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Park MJ, Choi JW, Kim JH, Chung YS, Yu MS. Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients. Laryngoscope 2024; 134:1581-1590. [PMID: 37772801 DOI: 10.1002/lary.31057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. MATERIALS AND METHODS Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. RESULTS The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. CONCLUSION Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1581-1590, 2024.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Medical Center, Inha University School of Medicine, Incheon, Korea
| | - Ji-Won Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kitaoka K, Yoshida H, Kumagami H. Organized hematoma of the sphenoid sinus with epistaxis. Radiol Case Rep 2024; 19:1171-1175. [PMID: 38259700 PMCID: PMC10801137 DOI: 10.1016/j.radcr.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Few reports have been made on organized hematoma (OH) originating in the sphenoid sinus. We report the case of a 24-year-old man who presented to the hospital with consistent epistaxis for 1 month. Preoperative computed tomography and magnetic resonance imaging (MRI) detected an expansive heterogeneous mass with minimal bone destruction and hypointense peripheral rim in T2-weighted images of the left sphenoid sinus as a solitary lesion. An OH was suspected first based on the history of repeated epistaxis and characteristic imaging findings, although quite rare. Preoperative vascular embolism was not performed because its effects on the ocular artery should be considered. With endoscopic sinus surgery under hypotensive anesthesia, the mass was carefully and successfully removed without bleeding and diagnosed as OH based on postoperative pathological examination. When solitary lesions are found in the sphenoid sinus with epistaxis, this disease should be differentiated. If it increases, complications, such as visual impairment, frequently occur, and control of intraoperative bleeding is sometimes difficult. Not only missing the characteristic imaging findings, especially MRI with contrast administration but also evaluating the anatomical relationship between OH and other important organs is important for a successful intervention of sphenoid sinus OH.
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Affiliation(s)
- Kyoko Kitaoka
- Department of Otolaryngology-Head and Neck Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, 3-15 Morimachi, Nagasaki 852-8511, Japan
| | - Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Nagasaki 856-8562, Japan
| | - Hidetaka Kumagami
- Department of Otolaryngology-Head and Neck Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, 3-15 Morimachi, Nagasaki 852-8511, Japan
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Goyal A, Dubey D, Burdette JH, Coldren DL, Plonk DP, Lack CM, Bunch PM. Sinonasal organized hematoma: Case report and review of the literature. Radiol Case Rep 2023; 18:4569-4573. [PMID: 37886728 PMCID: PMC10597775 DOI: 10.1016/j.radcr.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Sinonasal organized hematoma is a rare condition characterized by an organizing blood clot in the sinonasal cavity, which consists of blood products, fibrin, and dilated blood vessels. As a benign entity with an aggressive imaging appearance, it is important to differentiate sinonasal organized hematoma from malignancies affecting the paranasal sinuses and nasal cavities to guide appropriate management. In this report, we discuss the clinical presentation and diagnostic evaluation of an 82-year-old male with a left maxillary sinus organized hematoma and provide a comprehensive review of the relevant literature.
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Affiliation(s)
- Aakshit Goyal
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Devanshi Dubey
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jonathan H. Burdette
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Daniel L. Coldren
- Department of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Drew P. Plonk
- Department of Otolaryngology – Head and Neck Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Christopher M. Lack
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Paul M. Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Choi KY, Choi S, Jeong S, Won TB. Successful Endoscopic Transsphenoidal Approach Treatment of Sphenoid Sinus Organized Hematoma Causing Visual Deficit: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1802. [PMID: 37893520 PMCID: PMC10608076 DOI: 10.3390/medicina59101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background: Organized hematoma in the sphenoid sinus is rare, but serious complications, such as visual deficits, can occur. Three such case reports have been published previously in the literature; however, none have achieved complete recovery of the vision. Case presentation: A 69-year-old male patient was referred to the ear, nose, and throat department with an expansile soft tissue mass filling the right sphenoid sinus and blurry vision in his right eye. Complete mass removal was achieved by a wide opening of the sphenoid sinus via an endoscopic transsphenoidal approach, followed by cauterization of the feeding artery and coverage by a nasoseptal flap. The patient's vision was restored after the operation, and he declared no visual symptoms until the latest follow-up (one year after the surgery). Conclusions: Complete excision with an endoscopic endonasal transsphenoidal approach can restore visual deterioration caused by a sphenoid sinus organized hematoma.
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Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Sun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Suji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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R A, G K N, Shetty R, Gopal NK. Sinonasal Organised Haematoma- A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:1009-1013. [PMID: 37206709 PMCID: PMC10188838 DOI: 10.1007/s12070-023-03579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/12/2023] [Indexed: 02/25/2023] Open
Abstract
Sinonasal organised haematoma (SOH) is an uncommon, benign condition that can be locally aggressive. SOH can be mistaken for a malignant tumour but the characteristic imaging findings and histopathology facilitate the diagnosis of an organised haematoma. We report a 26 year old male patient presenting with unilateral nasal obstruction and painless epistaxis, which are the most common presenting symptoms of sinonasal tumour lesions. Based on the clinical features, age, radiological investigation, intraoperative finding, location of the lesion and histopathological examination; a diagnosis of SOH was arrived at. Surgical excision utilized the COBLATION technology and endoscopic complete removal of the nasal mass was done. Intraoperatively minimal bleeding was encountered. On histopathology, haematoma at the center and fibrosis at the periphery was noted. To our knowledge, this is the first reported case of SOH excision using Coblator. No recurrence was seen in subsequent follow ups. Although SOH can be mistaken for a malignant tumour, the characteristic imaging and histopathology findings facilitate the diagnosis of an organised haematoma.
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Affiliation(s)
- Ashwini R
- Department of ENT, Sri Sathya Sai Institue of Higher Medical Sciences, EPIP Zone, C 302, Sahana Block, SSSIHMS, Whitefield, 560066 Bengaluru, Karnataka India
| | - Narayana G K
- Department of ENT, Sri Sathya Sai Institue of Higher Medical Sciences, EPIP Zone, C 302, Sahana Block, SSSIHMS, Whitefield, 560066 Bengaluru, Karnataka India
| | - Reema Shetty
- Department of ENT, Sri Sathya Sai Institue of Higher Medical Sciences, EPIP Zone, C 302, Sahana Block, SSSIHMS, Whitefield, 560066 Bengaluru, Karnataka India
| | - Naveen Kumar Gopal
- Department of ENT, Sri Sathya Sai Institue of Higher Medical Sciences, EPIP Zone, C 302, Sahana Block, SSSIHMS, Whitefield, 560066 Bengaluru, Karnataka India
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Kurozumi M, Takumi Y, Uehara T, Suzuki T, Ohya A, Shinagawa J, Miyagawa J, Tsukahara Y, Yamada A, Tsukada K, Suzuki H, Fujinaga Y. Preoperative Arterial Embolization to Avoid Intraoperative Bleeding during Endoscopic Sinus Surgery for Organized Hematoma of the Maxillary Sinus: A Case Series and Literature Review. INTERVENTIONAL RADIOLOGY 2021; 6:102-107. [PMID: 35912279 PMCID: PMC9327429 DOI: 10.22575/interventionalradiology.2021-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022]
Abstract
Purpose: This study aimed to evaluate the safety and efficacy of preoperative arterial embolization of organized hematoma of the maxillary sinus. Material and Methods: Seven patients who were pathologically diagnosed with an organized hematoma of the maxillary sinus and who underwent endoscopic sinus surgery following preoperative arterial embolization for the same from July 2013 to April 2020 at our hospital were included. A literature review of the PubMed database was performed to identify 13 cases on organized hematomas of the maxillary sinuses. The embolization and nonembolization groups comprised patients who underwent preoperative embolization (n = 10, seven from this study and three from literature) and those who did not undergo preoperative embolization (n = 10, from literature), respectively. Outcomes of embolization including embolization-related complications and postoperative bleeding were assessed, and volumes of intraoperative blood loss and duration of surgery were compared between the groups. Results: No preoperative embolization-related complications were observed in our cases. The volume of surgical blood loss in the seven cases varied from 0 to 100 mL with a median of 30 mL, and the duration of surgery ranged from 45 to 166 minutes with a median of 112 minutes. The volume of blood loss was significantly lower for the embolization group than that for the nonembolization group (p = 0.0031). There was no statistically significant difference regarding duration of surgery between the groups (p > 0.10). Conclusions: Preoperative embolization of an organized hematoma of the maxillary sinus is a safe and effective method that helps prevent serious intraoperative hemorrhage.
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Affiliation(s)
| | - Yutaka Takumi
- Department of Otorhinolaryngology, Shinshu University School of Medicine
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine
| | - Takeshi Suzuki
- Department of Radiology, Shinshu University School of Medicine
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine
| | - Jun Shinagawa
- Department of Otorhinolaryngology, Shinshu University School of Medicine
| | - Jun Miyagawa
- Radiology Division of Shinshu University Hospital
| | | | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine
| | - Keita Tsukada
- Department of Otorhinolaryngology, Shinshu University School of Medicine
| | - Hiroaki Suzuki
- Department of Otorhinolaryngology, Shinshu University School of Medicine
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Sekino H, Ishii S, Sato H, Nomoto M, Kawana S, Suenaga H, Kuroiwa D, Ito H. Three cases of organized hematoma of the maxillary sinus in patients who underwent preoperative arterial embolization. Radiol Case Rep 2021; 16:3945-3949. [PMID: 34712374 PMCID: PMC8529391 DOI: 10.1016/j.radcr.2021.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023] Open
Abstract
Organized hematoma (OH) is benign tumor in the maxillary sinus. The standard treatment for OH is complete surgical resection, however massive bleeding can occur during the procedure, albeit rarely. Some reports have suggested preoperative embolization is useful for reducing the volume of intraoperative bleeding. We report 3 cases of OH in the maxillary performed preoperative embolization. We identified the feeding arteries by angiography or IVR-CT, and we embolized them using Gelatin sponge particles. The embolized artery was the maxillary artery or both the maxillary and the facial artery. There were no major complications as a result of embolization. The mean fluoroscopy time was 35.8 minutes, and the mean fluoroscopy dose was 329.3 mGy. Tumor resection was performed the next day after arterial embolization. The mean bleeding volume for surgery was 383.3 ml, and the mean operative time was 194 minutes. No recurrence was observed in any of the cases over a 4-year follow-up period. We considered that it is possible that preoperative artery embolization is useful for decreasing intraoperative bleeding volume. Although the methods and usefulness of embolization await future reports, it is a technique that should be considered preoperatively because of its potential to prevent massive bleeding.
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Affiliation(s)
- Hirofumi Sekino
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan,Corresponding author. Hirofumi Sekino.
| | - Shiro Ishii
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hirohito Sato
- Department of Otorhinolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Mika Nomoto
- Department of Otorhinolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Kawana
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Suenaga
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Daichi Kuroiwa
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
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Oungsakul P, Perez-Guaita D, Shah AK, Duffy D, Wood BR, Bielefeldt-Ohmann H, Hill MM. Addressing Delicate and Variable Cancer Morphology in Spectral Histopathology Using Canine Visceral Hemangiosarcoma. Anal Chem 2021; 93:12187-12194. [PMID: 34459578 DOI: 10.1021/acs.analchem.0c05190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Spectral histopathology has shown promise for the classification and diagnosis of tumors with defined morphology, but application in tumors with variable or diffuse morphologies is yet to be investigated. To address this gap, we evaluated the application of Fourier transform infrared (FTIR) imaging as an accessory diagnostic tool for canine hemangiosarcoma (HSA), a vascular endothelial cell cancer that is difficult to diagnose. To preserve the delicate vascular tumor tissue structure, and potential classification of single endothelial cells, paraffin removal was not performed, and a partial least square discrimination analysis (PLSDA) and Random Forest (RF) models to classify different tissue types at individual pixel level were established using a calibration set (24 FTIR images from 13 spleen specimens). Next, the prediction capability of the PLSDA model was tested with an independent test set (n = 11), resulting in 74% correct classification of different tissue types at an individual pixel level. Finally, the performance of the FTIR spectropathology and chemometric algorithm for diagnosis of HSA was established in a blinded set of tissue samples (n = 24), with sensitivity and specificity of 80 and 81%, respectively. Taken together, these results show that FTIR imaging without paraffin removal can be applied to tumors with diffuse morphology, and this technique is a promising tool to assist in canine splenic HSA differential diagnosis.
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Affiliation(s)
- Patharee Oungsakul
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, QLD 4343, Australia.,QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - David Perez-Guaita
- FOCAS Research Institute, Technological University Dublin, City Campus, Dublin D02 HW71, Ireland.,Department of Analytical Chemistry, University of Valencia, Burjassot 46000, Spain
| | - Alok K Shah
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - David Duffy
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - Bayden R Wood
- Centre for Biospectroscopy, School of Chemistry, Faculty of Science, Monash University, Clayton, VIC 3800, Australia
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, QLD 4343, Australia.,School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Michelle M Hill
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Eissa L, Eid M, Razek AAKA. MR and CT imaging features of sino-nasal organized hematomas. Oral Radiol 2020; 37:297-304. [PMID: 32462337 DOI: 10.1007/s11282-020-00450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe the MR and CT imaging features of organized hematomas [OH]. METHODS A retrospective analysis of MR imaging and CT of eight patients [6 male, 2 females; age range is 6-86 years] with pathological proven OH was performed. Routine contrast MR and CT scan were done for all patients, and diffusion-weighted imaging and dynamic contrast CT were done for only five patients. Imaging analysis was done for the signal intensity, the enhancement pattern at MR imaging, the ADC value at DWI, bone remodeling at CT, and the neo-vascularization at dynamic contrast CT. RESULTS OH revealed T2 hypo-intense of the matrix in all patients with complete [n = 3] and incomplete [n = 5] marginal hypo-intensity rim. The lesions revealed a frond-like pattern of contrast enhancement of the central part of the lesion that associated with a peripheral rim of contrast enhancement. OH revealed unrestricted diffusion with high ADC value [1.7-2.5 × 10-3 cm2/s] in 5 patients. CT scan showed geographic bone remodeling and thinning of the nasal turbinates, and the sinus wall and contrast CT showed neo-vascularization with frond-like branching arteries of the central part of the lesions in five patients. CONCLUSION We conclude that MR and CT imaging findings can help in the diagnosis of OH.
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Affiliation(s)
- Lamya Eissa
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | - Mohamed Eid
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
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Wan Y, Gao F, Ye F, Yang W, Hua Y, Keep RF, Xi G. Effects of aging on hydrocephalus after intraventricular hemorrhage. Fluids Barriers CNS 2020; 17:8. [PMID: 32106865 PMCID: PMC7047364 DOI: 10.1186/s12987-020-0169-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hydrocephalus is a common and major complication that affects outcome after intraventricular hemorrhage (IVH). While aging impacts the occurrence of hydrocephalus in patients with IVH this and the underlying mechanisms have received little attention. The present investigation, therefore, studied the impact of aging on hydrocephalus after IVH in a rat model. METHODS Young and aged (3 and 18 months old, respectively) male Fischer 344 rats had an intraventricular injection of 200 μl autologous blood or saline. Ventricular volume was estimated using magnetic resonance imaging (MRI), while ventricular wall damage, heme oxygenase-1 (HO-1) and epiplexus cell activation were quantified by histological staining and Western blot. Additionally, the impact of intraventricular iron injection was examined in young and aged rats. RESULTS Intraventricular injection of autologous blood induced hydrocephalus in both young and aged rats but ventricular volumes were larger in aged rats compared to young rats from day 3 to day 14 followed IVH. In addition, ventricular wall damage and periventricular HO-1 upregulation were greater in aged versus young rats on day 1 after IVH. Aged rats also had more choroid plexus epiplexus cells on day 14 after IVH. Additionally, organized hematomas were observed in 23% (3/13) of aged rats but not in young rats after IVH. Organized hematomas in aged rats showed larger T2* lesions on MRI compared to rats with non-organized hematomas. Similar to the effects of IVH, intraventricular injection of iron resulted in more epiplexus cells activation and more severe hydrocephalus in aged compared to young rats. CONCLUSIONS IVH causes more severe hydrocephalus in aged compared to young rats. Enhanced ventricular wall damage, epiplexus cell activation and iron overload may contribute to this aggravated hydrocephalus development in aged animals.
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Affiliation(s)
- Yingfeng Wan
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Feng Gao
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
- Department of Neurology, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fenghui Ye
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Weiming Yang
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, R5018 Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.
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Varghese L, Mukhopadhyay S, Mehan R, Kurien R, Thomas M, Rupa V. Sinonasal organising haematoma - a little known entity. Braz J Otorhinolaryngol 2018; 85:698-704. [PMID: 30060926 PMCID: PMC9443051 DOI: 10.1016/j.bjorl.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. Objective To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. Methods A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. Results Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. Conclusion Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.
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Affiliation(s)
- Lalee Varghese
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India.
| | | | - Raghav Mehan
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
| | - Regi Kurien
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
| | - Meera Thomas
- Christian Medical College, Department of Pathology, Vellore, India
| | - V Rupa
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
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12
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Yoon YH, Kim SH, Kim YM, Rha KS. Organized hematoma of the sphenoid sinus causing acute visual loss. Eur J Ophthalmol 2018; 28:NP7-NP9. [PMID: 29869525 DOI: 10.1177/1120672118779484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sinonasal organized hematoma, which has locally aggressive characteristics, is a non-neoplastic disease. We report a rare case of sphenoid sinus organized hematoma causing acute visual loss. A 35-year-old male presented with progressive headaches, retro-orbital pain, and frequent epistaxis. He had a medical history of aplastic anemia and of taking warfarin for a valvular heart disease. On image studies, an expansive soft tissue density lesion with bony destruction was found in his left sphenoid sinus. While waiting for elective surgery, acute visual loss occurred. Emergent endoscopic surgery was performed after correction of abnormal hematological profiles, but his visual disturbance did not improve. Although sphenoid sinus organized hematoma is a rare disease, organized hematoma should be considered in the differential diagnosis for sphenoid sinus lesion with acute visual loss. Rapid and correct diagnosis and timely treatment are essential to prevent permanent sequela.
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Affiliation(s)
- Young Hoon Yoon
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sung Ha Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Yong Min Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Ki-Sang Rha
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
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Lee C, Yook JI, Han SS. Organized hematoma of temporomandibular joint. Imaging Sci Dent 2018; 48:73-77. [PMID: 29581953 PMCID: PMC5863023 DOI: 10.5624/isd.2018.48.1.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
Organized hematoma is a pseudo-tumorous lesion mostly occurs at sinonasal cavity and often confused with malignant neoplasm. The initiation of this lesion is blood accumulation, probably due to trauma, and this hematoma develops into organized hematoma as it encapsulated with fibrous band and neo-vascularized. Since it is uninformed at temporomandibular joint (TMJ) region, imaging diagnosis might be challenging. Also, delayed detection of mass involving TMJ is not uncommon due to confusion with joint disorder. Thus, this report introduced the rare pathology, organized hematoma on TMJ with advanced imaging features. Also, diagnostic point for early detection was described for the TMJ tumors and pseudo-tumors considering complexity of surgical intervention in this region.
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Affiliation(s)
- Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Jong In Yook
- Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
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A Case of Organizing Hematoma in a Maxillary Sinus After Reconstruction of a Blow-Out Fracture. J Craniofac Surg 2018; 28:1040-1041. [PMID: 28582957 DOI: 10.1097/scs.0000000000003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 36-year-old man presented because of nasal obstruction, rhinorrhea, and postnasal drip. The patient had undergone reconstruction of a blow-out fracture of the orbital floor 12 years before and had sinusitis that likely had resulted from implant migration into the maxillary sinus. The inflammation was successfully resolved, and the implant was removed through a minimally invasive endoscopic sinus surgery technique. On pathologic examination, an organizing hematoma was identified as the cause of the lesion. Pre- and postoperational paranasal sinus computed tomography images were taken to compare the anatomy of the sinus before and following surgery.
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Abstract
Chronic hematomas are defined as hematomas with slow, progressive growth over many weeks. They are an extremely rare cause of acute neck swelling in the pediatric population. They consist of an organized central mass of blood with granulation tissue and fibrotic changes peripherally. The presence of a capsule prevents resorption but allows for intracapsular bleeding with subsequent expansion. We describe a case of a 6-year-old girl who presented to the emergency department with a spontaneously occurring left neck mass in the supraclavicular region. A possible neoplasm was suggested on imaging. The patient was referred to a head and neck surgeon, she underwent a thorough workup, and the mass was ultimately surgically excised. Histologically, the mass was confirmed to be a chronic hematoma. The patient recovered uneventfully, and there has been no recurrence.
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Golub IJ, Garcia RA, Wittig JC. A 15-Year-Old Male Baseball Player With a Mass in the Brachialis Muscle. Orthopedics 2016; 39:e545-8. [PMID: 27045482 DOI: 10.3928/01477447-20160324-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/29/2015] [Indexed: 02/03/2023]
Abstract
A 15-year-old boy presented with a mass in his right arm after suffering a minor injury playing baseball. He had been diagnosed with a hematoma. There was no other outstanding medical/surgical history. Magnetic resonance images showed a heterogeneous mass arising from the brachialis muscle that mainly enhanced peripherally with extremely scant internal nodular enhancement. Core needle biopsy cells were positive for CD31 and CD34, markers for atypical endothelial cells, as well as MIB-1 and p53. The final diagnosis was an angiosarcoma of the brachialis muscle. Pediatric angiosarcoma, particularly within deep tissue, is exceedingly rare. Histological and immunohistochemical modalities led to the diagnosis. Magnetic resonance images suggested a mass with a large cystic/hemorrhagic space that could have been misconstrued as a hematoma had there been absolutely no nodular or septal enhancement. The patient underwent neoadjuvant chemotherapy and radiation before undergoing limb-sparing surgery that included resection of the mass with the brachialis muscle and short head of the biceps muscle. Neoadjuvant treatment was deemed successful due to a drastic reduction in the size of the tumor and 95% tumor necrosis. The patient was disease free 2 years postoperatively. There had been no local/systemic recurrences. He was pain free, had normal elbow function, and had returned to playing baseball. It is important to be extremely suspicious when a patient presents with a hemorrhagic, painless, enlarging mass after sustaining minor trauma. A careful and meticulous biopsy must be completed to achieve the correct diagnosis. Magnetic resonance imaging with gadolinium is recommended for evaluation because these masses can be often misinterpreted as hematomas. [Orthopedics. 2016; 39(3):e545-e548.].
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Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D. Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management. Otolaryngol Head Neck Surg 2016; 154:626-33. [PMID: 26861229 DOI: 10.1177/0194599815625956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities. RESULTS This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred. CONCLUSIONS OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
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Affiliation(s)
- Wenhui Pang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Na Ma
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Oubahmane T, Abou-Elfadl M, Mahtar M, Kadiri F. Unusual site of organized haematoma in a context of chronic myeloid leukaemia. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 133:221-2. [PMID: 26381677 DOI: 10.1016/j.anorl.2015.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T Oubahmane
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20 Août, Casablanca, Morocco.
| | - M Abou-Elfadl
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20 Août, Casablanca, Morocco
| | - M Mahtar
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20 Août, Casablanca, Morocco
| | - F Kadiri
- Service d'ORL et de chirurgie cervico-faciale, hôpital 20 Août, Casablanca, Morocco
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Three cases of organized hematoma of the maxillary sinus: clinical features and immunohistological studies for vascular endothelial growth factor and vascular endothelial growth factor receptor 2 expressions. Case Rep Otolaryngol 2015; 2015:846832. [PMID: 25699195 PMCID: PMC4325202 DOI: 10.1155/2015/846832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/28/2014] [Accepted: 01/01/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment.
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Wollina U, Heinig B, Langner D. Chronic Expanding Organized Hematoma of the Lower Leg: A Rare Cause for Nonhealing Leg Ulcers. INT J LOW EXTR WOUND 2015; 14:295-8. [PMID: 25691320 DOI: 10.1177/1534734615571129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic expanding hematoma is a rare entity on the leg. A 55-year-old women presented with 2 small nonhealing leg ulcers. On examination we observed a painless bulky tumor-like mass that developed slowly after deep soft tissue infection almost 2 years ago. Vascular computed tomography suggested an organized hematoma. Important differential diagnoses include sarcoma and lymphoma. Treatment of choice is surgery. Histology confirmed the diagnosis of an organized hematoma. Chronic expanding hematoma is a rare cause of nonhealing leg ulcers.
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Affiliation(s)
- Uwe Wollina
- Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Birgit Heinig
- Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Dana Langner
- Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Ohta N, Ishida A, Kurakami K, Suzuki Y, Kakehata S, Ono J, Ikeda H, Okubo K, Izuhara K. Expressions and roles of periostin in otolaryngological diseases. Allergol Int 2014; 63:171-80. [PMID: 24759558 DOI: 10.2332/allergolint.13-rai-0673] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 02/05/2023] Open
Abstract
Periostin is a 90-kDa member of the fasciclin-containing family; it functions as part of matricellular proteins, and its production by airway epithelial cells is induced by IL-4 and IL-13. Periostin is secreted by fibroblasts and upregulated in the airway epithelia of patients with bronchial asthma; it is considered to contribute to remodeling under this pathological condition. However, despite many studies in diverse research areas, our overall understanding of this intriguing molecule is still inadequate. Here, we integrate the available evidence on periostin expression and its roles in otolaryngological diseases, including allergic rhinitis, chronic rhinosinusitis with nasal polyps, aspirin-induced asthma, organized hematoma, eosinophilic otitis media, and IgG4-related disease. Periostin might be involved as an important structural mediator in pathological processes such as insult and injury, Th2-driven inflammation, extracellular matrix restructuring, fibrosclerosis, tumor angiogenesis, and tissue remodeling.
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Affiliation(s)
- Nobuo Ohta
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akihiro Ishida
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kazuya Kurakami
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yusuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Junya Ono
- Shino-Test Corporation, Kanagawa, Japan
| | - Hiroki Ikeda
- Department of Otolaryngology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Faculty of Medicine, Saga Medical School, Saga, Japan
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