Burkitt's lymphoma presenting as mandibular swelling--report of a case and review of publications

Burkitt's lymphoma in a 4-year-old Chinese boy presented with acute mandibular swelling but no associated systemic disturbance. A review of published reports shows that the diagnosis should be suspected in jaw lesions with no obvious cause.

Bone formation in a carcinoma of the maxillary antrum

Malignant tumors of the paranasal sinuses are rare: about 80% are found in the maxillary sinus123. The presence of dense radiopaque masses in combination with destruction of the bone margins suggests osteosarcoma or aspergillosis4 rather than carcinoma. We present a unique mucoepidermoid carcinoma of the maxillary antrum containing new bone formation and discuss the differential diagnosis.

[Sonographic diagnosis of metastatic renal cell carcinoma to the head and neck region]

In the area of the head and neck metastases from distant primary tumours are rare in comparison to the common squamous cell carcinomas of the upper respiratory and digestive tract. Thus correct preoperative diagnosis may be difficult. Two cases with distant metastases of renal cell carcinoma to the head and neck region are presented in this report. In a 60-year-old male patient, diagnostic evaluation of unilateral epistaxis revealed a radioopacity of the maxillary sinus, six months after removal of a renal cell carcinoma. In the second case a slowly progressive indolent swelling of the left neck developed in a 56-year-old man six years after resection of a renal cell carcinoma and two years after surgical treatment of a pancreatic carcinoma. Following clinical examination, modern imaging techniques with special emphasis on colour Doppler sonography with a Siemens Quantum 2000 were used for diagnostic evaluation in both patients. Sonography of metastatic renal cell carcinoma to the maxillary sinus revealed complete opacity of the antrum. The cervical mass proved to the inhomogeneous and hypoechogenic and was difficult to distinguish from the lower parotid lobe and the vessel sheath. A common feature of both tumours was a high degree of perfusion which could be confirmed by superselective angiography. The histological examination of the surgical specimen showed an isolated metastasis of a renal cell carcinoma in both cases. In patients with a history of renal cell carcinoma the possibility of distant spread to the head and neck region should be taken into account even after a long period of complete remission. Colour Doppler sonography facilitates the distinction between the normally well perfused secondary tumours and squamous cell carcinomas which usually only have a minimal blood supply. Because of the high risk of profuse bleeding a biopsy should only be performed in the operating theatre.

[Imaging of solitary maxillo-mandibular plasmacytoma]

CT was performed in three patients with plasmacytoma of the maxilla and mandible. CT allows improved depiction of the tumor and associated local invasion and bony destruction but remains non-specific. Histology is mandatory for diagnosis and work-up necessary to confirm the solitary nature of the lesion. Intraosseous intramedullary lesions often evolve to multiple myeloma after a few years whereas extramedullary lesions, commonly involving sinonasal structures, typically remain solitary.

Benefits of stereolithography in orbital reconstruction

OBJECTIVE

To describe the benefits of the stereolithography (SLA) modeling system in the evaluation and surgical planning of selected bony orbital pathology.

DESIGN

Two case reports.

PARTICIPANTS

One patient presented with a displaced left orbital roof fracture into his orbit causing globe compression and binocular vertical diplopia. A second patient underwent removal of his right orbital floor, medial wall, and inferior portion of his lateral wall during excision of a cylindrical cell papilloma of the paranasal sinuses. Postoperatively, he suffered from globe ptosis and binocular oblique diplopia.

INTERVENTION

Stereolithographic models of the patients' orbits were obtained from computed tomography data to better assess the bony orbital pathology. In the second patient, the model was used as a template to create a temporary custom fit prosthesis to repair the defect of his orbital walls.

RESULTS

The SLA models were useful in evaluating the dimensions of the bony defects and in preoperative surgical planning. Intraoperatively, the SLA models facilitated orbital surgical rehabilitation. Postoperatively, both patients noted resolution of their diplopia after reconstruction of more normal bony anatomy.

CONCLUSIONS

In selected cases, SLA offers highly accurate models of the bony orbit for preoperative evaluation, surgical planning, and teaching and can act as a template for custom prosthesis manufacturing. This technology increases the orbital surgeon's options in managing complex orbital pathology.

Breast metastases in adolescent girls: US findings

We report five adolescent girls with secondary breast tumours. All were imaged by US and the imaging findings have been analysed. Four girls had rhabdomyosarcoma as the primary malignant disease and one had leukaemia. US features were variable, but most of the cases showed heterogeneous nodules which were quite different from the usual benign lesions (fibroadenoma, abscess, cyst) encountered at this age. The metastases produced a variety of echo characteristics: masses with well-defined margins, hyperechoic foci and sonolucent or hypoechoic nodules with posterior attenuation or lacking posterior enhancement. One lesion was round and heterogeneous with a hyperechoic centre. These US findings in an adolescent girl suggest the need for fine-needle aspiration. Mammograms, when performed, never revealed microcalcifications and were quite difficult to analyse at this age, due to the dense glandular breast tissue.

Malignant melanoma imaging with Tl-201

Two patients with malignant melanoma were evaluated using Tl-201 scintigraphy. Planar scintigraphy showed tumor accumulation, and SPECT Tl-201 imaging revealed exact tumor localization. The findings indicate the utility of Tl-201 to detect the primary lesion and to identify postoperative recurrence in malignant melanoma.

Non-Hodgkin's lymphoma of the maxillary sinus in a patient with acquired immunodeficiency syndrome

Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies in patients infected with human immunodeficiency virus (HIV): it occurs 25-60 times more frequently in HIV-infected patients than in the general population. This neoplasm in acquired immunodeficiency syndrome (AIDS) patients is a highly aggressive tumour with a poor prognosis and tends to develop in extranodal sites, such as the central nervous system, digestive tract and bone marrow. NHL involving the paranasal sinuses is rare in HIV-infected patients, and is likely to be confused clinically and radiographically with sinusitis; moreover, its optimal treatment is currently uncertain. We present a case of NHL involving the left maxillary sinus in a patient with AIDS. The patient was treated with systemic chemotherapy (low dose-CHOP), but the malignancy did not respond. Subsequently, he was treated with local maxillary sinus irradiation which resulted in partial regression of the neoplasm and in decrease of local symptoms.

Verrucous carcinoma of the maxillary antrum

Verrucous carcinoma is a distinct variant of well differentiated squamous cell carcinoma. Its occurrence in the maxillary antrum is rare. Only three cases have previously been documented. We present a case report of verrucous carcinoma in the maxillary antrum and a review of the literature.

Leiomyosarcoma of the maxillary sinus: CT and MRI findings

This report describes the CT and MRI appearances of a leiomyosarcoma of the maxillary sinus. CT showed frank bony destruction, no calcification and a low attenuation area within the mass. MRI showed intermediate intensity on T1 weighted images, intermediate to slightly high signal intensity on T2 weighted images and moderate inhomogeneous enhancement. Precise identification of the extent of the tumour, especially of orbital invasion, is of utmost importance because local recurrence is common after the resection of leiomyosarcomas.

Orthovoltage radiation therapy treatment planning using Monte Carlo simulation: treatment of neuroendocrine carcinoma of the maxillary sinus

Dose distributions that result from treating a patient with orthovoltage beams are best determined with a treatment planning system that uses the Monte Carlo method, and such systems are not readily available. In the present work, the Monte Carlo method was used to develop a computer code for determining absorbed dose distributions in orthovoltage radiation therapy. The code was used in planning treatment of a patient with a neuroendocrine carcinoma of the maxillary sinus. Two lateral high-energy photon beams supplemented by an anterior orthovoltage photon beam were utilized in the treatment plan. For the clinical case and radiation beams considered, a reasonably uniform dose distribution (+/- 10%) is achieved within the target volume, while the dose to the lens of each eye is 4-8% of the prescribed dose. Therefore, an orthovoltage photon beam, when properly filtered and optimally combined with megavoltage beams, can be effective in the treatment of cancers below the skin, providing that accurate treatment planning is carried out to establish with accuracy and precision the doses to critical structures.

[CT diagnosis of maxillary sinus diseases]

To evaluate the diagnostic value of CT scan in maxillary sinus diseases, CT findings in 100 cases of maxillary sinus diseases, which included 64 inflammatory diseases; 14 benign tumors; 17 malignant tumors and 5 fractures The result showed that the accordance rate between CT scan and operative diagnosis was 95.0%; between CT scan and pathology was 92.6%(88/95). It is concluded that CT scan showed a better visualization of maxillary sinus than X-ray tomogram.

Primary non-Hodgkin lymphoma of the sinonasal cavities: correlation of CT evaluation with clinical outcome

PURPOSE

To determine retrospectively the primary site of origin of sinonasal lymphomas with computed tomography (CT) and correlate the CT findings with histologic phenotype and clinical outcome.

MATERIALS AND METHODS

In 24 patients with stage I and II non-Hodgkin lymphomas of the sinonasal cavities, the CT appearances and clinical data were reviewed retrospectively.

RESULTS

The sites of primary tumor determined at CT were the nasal cavity in 13 patients, the ethmoidal sinus in three patients, and the maxillary sinus in eight patients. B-cell lymphomas were found mainly in the maxillary sinus, while T-cell lymphomas were found in the nasal cavity and ethmoidal sinus (P < .005). The 5-year survival rates in relation to the primary site of the tumor were 64% for the nasal cavity, 50% for the ethmoidal sinus, and 100% for the maxillary sinus (P = .26).

CONCLUSION

Patients with B-cell primary lymphoma of the maxillary sinus tended to have a good prognosis in contrast to those with T-cell lymphomas that originated from midline structures. The primary site determined at CT appears to be correlated with the histologic phenotype and clinical outcome.

Maxillary sinus inflammatory disease: ultrasound compared to computed tomography

Fifty-six patients (age range, 15-79 yr, average, 37.0+/-18.5 yr), with a clinical and/or radiological diagnosis of acute maxillary sinusitis, were prospectively studied with ultrasound (US) and computed tomography (CT). The imaging finding which supported the diagnosis of acute sinusitis with US was the identification of the hyperechoic posterior antral wall through the hypoechoic inflammation. The findings were compared to CT (3 mm axial sections). The sensitivity of US for maxillary sinus disease was found to be 66.7% and the specificity was 94.9%, which were similar to the plain film ones (65.2 and 96.8%, respectively). The results of the present study suggest US as the method of first choice for acute sinusitis of the maxillary antra, particularly for children and pregnant women.

Computed tomography of carcinoma of the upper gingiva and hard palate: correlation with the surgical and histopathological findings

OBJECTIVES

To clarify the diagnostic utility of CT in the evaluation of carcinoma of the maxillary gingiva and hard palate.

METHODS

The CT scans of 27 patients with squamous cell carcinoma of the upper gingiva and hard palate were reviewed. Tumor extent and bone destruction were compared with the surgical and histopathological findings to estimate the sensitivity, specificity and accuracy of CT.

RESULTS

The primary tumor was detected by CT in 89% of patients. The grade of bone destruction determined by CT correlated well with that verified at surgery or by histopathological examination. The sensitivity, specificity, and accuracy of CT for invasion to the buccal mucosa were 64%, 89% and 75% respectively. For maxillary sinus invasion, CT showed low specificity but high sensitivity. The accuracy was 86% when the criterion for sinus invasion was the presence of an enhanced mass continuous with the primary tumor.

CONCLUSION

CT is helpful for the evaluation of tumor extent in the upper gingiva and hard palate carcinoma. However, invasion of the maxillary sinus should be considered carefully, because CT findings suggestive of destruction of the floor of the maxillary sinus are not always consistent with sinus invasion.

[Digital subtraction angiography and selective arterial embolization in the treatment of vascular tumors in nasopharynx and nasal sinuses]

The paper presents the treatment of vascular tumors in nasopharynx and nasal sinuses with digital subtraction angiography (DSA) and selective arterial embolization. By using preoperative embolization of blood supply arteries, the intraoperative bleeding was reduced significantly, the tumors were shrank and the tumor limits were clear. We recommend that DSA and selective arterial embolization should be used as a routine preoperative method adjunct to surgery for the treatment of vascular tumors of nasopharynx and nasal sinuses.

Radiographic findings in the teeth and jaws of 14- to 17-year-old Estonian schoolchildren in Tartu and Tallinn

Panoramic radiographs were taken of 392 Estonian schoolchildren (33% boys and 67% girls) aged 14-17 years, 197 in Tartu and 195 in Tallinn. The mean number of permanent teeth was 31.5. In 14% of the children one to four teeth (excluding wisdom teeth) were missing. The frequencies of missing wisdom teeth and supernumerary teeth agreed with those in the literature, being 17% and 3%, respectively. The mean number of radiographically detected carious teeth was 1.9 in Tartu and 3.3 in Tallinn. Secondary caries was common, being found radiographically in half of the schoolchildren. Endodontic treatment had been given to 13% of the subjects in Tartu and to 46% in Tallinn, the success rates being 47% and 44%, respectively. The percentage of radiographic signs in the mandibular condyles of girls (5%) was greater than that of the boys (1%). Changes in the maxillary sinuses were found in 16% of the children. Eight odontogenic cysts, one cyst of the incisal canal, and one solitary bone cyst were found. Tumors included two odontomas, two cemento-ossifying lesions, and one osteoma in the maxillary sinus. The health status of the jaws of the Estonian schoolchildren was considered to be fairly good.

Differential diagnosis of tumours of the minor salivary glands of the palate by computed tomography

OBJECTIVE

To define the CT criteria for differentiating malignant from benign tumours of the minor salivary glands of the palate and to evaluate their accuracy.

PATIENTS AND METHODS

CT findings of 63 patients with histopathologically proven minor salivary gland tumours of the palate (23 malignant, 40 benign) were retrospectively evaluated.

RESULTS

Aggressive bone destruction was a specific finding of malignant tumours, but was seen in only 57% (13/23) of this series. Extension into the pterygopalatine fossa was observed in seven malignant and one benign tumour. Calcifications within a tumour were observed in four cases, all of which were malignant. These three CT findings were significantly more frequent in malignant tumours. Using any one of these as the criterion for the malignancy, the sensitivity was 78% (18/23), specificity 98% (39/40) and accuracy 90% (57/63).

CONCLUSION

Malignant tumours of the minor salivary glands of the palate are very likely to show any or all of aggressive bone destruction, extension into the pterygopalatine fossa and calcification, whereas benign tumours can almost always be correctly diagnosed by their absence.

Non-Hodgkin's lymphoma of the paranasal sinuses. Report of two cases

Lymphoma of the paranasal sinuses is relatively rare compared to the occurrence of carcinoma in the same region. The diagnosis is often missed at the early stages of the disease. Two cases of primary extranodal lymphoma of the maxillary sinus are reported. The diagnosis of these malignancies is emphasized.

Positron emission tomographic imaging of head and neck lesions

Positron emission tomography (PET) produces images that reflect the rate and distribution of biochemical and physiological processes in tissue in vivo. This has been observed with many types of neoplasm not evident when using such anatomical imaging techniques as computed tomography or magnetic resonance imaging. We evaluated the feasibility of 2-18F-2-deoxy-D-glucose (FDG) PET studies in diagnosing and assessing the effects of treatment on lesions of the tongue, maxillary sinus and nasopharynx. FDG-PET imaging was performed 45 times in 17 patients with tumors before treatment. Ten patients with malignant lesions also underwent imaging after treatment. The differential absorption ratio (DAR) of the isotope was calculated at 55 min and the time activity curve (TAC) was obtained by dynamic emission scans for 0-55 min following injection of FDG. FDG-PET images, DAR and TAC were evaluated in all lesions. Findings showed that FDG-PET images could be used to diagnose malignant tumors and evaluate treatment when the DAR was > 4.0 and TAC was steep upward. Images suggestive of benign lesions had low DAR values (< 4.0) and mildly upward or flat TACs.

Radiological findings in the maxillary sinuses of symptomless young men

The maxillary sinuses were examined radiologically by occipitomental projection (Waters' view) in 404 conscripts without any symptoms of sinusitis. Abnormalities were found in 188 (23.3%) of all 808 sinuses, the most common being mucosal thickening of > 6 mm (12.3% of the sinuses), cysts or polyps (7.2%), and completely opacified sinus (3.3%). Normal x-ray findings were more common in the conscripts examined during the summer months and mucosal thickening was more frequently encountered in winter than in summer. Nasal bacteria were studied in 100 cases. Findings of normal bacterial flora and of pathogenic bacteria were equally frequent among subjects with normal sinus x-ray (score 0 and 1) and subjects with severe abnormalities (scores 3-6), but mucosal cysts (score 2) was more often combined with pathogens in the nose. Mucosal thickening was more often observed in non-allergic than in allergic persons; thus allergy did not seem to increase radiological abnormalities. Of young men engaged in outdoor activities, about one fifth seem to have significant chronic mucous membrane abnormalities in the maxillary antra without clinical symptoms. In 1-2% of cases secretion is detected in the maxillary sinus indicating a subclinical sinusitis.

An adjuvant afterloading brachytherapy device for use after orbital exenteration in patients with orbital malignancies

In cases of malignant diseases situated within the orbit and threaten to extend beyond it, removal of the orbit and periorbital contents may be indicated, followed by adjuvant chemotherapy or irradiation. An effective radiotherapy device for treatment of residual or suspicious cancer in the enucleated orbit consists of an external-beam radiation source (60Co) and an intraoperatively fitted mould as a guide for the flexible afterloading tubes using a 192Ir source. Considering the physical dose distribution and the local situation, this therapy permits a high dose with homogeneous dose distribution to the target area of the orbit but also allows significant dose reduction to adjunctive critical structures. Four patients with different orbital malignancies were treated by means of a combination of percutaneous radiotherapy with afterloading brachytherapy following orbital exenteration. The individual mould of the orbital cavity is modeled at the end of the operation. The technique of radiotherapy, dose distribution, and follow-up of the disease are demonstrated. Orbital malignancies with an extremely poor prognosis may profit from the application of this combined radiotherapy to avoid supraradical surgical intervention.