Unexpected pathologies in patients referred for endoscopic DCR

Effectiveness of Nasolacrimal SCC Treatments and Promising Role of Chemo-Induction: A Case Report and Systematic Review

OBJECTIVE

To comprehensively analyze reported cases of nasolacrimal squamous cell carcinoma (NLSCC), focusing on risk factors, treatment modalities, and outcomes. Additionally, investigate the impact of human Papillomavirus (HPV) status and histopathological subtypes' impact on prognosis.

DATA SOURCES

Pubmed, Embase.

REVIEW METHODS

We conducted a systematic literature review to identify relevant studies reporting cases of NLSCC. The review methods adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The final update was performed on May 31, 2023.

RESULTS

The 72 studies included a total of 313 participants (mean age: 55; 60% male). Longer symptom duration (44.1 ± 59.2 months) correlated with recurrence (p = 0.004), and males exhibited higher mortality rates (19.6% vs. 2.4% in females, p = 0.01). The overall survival (OS) rate among all patients was 87.1%. Basaloid NLSCC had a worse death outcome (p ≤ 0.001). HPV-positive cases showed comparable OS, recurrence, and metastasis rates to the general population (p = 0.917, 0.851, 0.07, respectively). Comparing treatment approaches (surgery, surgery with adjuvant radiation, chemoradiotherapy [CRT] followed by surgery), no significant differences in 5 and 10-year OS rates or recurrence were observed (p = 0.4, 0.24, respectively), but 5-year metastasis events were significant (p = 0.024). Eye exenteration rates were 31.1%, 20%, and 0% for the respective treatments (p = 0.089). Induction chemotherapy saved four cases from potential exenteration with favorable prognosis.

CONCLUSION

Early detection and diagnosis are of utmost importance in the management of NLSCC. Regardless of the treatment approach, HPV-related NLSCC demonstrated similar outcomes to the general population. Basaloid histology represents the worst subtype in terms of prognosis. Limited adjuvant CRT cases showed improved outcomes and induction chemotherapy's importance was emphasized in recent literature and our shared experience. Laryngoscope, 134:3892-3902, 2024.

Idiopathic acquired dacryocystocele in an adult: case report of a rare entity

Background

Idiopathic acquired dacryocystocele in adults is a rare disorder of the lacrimal drainage pathway. Only 20 cases have been reported in the literature. It presents with a triad of epiphora, medial canthal swelling, and recurrent dacryocystitis. Patients presenting without recurrent dacryocystitis is quite uncommon. This presentation can be confused with secondary nasolacrimal duct obstruction and other non-inflammatory pathologies. Dacryocystorhinostomy with stenting is the treatment employed in most reported cases.

Case presentation

A 24-year-old male presented with epiphora and medial canthal swelling for 3 years. Examination revealed features of left nasolacrimal duct obstruction. Imaging was suggestive of a cystic, homogenous, non-enhancing lesion in the left lacrimal sac region without bone destruction. Findings were suggestive of dacryocystocele. Patient underwent endoscopic dacryocystorhinostomy without stenting. Postoperatively, the swelling and epiphora resolved. Patient is symptom-free on follow-up.

Conclusion

Idiopathic dacryocystocele must be considered in evaluation of a medial canthal mass with epiphora without dacryocystitis. Conservative treatment is ineffective. Endoscopic dacryocystorhinostomy is safe and effective.

The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy

BACKGROUND

During dacryocystorhinostomy (DCR), the lacrimal sac wall biopsy is not routinely performed in our hospital, but it is recommended if there is a suspicion of underlying disease other than preoperatively or intraoperatively chronic inflammation.

OBJECTIVE

Most of patients with epiphora have different causes of nasolacrimal duct obstruction (NLDO). This study aims to examine how important routine lacrimal sac biopsy is during endoscopic DCR surgery.

PATIENTS & METHODS

The study included 50 patients with chronic unilateral epiphora. All patients underwent endoscopic DCR with NLD biopsy. Histopathologic analysis was performed for each specimen.

RESULTS

The findings of NLD biopsy showed chronic inflammation in 33 cases (66%), chronic dacryocystitis in 9 cases (18%), dacryolith with dacryocystitis in one case, granuloma in 4 cases (8%), rhinoscleroma in 2 cases (4%), and one case had a neoplasm. Histopathologic findings were inflammatory cellular infiltrates in 56%, 30% and 14% in mild, moderate and severe chronic inflammatory state (CIS) score, respectively. Fibrosis in 18%, 20% and 62% in mild, moderate and severe CIS score, respectively. Capillary proliferation in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. Chronic inflammatory signs in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively.

CONCLUSION

Although neoplasm and granuloma are rare cause of lacrimal sac or duct obstruction requiring DCR, they were detected through nasolacrimal assessment and routine intraoperative lacrimal sac biopsy.

Investigating the effects of inferior turbinate outfracture on the lacrimal system by evaluating the results of paranasal sinus computed tomography and nasolacrimal irrigation test

OBJECTIVES

This study aims to investigate the effects of inferior turbinate outfracture on the nasolacrimal system and tear flow.

METHODS

Forty-seven patients (26 males, 21 females) between the ages 18 and 52 years (mean age-29.0 ± 9.6 years) were included in the study. Preoperative nasal examinations and paranasal sinus computed tomography of the patients were carried out; the direction, location, nasal septum deviation classification and inferior turbinate hypertrophy size classification were evaluated. Lacrimal irrigation test was performed preoperatively and 14 days postoperatively.

RESULTS

The study included 47 patients who underwent septoplasty and inferior turbinate outfracture. The mean duration of lacrimal irrigation test was 2.9 ± 0.8 s on the right side and 3.0 ± 1.1 s on the left side preoperatively, and 2.1 ± 0.8 s on the right side and 2.2 ± 1.0 s on the left side postoperatively. No significant relationship between direction, location classification, angle nasal septum deviation classification and lacrimal irrigation test duration was found. A significant relationship between size classification of the left inferior turbinate and preoperative lacrimal irrigation test duration was noted (p = 0.030). Moreover, a significant decrease between preoperative and postoperative lacrimal irrigation test duration after inferior turbinate outfracture (p = 0.000) was noted.

CONCLUSION

We concluded that outfracture of the inferior turbinate with septoplasty surgery may benefit the regulation of tear flow. In addition, we concluded that lacrimal irrigation test duration may be effective in determining the patients with subclinical nasolacrimal duct partial obstruction due to inferior turbinate pathologies.

Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

Purpose

Epiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.

Methods

Dynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.

Results

Fifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.

Conclusions

Although DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction.

Rhinoscleroma

CONTEXT.—

Rhinoscleroma is a rare, chronic, infectious granulomatous process involving the upper respiratory tract caused by gram-negative bacilli, Klebsiella rhinoscleromatis. The site most commonly affected is the nasopharynx; however, lesions in various other locations have been described.

OBJECTIVE.—

To review the literature for all the reported cases of rhinoscleroma in the past 5 years.

DATA SOURCES.—

Published cases of rhinoscleroma from a PubMed (National Center for Biotechnology Information, Bethesda, Maryland) search were reviewed.

CONCLUSIONS.—

Rhinoscleroma in nonendemic regions is extremely rare; however, with increased travel, immigration, and globalization, it is imperative to recognize this entity because the symptoms can be devastating and in some cases fatal. Although nasopharynx is the common site of involvement, unusual sites such as the trachea can be involved in rare cases. Rhinoscleroma can be managed effectively with a combination of antibiotics and surgical debridement and repair; however, recurrence rates do remain high.

Avoiding dacryocystorhinostomy in cases of epiphora caused by inferior meatus obstruction

AIMS

To determine the role of inferior meatus pathologies as an underdiagnosed cause of epiphora.

METHODS

This study was conducted in the oculoplastic institution of Tel Aviv medical center-a regional referral center. A retrospective review of files of patients presenting to the lacrimal clinic with nasolacrimal duct obstruction between October 2010 and September 2016. Cases in which a pathology of the inferior meatus was identified and treated are presented in this article.

RESULTS

During this time frame, we preformed 186 endoscopic dacryocystorhinostomy surgeries. Out of those, eight patients (4.3%) were diagnosed and treated for pathology causing an obstruction of the inferior meatus. Seven of our patients were females; the mean age was 24 years. A wide range of pathologies were found: cysts, dacryoliths, membranes obstructing the inferior meatus, and concheal obstruction. All patients went through endoscopic treatment targeted at the cause of obstruction. During follow-up (average 35 months) only two patients remained symptomatic and were referred for an endonasal endoscopic dacryocystorhinostomy.

CONCLUSIONS

Inferior meatus obstruction is an underdiagnosed cause of epiphora. Multiple pathologies may co-exist in the same patient. In select cases of NLDO, diagnosis and treatment can be done endoscopically, avoiding the need for dacryocystorhinostomy.

Fungus Ball of the Maxillary Sinus Presenting With Epiphora

The authors report a case of fungus ball of the maxillary sinus with bone erosion presenting with epiphora, which was diagnosed after treatment failure using silicone intubation for nasolacrimal duct obstruction. Symptoms of sinus fungus ball are similar to those of chronic bacterial rhinosinusitis, although occasionally asymptomatic. To our knowledge, epiphora has never been reported as a symptom of sinus fungus ball. The purpose of this report is to emphasize the importance of considering sinonasal causes when evaluating epiphora patients, as well as to suggest the use of preoperative CT scans for a more accurate diagnosis and to prevent unnecessary procedures.

Macroscopic techniques for ophthalmic tumor specimens

This article explores the range of tumor specimens that may be submitted to ophthalmic pathology. The handling of complex enucleation and exenteration is described along with smaller eyelid, conjunctival and corneal specimens. The importance of a good understanding of the unique anatomy of the ocular region and detailed clinical information is emphasized as this results in the taking of appropriate blocks for histology and consequently clinically helpful reports. Recommendations for handling specimens where further tissue is required for molecular studies is discussed.