal and other primary ovarian neoplasms. Available H&E slides and clinical information from a retrospective surgical series of 186 primary ovarian tumors were reviewed to verify diagnoses, and representative paraffin sections were immunostained with anti-inhibin (R1 monoclonal, Serotec, Kidlington, Oxford, UK). Immunoreactivity was graded as weak/strong (W/S), and the proportion of strong staining cells was coded as follows: S1 = <10%, S2 = 10%-50%, S3 = >50%, respectively. Inhibin immunoreactivity for 137 sex cord-stromal lesions was as follows: 100% of 66 granulosa cell tumors: 80% S3, 20% S2; 100% of 17 Sertoli-stromal tumors: 90% S3, 10% S2; 100% of 13 hyperplastic follicular/stromal lesions: 90% S3, 10% S2; 100% of six steroid cell tumors: 100% S3; 90% of 18 thecomas: 40% S3, 10% S2, 10% S1, 30% W; 0% of 12 fibromas, three myxomas, and two sclerosing stromal tumors. None (0 of 49) of the other ovarian neoplasms exhibited inhibin: 22 carcinomas, 12 carcinosarcomas, seven small cell carcinomas, six germ cell tumors, and two lymphomas. In the typical case, the distinction between sex cord-stromal and other ovarian neoplasms requires nothing more than routine pathological examination. In diagnostically challenging cases, our data indicate that inhibin immunohistochemistry is a very useful adjunct because granulosa and sertoli-stromal tumors are positive whereas other potential mimickers have been negative thus far.     

Diagnosis and evaluation of cervico-facial cancers in children

Malignant neoplasia of head and neck in children are mostly embryonal sarcoma and non Hodkgin's lymphomata. Squamous-sell carcinomas are only 10%. The main locations are in nasopharynx and paranasal sinuses. Symptoms are corelated with location of the primary. Treatment depends of the pathologic type. Combination of chemotherapy and radiotherapy, and sometimes surgery, yield now more cured patients, especially in embryonal sarcoma.     

Nasal cerebral heterotopic tissue (nasal glioma) in the adult: a rare cause of primary cerebrospinal fluid rhinorrhea

BACKGROUND: Nasal cerebral heterotopia is a congenital lesion that is mainly detected in early childhood. The rare cases of this disorder found in adult patients are located intranasally. A common symptom is compromised nasal air passage. Clinical findings include polypoid masses in either the nasal cavity or the paranasal sinuses. To our knowledge, primary cerebrospinal fluid (CSF) rhinorrhea has been reported only twice in these patients. PATIENT: A 64-year-old female patient presented with CSF rhinorrhea proven by beta 2-transferrin testing. Previous head injury or intranasal manipulation were excluded. Anterior rhinoscopy revealed a watery drainage from the right middle meatus. CT scan showed a defect in the lateral roof of the right ethmoid sinus, approximately 5 mm in diameter; MRI revealed a mass in the right ethmoid and frontal sinuses, penetrating the anterior skull base. The lesion was resected by an extranasal approach. It showed a fibrous connection to the frontal lobe. Histologically, the lesion consisted of neural tissue composed of gray and white matter, both with a normal structuring. Dura and skull base were reconstructed. There were no signs of a CSF leak postoperatively. RESULTS AND CONCLUSIONS: The differential diagnosis of CSF rhinorrhea includes traumatic events and neoplasms, elevated intracranial pressure, and connate lesions as encephaloceles and, in rare cases, nasal cerebral heterotopia.     

Genetic mapping and characterization of novel mutations which suppress the effect of a relC mutation on antibiotic production in Streptomyces coelicolor A3(2)

Fifteen patients at the University of Mainz were diagnosed as having T3 or T4 carcinomas of the paranasal sinuses that invaded the orbit. Treatment involved surgical resections of tumor with adjacent periorbita but without enucleation in an attempt to preserve vision and/or cosmesis. Survival rates and especially the rate, time and locations of recurrences were investigated. Analysis of the data revealed that preservation of the eye in these cases with advanced sinus carcinomas with orbital tumor involvement did not seem to worsen prognosis. The individual gain in terms of quality of life through the preservation of vision and cosmesis seems to justify the surgical approach used.     

Eye movement evoked by stimulation of lateral posterior nucleus and pulvinar in the alert cat

The carcinogenic effects of diisopropanolinitrosamine (DIPN) were tested in Sprague-Dawley rats and were then compared with results produced earlier by the same substance in Syrian hamsters. In addition to the similarities, several differences were noted; for example, DIPN caused pancreatic tumors in all the hamsters, but only 1 pancreatic tumor was observed among the 150 rats. Administration of DIPN to rats led to the development of neoplasms in the nasal and paranasal cavities, lungs, thyroid gland, esophagus, liver, and kidneys. The highest tumor incidence in rats was in the nasal cavities. Almost all the pulmonary neoplasms were malignant and were usually squamous cell carcinomas. We found a 15.4-50% incidence of malignant tumors of the thyroid gland; we also noted that thyroid neoplasms occurred at almost the same rate (36.4-50%) in the groups given 1/5, 1/10, and 1/20 the median lethal dose.     

The status of paranasal sinuses in children according to computer tomography

Computed and MR tomography of the paranasal sinuses have been conducted in 26 children aged 5-15 years. According to the CT images, 11 of them had affected maxillary sinuses and ethmoidal labyrinth cells, 15 had inflammation in the sphenoid sinuses alone or in combination with affection of the other sinuses.     

Frequency and prognostic significance of isolated tumour cells in bone marrow of patients with non-small-cell lung cancer without overt metastases

BACKGROUND: Metastasis is generally looked on as a late event in the natural history of epithelial tumours. However, the poor prognosis of patients with apparently localised lung cancer indicates that micrometastases occur often before diagnosis of the primary tumour. METHODS: At primary surgery, disseminated tumour cells were detected immunocytochemically in bone marrow of 139 patients with non-small-cell lung carcinomas without evidence of distant metastases (pT(1-4)pN(1-2)M(0)). Tumour cells in bone-marrow aspirates were detected with monoclonal antibody CK2 against cytokeratin polypeptide 18. Patients were followed up for a median of 39 months (range 14-52) after surgery. 215 patients without epithelial cancer (ie, with benign epithelial tumours, non-epithelial neoplasms, or inflammatory diseases) acted as controls. FINDINGS: In 83 of 139 (59.7%) patients cytokeratin-positive cells were detected at frequencies of 1 in 100 000 to 1 in 1 000 000. Even without histopathological involvement of lymph nodes (pN(0)), tumour cells were found in 38 of 70 (54.3%) patients. 1 positive cell was found in each of 6 out of 215 controls. Surgical manipulation during primary tumour resection did not affect the frequency of these cells. In Cox's regression analyses, the presence of such cells was a significant and independent predictor for a later clinical relapse in node-negative patients (p=0.028). INTERPRETATION: Early dissemination of isolated tumour cells is a frequent and intrinsic characteristic of non-small-cell lung carcinomas. The finding of these cells may help to decide whether adjuvant systemic therapy is required for the individual patient.