Osteoma of maxillary sinus: a case report

Craniofacial osteomas may be located either superficially or intraosseously on any bone of the cranium or face or within a paranasal sinus. Osteomas within the paranasal sinus account for 0.01% to 0.43% of patients; of these, up to 80% occur in the frontal sinus. An osteoma of maxillary sinus is extremely rare. We describe a rare case of osteoma of a 56-year-old Asian woman in the maxillary sinus.

Sarcomatoid carcinoma and orbital apex syndrome

PURPOSE

To report a case of sarcomatoid carcinoma and orbital apex syndrome in a previously healthy adult.

METHODS

A previously healthy 45-year-old man presented with exophthalmos of the left eye and a mass visible through his left nostril. A biopsy was performed and immunohistochemistry was used to confirm the diagnosis of the tumor. The patient was treated with chemotherapy and radiotherapy.

RESULTS

After treatment, we observed a substantial reduction in the size of the mass, but side effects of treatment developed. The visual acuity of the left eye was no light perception. Eight months later, the patient presented with bone and liver metastases, and he died 4 months later.

CONCLUSIONS

Sarcomatoid carcinoma is an aggressive tumor that can produce compressive symptoms with very poor visual and survival prognoses. A cranio-orbital computed tomography scan should be performed when patients present with symptoms of conjunctivitis and orbital apex syndrome.

Value of CT Thallium-201 SPECT Fusion Imaging over SPECT Alone for Detection and Localization of Nasopharyngeal and Maxillary Cancers

OBJECTIVE

The purpose of this study was to investigate the incremental clinical utility of CT and high-resolution SPECT fusion imaging.

MATERIALS AND METHODS

Eighteen patients with nasopharyngeal cancer or cancers around the maxilla were scanned with high-resolution SPECT at the time of initial diagnosis (18 studies) and during follow-up after chemoradiotherapy (23 studies). SPECT results were compared with histologic findings or the findings of other imaging techniques. In addition, automatic image registration without fiducial markers was performed from CT and SPECT data, and the effect of fusion imaging on the localization of abnormalities was evaluated.

RESULTS

All of the original 18 untreated lesions showed high uptake. Recurrent tumors had a tendency to show high uptake (seven of nine patients), whereas little or no uptake generally represented no recurrence (12 of 14 patients) (chi-square test with Yates correction: chi2 = 6.80, p < 0.01). In two patients, physiologic uptake in the unilateral prevertebral muscle was revealed on image fusion. In four of the nine recurrent nasopharyngeal cancers (44%), SPECT alone could not determine abnormalities in uptake sites, whereas CT/SPECT fusion imaging clearly localized the sites and was helpful for treatment strategy.

CONCLUSION

High-resolution thallium-201 (201Tl) SPECT has a very high detection rate in patients with nasopharyngeal cancer and cancers around the maxilla. However, the anatomic identification or localization of the uptake sites is sometimes difficult without CT/SPECT fusion imaging. This technique without external markers is practically feasible to generate clinically valid fusion images.

Case report: B-cell lymphoma of the maxillary sinus

The radiographic manifestation of malignant lesions of the maxillary sinus on dental radiographs may be nonspecific, making it difficult to differentiate the lesion from disease of odontogenic origin or more benign sinus pathoses. A radiopaque mass in the maxillary sinus, resulting from a malignant neoplasm growing within or extending into the sinus, can be easily confused with the mass of a mucous retention pseudocyst. Similarly, a malignant growth in the early stages of development can produce radiographic patterns in the alveolar process that may resemble inflammation of odontogenic origin. A case of B-cell lymphoma is reported. The lesion involved the maxillary alveolar process and sinus, producing such a radiographic pattern on the panoramic radiograph. Radiographic and clinical features that should be considered in establishing a differential diagnosis of malignant disease are discussed.

Primary cutaneous follicular center cell lymphoma of the nose with maxillary sinus involvement in a pediatric patient

We report a primary cutaneous follicular center cell lymphoma (PCFCCL) that arose on the nose and the left naso-labial fold, spread to the left cheek, the left maxillary sinus, and the soft palate in a 16-year-old boy. Polychemotherapy was performed and the patient is disease-free after 41 months. This case is unusual because PCFCCL rarely arises on the nose, only occasionally disseminates to extracutaneous sites, and, to our knowledge, has never been described in pediatric patients.

[Cancer of maxillary mucosa (symptoms and diagnosis)]

The experience in diagnosis of maxillary mucosa cancer in 222 patients is reviewed. Male and female mortalities were the same. Mean age of the men was 59.9+/-13.1 years, of the women 69.4+/-15.2 years. 211 patients were admitted to hospital for the first time and 11 with relapses after conducted treatment. The disease history in 121 patients varied from 1 week to 3 months from the disease onset, in 90 (45.6%) patients--from 3 months to 1 year. Patients with stage 3 (n=141) and stage 01 (n=51) made up 90.9% of all the cases. Stage 2 was diagnosed in 16 patients and stage 1--in 3 patients. Diagnostic potential of the conventional X-ray study, computed and magnetic resonance tomography in diagnosis of maxillary cancer is shown.

Large complex odontoma of the left maxillary sinus

Odontomas as a group are the most common odontogenic neoplasms. They are mixed lesions containing fully formatted dental tissues, both epithelial and mesenchymal, and are usually found during a routine radiographic examination or as a factor in noneruption. Odontomas can be divided into two types: the complex and the compound odontoma. Both types are composed of enamel, dentin, cementum and pulp tissues, but in complex odontomas the tissues are arranged in a haphazard fashion with no discernible dental structures, whereas in compound odontomas the dental tissues exist in a more regular pattern so that the lesion consists of tooth-like structures. We report a case of a 23-year-old man with a large complex odontoma involving the left maxilla and maxillary sinus with clinical, radiographic and histological findings. Because of the size of the mass and its clinical course, benign neoplasms were considered in the differential diagnosis. Surgery was the treatment of choice, and recurrence of the lesion is not expected.

Large central osteoma of the maxillary antrum

The aim of this report is to describe a case presenting with complaints of orbital pain, altered facial sensation, nasal obstruction and unilateral spontaneous nose bleeding. Panoramic radiography and computerized tomography disclosed a large pedunculated heterogeneous mineral opacity with two impacted molar teeth invading the maxillary sinus. The patient was operated on under general anaesthesia. Microscopic examination of the surgical specimen revealed relatively dense, compact bone with sparse marrow tissue that was diagnosed as osteoma. Clinical characteristics and biological behaviour of this lesion were evaluated with special regard to the reliability of imaging modalities and surgical procedures.

A case of metastatic hepatocellular carcinoma in the nasal cavity

Metastatic hepatocellular carcinoma in the nasal cavity and paranasal sinuses is rare. We report the case of a 71-year-old male afflicted with hepatocellular carcinoma with metastasis in the maxillary sinus and nasal cavity. He underwent radiation therapy with a total dose of 36 Gy, but he died of terminal liver failure. The possible metastatic route and prognosis of metastatic hepatocellular carcinoma in the sinonasal tract are discussed.

Cytologic findings in calcifying epithelial odontogenic tumor: a case report

BACKGROUND

Calcifying epithelial odontogenic tumor (CEOT), or Pindborg's tumor, is a rare, benign, odontogenic neoplasm first described by Pindborg in 1955. It is most commonly seen in the fourth and fifth decades of life, usually arises in the mandibular premolar-molar areas and accounts for approximately 1% of all intraosseous odontogenic tumors. This report describes the cytologic findings in a case of CEOT.

CASE

A 62-year-old woman was referred to the ear, nose and throat clinic with a right maxillary mass. The fine needle aspiration (FNA) smears showed numerous calcifications; amorphous, eosinophilic material; and clusters of round epithelial cells embedded in a bloody background. The smears were diagnosed as suspicious for malignancy. Maxillectomy was done. The histologic sections were diagnosed as CEOT.

CONCLUSION

FNA findings of calcifying epithelial odontogenic tumor have been described rarely. The clusters of epithelial cells with prominent nucleoli are mistaken for features of a malignant tumor.

Isolated maxillary sinus Ewing's sarcoma

Extraskeletal Ewing's sarcoma is rarely found arising in the head and neck region. Only six cases of extraskeletal Ewing's sarcoma invading the nasal cavity or paranasal sinuses have been reported in the literature. The first described case of that Ewing's sarcoma located in isolated maxillary sinus extending into the orbita without involving the nose is presented. A 16-year-old woman presented with swelling in her right cheek. The nasal examination was normal. A computed tomography (CT) and magnetic resonance imaging (MRI) of the sinuses revealed a large mass in the right maxillary sinus with extension to the orbita. Under general anesthesia biopsies were taken. Based on histopathological analysis, a diagnosis of extraskeletal Ewing's sarcoma was made. The patient did not accept the surgical therapy. The patient was treated with combined chemotherapy and radiotherapy. The patient has done without evidence of recurrence or metastasis for one year.

Metastatic tumours in upper maxillary bone of esophageal adenocarcinoma. A case report

Metastases in the oral cavity are rare lesions which represent approximately 1% of all malignant neoplasms in the oral cavity. Oral metastases are located in the mandible 80-90% on average, the maxilla location being rarer. Metastases in mouth soft tissue are also rare, and within these it is on the gums where they more frequently occur. Primary tumours which metastasize to mouth are most commonly: lung, breast and kidney. Oral cavity metastases appear as a result of distant disease spreading and show wrong prognosis, with short survival. Here we present a clinical case of a patient diagnosed with esophagus adenocarcinoma which presented metastasis in upper-left maxillary bone.

Recurrent calcifying odontogenic cyst involving the maxillary sinus

The calcifying odontogenic cyst is an uncommon lesion that occurs in both jaws, however involvement of the maxillary sinus is rare. The accepted mode of treatment is enucleation with curettage since it is generally believed that recurrence following such treatment is extremely rare. Of the reported cases of recurrent calcifying odontogenic cysts, none have involved the maxillary sinus. This report is of a large recurrent calcifying odontogenic cyst involving the maxillary sinus, eroding the orbital floor as well as anterior and medial walls of the maxillary sinus and displacing an impacted upper canine into the nasal cavity, in a 45-year-old male patient, 8 years after the initial enucleation.

Complex odontoma of unusual size involving the maxillary sinus: report of a case and review of CT and histopathologic features

An unusually large complex odontoma of the maxilla, occupying the entire maxillary sinus with expansion into the floor of the orbit and left nasal fossa, is reported. Although occurrences of complex odontomas are not considered rare, odontomas attaining extremely large sizes, especially involving the entire maxillary sinus with extension to the orbital floor and nasal fossae, are indeed, rare. In this article, the literature is reviewed to identify the common clinical, radiographic, and histologic characteristics of such lesions, and the outcome of treatment is discussed. Complex odontomas occasionally have significant growth potential, especially in the first two decades of life. Early recognition and consideration for surgical excision are key to successful management of this common odontogenic lesion. When odontomas extend beyond the alveolar process into the fascial planes, nasal fossae, paranasal sinuses, and orbits, computed tomography can readily demonstrate the extent and boundaries of the lesion.

Extramedullary plasmacytoma of the maxillary sinus

Extramedullary plasmacytomas (EMPs) are localized plasma cell neoplasms that occur within the soft tissues; by definition they cannot occur within bone. They account for 1-2% of all plasma cell growths and have a great predilection for the upper respiratory tract, without specific manifestations. Males are more frequently affected during the fifth and sixth decades of life. At initial presentation, multiple myeloma should be excluded. We report herein the case of a 63-year-old man with an EMP arising in the right maxillary sinus who was referred for surgical excision and postoperative radiotherapy and briefly review the clinical implications and management of this pathology.

[Orbital extension of sinus plasmacytoma secondarily transforming into multiple myeloma: a case study]

We report the case of a 39-year-old man who consulted for severe exophthalmia with diplopia associated with chronic sinusitis evolving over 6 months. A cervicofacial CT scan showed a tumoral mass invading the maxillary and ethmoidal left sinus and orbital cavity. A biopsy of the mass and general evaluation confirmed the diagnosis of extramedullary plasmocytoma. Secondarily it transformed into multiple myeloma. In light of this case of extramedullary plasmocytoma in a young subject, we discuss the clinical characteristics, ophthalmologic manifestations, and the various therapeutic modalities according to the stage of the disease and the ocular repercussions.

The choice of optimal radiotherapy technique for locally advanced maxillary carcinoma using 3d treatment planning system

Aim. To compare the isodose distribution of three radiotherapy techniques for locally advanced maxillary sinus carcinoma and analyze the potential of three-dimensional (3D) conformal radiotherapy planning in order to determine the optimal technique for target dose delivery, and spare uninvolved healthy tissue structures. Methods. Computed tomography (CT) scans of fourteen patients with T3-T4, N0, M0 maxillary sinus carcinoma were acquired and transferred to 3D treatment planning system (3D-TPS). The target volume and uninvolved dose limiting structures were contoured on axial CT slices throughout the volume of interest combining three variants of treatment plans (techniques) for each patient: 1. A conventional two-dimensional (2D) treatment plan with classically shaped one anterior two lateral opposite fields and two types of 3D conformal radiotherapy plans were compared for each patient. 2. Three-dimensional standard (3D-S) plan one anterior + two lateral opposite coplanar fields, which outlines were shaped with multileaf collimator (MLC) according to geometric information based on 3D reconstruction of target volume and organs at risk as seen in the beam eye's view (BEV) projection. 3. Three-dimensional non-standard (3D-NS) plan: one anterior + two lateral noncoplanar fields, which outlines were shaped in the same manner as in 3D-S plans. The planning parameters for target volumes and the degree of neurooptic structures and parotid glands protection were evaluated for all three techniques. Comparison of plans and treatment techniques was assessed by isodose distribution, dose statistics and dose-volume histograms. Results. The most enhanced conformity of the dose delivered to the target volume was achieved with 3D-NS technique, and significant differences were found comparing 3D-NS vs. 2D (Dmax: p<0,05 Daver: p<0,01; Dmin: p<0,05; V90: p<0,05, and V95: p<0,01), as well as 3D-NS vs. 3D-S technique (Dmin: p<0,05; V90: p<0,05, and V95: p<0,01), while there were no differences between 2D vs. 3D-S technique. 3D-S conformal plans were significantly superior to 2D plans regarding the protection of parotid glands, and the additional improvement of dose conformity was achieved with 3D-NS technique. 3D-NS technique resulted in the decrease of Dmax for ipsilateral retina compared with 3D-S technique, while the level of Dmax for optic nerve was increased (within an acceptable range) with 3D-NS technique. Conclusion. In this study, 3D planning of radiotherapy for locally advanced maxillary sinus carcinoma with noncoplanar fields, which number did not exceed the number of fields for conventional arrangement enabled conformal delivering of the adequate dose to the target volume with the improved sparing of adjacent uninvolved healthy tissue structures.

A case of oncogenic osteomalacia detected by 111In-pentetreotide total body scan

A case of tumor-induced osteomalacia in a 35-year-old woman suffering from severe bone pain and muscle weakness is described. This uncommon disease is characterized by a reduced serum phosphorus level with elevated urinary phosphate excretion, normocalcemia, high serum bone alkaline phosphatase and a deficiency of 1,25 dihydroxyvitamin D3. The tumors responsible for oncogenic osteomalacia are usually small, benign and commonly located in bone or soft tissues of the head and the limbs, so the diagnosis can often be difficult. In this case a 111In-pentetreotide scintigraphy was able to detect a hemangiopericytoma located in the right mascellar sinus. Removal of the tumor resulted in the reversal of clinical and biochemical abnormalities.

A case of paranasal sinus angiolipoma

OBJECTIVE

To present the first documented case of an angiolipoma of the maxillary sinus, our treatment of the patient, and the 1-year follow-up results. At the conclusion of the report, the reader should be able to discuss the incidence, treatment options, and long-term prognosis of angiolipomas of the paranasal sinuses.

STUDY DESIGN

A case study reporting on a single patient with the diagnosis of maxillary sinus angiolipoma.

METHODS

Review of diagnostic studies, the operative technique, and the patient's chart for the 1-year period after treatment.

RESULTS

The patient remains free of disease 1 year after definitive surgical treatment.

CONCLUSIONS

Angiolipomas are exceedingly rare in this location. The accepted treatment for this disease in other regions of the body consists of wide local excision with close follow-up. The extent of the disease found in this patient required a medial maxillectomy for en bloc resection. We would advocate such an approach for other physicians who are faced with a patient with this rare diagnosis.