A rare case of recurring calcifying epithelial odontogenic cyst in the maxillary sinus: a case report and literature review

Calcifying epithelial odontogenic cyst (CEOC) is an odontogenic cyst with epithelial lining. CEOC is a rare entity that occurs in a wide age range, does not show any gender predilection, and accounts for only 1% of all jaw cysts. The lesion generally occurs in the region anterior to maxillary and mandibular molars and either intraosseously or extraosseusly. This entity might present as a cystic or solid lesion. Enucleation is the recommended treatment for a simple, unicystic CEOC. A case of recurring CEOC in the right maxilla antrum is presented here. The patient presented to the authors after postsurgical recurrence. The case was evaluated thoroughly, and the cyst was resolved.

Sinonasal undifferentiated carcinoma (SNUC): morphoproteomic-guided treatment paradigm with clinical efficacy

Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly malignant tumor that occurs in the nasal cavity and/or paranasal sinuses. Prognosis is poor despite multimodality treatment. Currently, there is no optimal standard of treatment, partially due to a lack of research defining the biology of such tumors. This report discusses two SNUC cases where patients received a novel chemotherapeutic approach using cisplatin, etoposide, Adriamycin (doxorubicin), metformin, and adjuvant melatonin therapies based on morphoproteomic-guidance, followed by consolidation with chemoradiation therapy. This resulted in excellent and objective tomographic and magnetic resonance imaging and clinical responses including complete responses in the induction phase utilizing morphoproteomic-guided therapies. Later, endoscopic excision of the tumor bed failed to reveal any residual tumor. Morphoproteomics helped to define the biology of these SNUC tumors and provided targets for the agents employed, creating a new treatment paradigm for such tumors. This treatment regimen poses a new effective regimen to treat SNUC.

Adenoid cystic carcinoma of head and neck: apropos of a case

Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm, arising from glandular tissues, found mainly in the head and neck. Generally, it presents insidiously but can behave aggressively making its course unpredictable. Surgery and adjuvant radiotherapy continue to be the cornerstone for its treatment. ACC remains extremely difficult to treat. The authors report a case of a 37-year-old woman with bloody rhinorrhea for 6 months. She was diagnosed with a left nasal cavity lesion that was biopsied, and the anatomopathological result showed ACC. The patient was submitted to a left extended maxillectomy, microsurgical reconstruction and radiotherapy.

Material depth reconstruction method of multi-energy X-ray images using neural network

With the advent of technology, multi-energy X-ray imaging is promising technique that can reduce the patient's dose and provide functional imaging. Two-dimensional photon-counting detector to provide multi-energy imaging is under development. In this work, we present a material decomposition method using multi-energy images. To acquire multi-energy images, Monte Carlo simulation was performed. The X-ray spectrum was modeled and ripple effect was considered. Using the dissimilar characteristics in energy-dependent X-ray attenuation of each material, multiple energy X-ray images were decomposed into material depth images. Feedforward neural network was used to fit multi-energy images to material depth images. In order to use the neural network, step wedge phantom images were used for training neuron. Finally, neural network decomposed multi-energy X-ray images into material depth image. To demonstrate the concept of this method, we applied it to simulated images of a 3D head phantom. The results show that neural network method performed effectively material depth reconstruction.

Juvenile aggressive cemento-ossifying fibroma of the sinonasal tract: case report

Cemento-ossifying fibroma (COF) is a rare nonodontogenic tumor of the periodontal membrane that arises from the mesodermal germ layer. Clinically, these lesions are usually asymptomatic, slowly growing, and well circumscribed. However, they have demonstrated an aggressive course of development in a very small number of cases, particularly in younger patients. Surgical management via wide local excision is necessary because COF is notorious for recurrence, particularly lesions in the paranasal sinuses. We describe a case of juvenile aggressive COF of the sinonasal tract in a 12-year-old boy. This tumor presented with various overlapping clinical, radiologic, and pathologic features, which led to initial confusion and a diagnostic dilemma. We also discuss the radiologic interpretation of COF, which can be helpful in making the diagnosis and in selecting the appropriate surgical approach in a growing child.

Ameloblastoma of the maxillary sinus 11 years after extirpation of extensive dentigerous cysts and dystopic wisdom tooth

We present the case of a 36-year-old patient with ameloblastoma of the maxillary sinus. The history of the patient was extraordinary with respect to the diagnosis of an extensive odontogenic cyst of this sinus with a maxillary wisdom tooth located far from the region of origin. Both cyst and tooth had been completely extirpated more than 10 years prior to the current tumor diagnosis. Diagnosis of ameloblastoma was based on routinely processed specimen and supported by immunohistochemical markers. Localization and extension of both cyst and neoplasm support the assumption that both entities arose from the same area. Long-term follow-up is recommended in the treatment of odontogenic cysts.

Radiologic evaluation of an unusually sized complex odontoma involving the maxillary sinus by cone beam computed tomography

As a group, odontomas are the most common odontogenic neoplasms. This case report illustrates the benefits of cone beam computed tomography, in terms of treatment planning and surgical technique, to localize a large maxillary odontoma and accurately establish its relationship with the maxillary sinus and molar.

Extramedullary plasmacytoma in the maxillary sinus

Extramedullary plasmacytoma is a rare malignant plasma cell tumour. We report an extremely aggressive case of extramedullary plasmacytoma of the right maxillary sinus, which had metastasised to the brain and rib. A 56-year-old man presented with recurrent epistaxis and acute anaemia. Nasendoscopy revealed a medialised medial wall of the right maxilla and a mass occupying the whole nasopharynx. Magnetic resonance imaging revealed a right maxillary tumour with extension to the ipsilateral nasal cavity, nasopharynx, right sphenoid and ethmoidal sinuses. There was an extra-axial brain metastasis. There were metastases to the right parietal region and left eighth rib. Histopathology examination of the maxillary mass revealed abundant plasma cells with kappa-chain restriction. He was planned for four cycles of chemotherapy. Unfortunately, in view of the advanced stage of disease, he succumbed to his disease during the first cycle of chemotherapy.

A case of invasive meningioma involving the maxillary sinus

Meningiomas account for nearly 15% of primary brain tumors, but extracranial meningiomas are very rare. We presented a case of invasive maxillary sinus meningioma. A 50-year-old man presented with facial tenderness and severe pain in the left cheek. He had a prior surgery for a meningioma in the left frontal lobe eight months before. Physical examination and computed tomography showed a mass in the left maxillary sinus. Histopathological result of the biopsy obtained via the Caldwell-Luc approach was invasive meningioma. The mass was removed with the sinus mucosa. The histology of the resected specimen was compatible with invasive angioblastic meningioma. Postoperative radiotherapy was administered because of residual intracranial tumor. No recurrence was detected over an 11-month follow-up period.

Ewing's sarcoma/primitive neuroectodermal tumour occurring in the maxillary sinus

A 12-year-old boy complained of swelling of the left cheek. Fiberscopic examination revealed the presence of a soft reddish mass in the middle meatus of the left nostril. CT scan showed a large mass completely filling the left maxillary sinus. The lesion originated from the maxillary sinus and extended to the middle nasal meatus; bone destruction and invasion of the subcutaneous tissue of the cheek were noted. T2-weighted MRI images revealed a heterogeneous signal in the left maxillary sinus. Under general anaesthesia, biopsies were obtained through an intraoral incision. On pathology, atypical cells containing irregular nuclei with scanty cytoplasm were noted. The tumour cells were strongly positive for CD99 and reacted weakly with NSE however the cells were negative for synaptophysin, LCA and cytokeratin on immunohistochemical examination. Based on these findings, the tumour was diagnosed as a Ewing's sarcoma/primitive neuroectodermal tumour. The patient was treated with radiotherapy and combination chemotherapy; subsequently, the tumour's size decreased markedly. After 20 months of follow-up, the patient showed no evidence of local tumour growth or metastasis.

Maxillary sinus melanoma as the presenting feature of Carney complex

We present a case of a large maxillary sinus tumor in a 6-year-old boy, immunohistologically indistinguishable from a malignant melanoma, that led to the diagnosis of Carney complex. The Carney complex is an autosomal dominant disorder characterized by mucocutaneous pigmented lesions and neoplasia of multiple endocrine glands and is usually due to an inactivating mutation of the gene for the protein kinase A regulatory subunit 1A. The Carney complex has characteristic head and neck manifestations that can point to the diagnosis of this potentially lethal condition.

Maxillary sinus lipoma: an unanticipated diagnosis

Subcutaneous tissue gives rise to numerous lesions such as lipoma, the most common benign soft tissue tumors. Lipoma is seen only extremely rarely in osseous units. In addition, craniofacial involvement of intraosseous lipoma may be misdiagnosed as a fibroosseous tumour such as fibrous dysplasia. Here, we present a case of an intraosseous lipoma obviously destroying and invading the maxillary bone.

Benign schwannoma in paranasal sinuses: a clinico-pathological study of five cases, emphasising diagnostic difficulties

OBJECTIVES

To highlight the difficulty in making a correct diagnosis of benign schwannoma in the paranasal region, to raise awareness of this rare condition, and to suggest the most appropriate treatment.

METHOD

Retrieval of cases retrospectively from archives of the histopathology department of a major UK cancer centre with central review of all cases.

RESULTS

Five cases were identified since 1990 and clinical and pathological features are summarised. Median follow up of patients was 8.1 years. Radiological appearances of local bone invasion and histological features of tumour unencapsulation and hypercellularity could give the mistaken impression of malignant disease and lead to unnecessary over-treatment.

CONCLUSION

Central pathological review and clinical awareness is required. Although local recurrence can occur, the prognosis is excellent. The treatment of choice is local excision. Radiotherapy can be considered, but in most cases it would incur unnecessary morbidity.

Cementoblastoma involving the maxillary sinus

A cementoblastoma is rare, benign, and of odontogenic ectomesenchymal origin, usually associated with the roots of the first mandibular tooth. We present an unusual case of one that involved the roots of the first and second maxillary molars, extended into the maxillary sinus, and was associated with a displaced unerupted third molar. The initial presentation was misleading and resulted in inadequate management. The definitive diagnosis had not been established until 2 years later.

[Maxillary sinus metastasis of renal cell carcinoma]

Paranasal sinuses and nose metastasis are very uncommon tumors, about 50 have been reported. Renal cell carcinoma is the primary neoplasm which most frequently metastasizes in the nasosinusal region, followed by breast and lung. Symptoms are unspecific, but the epistaxis constitutes the most common sign due to the significant vascularizations of the tumor. Prognosis is poor. The survival rate fluctuates between 15-30% at 5 years. Surgery is the elective treatment.

Imaging characteristics of neoplasms and other lesions of the jawbones

Obtaining an accurate diagnosis of odontogenic tumor-mimickers (nonodontogenic lesions masquerading as odontogenic lesions) and tumor-like lesions of the jawbones can be difficult and requires a multidisciplinary approach. Lack of familiarity with these disease processes may lead to uncertainty and errors in diagnosis, which increase the possibility of errors in treatment. Radiologists should be aware of the imaging appearances of lesions affecting the jawbones in order to provide a complete differential diagnosis and to guide clinicians in proper patient treatment. The morphologic characteristics of tumors and tumor-like lesions of the jawbones may provide key diagnostic information regarding the aggressive or nonaggressive biologic behavior of such lesions. In addition to imaging findings, thorough physical examination and, often, histologic analysis of biopsy specimens are required.

Solitary plasmacytoma of the maxilla--a case report and review of the literature

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma. The solitary plasmacytoma of the maxilla is a rare condition that focuses solely on myelomatous tissue and is not disseminated to other parts of the skeleton. Some lesions appear to be benign and do not recur after complete removal, while others are locally invasive. The dense plasma cell infiltration that commonly is associated with inflammatory lesions within the oral tissues makes diagnosing plasmacytoma at this site problematic. This article presents a case of solitary plasmacytoma in the maxilla. Radiographic examination revealed an osteolytic lesion over the right maxillary bone, invading the maxillary sinus. A CT scan showed that the tumor mass occupied the right maxillary sinus and the lateral wall of the nasal cavity. The tumor cells were composed of densely packed, round, polygonal cell structures that were scattered in relatively sparse stoma. The neoplastic cells had a large, single eccentric nucleus, resembling typical plasma cells. The clinical, histopathological, and radiological features of solitary plasmacytoma are discussed.

[Metastasis in maxilar sinus as only manifestation of disseminate renal adenocarcinoma]

Paranasal sinuses and nose metastasis are very uncommon. About 50 have been reported. Renal cell carcinoma is the primary neoplasm which most frequently metastasizes in the nasosinusal region, followed by breast and lug. Symptoms are unspecific, but the epistaxis constitutes the most common sign due to the significant vascularizations of the tumor. Prognosis is poor. The survival rate fluctuates between 15-30% at 5 years. Surgery is the elective treatment.

[Malignant mucous primary sinonasal melanoma. A clinic case]

The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease.