[Clinical implications of acoustic neuromas growth rate in volumetric study]

OBJECTIVE

The pattern of neuroma growth is of great importance in choosing the appropriate management. This paper tests the clinical impact of tumor growth rate assessed by volumetry. There is a conviction that some slowly growing tumors could be observed for many years.

METHOD AND PATIENTS

Volume measurements were performed on T1- weighted MR images (spin echo sequences) after injection of gadolinium using a special dedicated software. The studied group included 17 patients in whom at least two MRI examinations were carried out and tumor growth was confirmed. The intervals between initial and the first follow-up examination were 14.2 months on the average. In 7 cases tumor evolution was observed in 2 periods (3 MRI studies) and in 4 cases in 3 periods (4 MRI studies).

RESULTS

The growth rate depended on tumors volume and clinical stage (P<0.01). Small tumors can be observed more safely than advanced tumors because their increase in mass is lower.

CONCLUSION

The observation with the tumoral volume measurements appears to be a useful and accurate tool to estimate the tumor growth rate. The growth rate is a major factor for choosing the appropriate management.

[A case of maxillary neurosarcoma]

A case of neurosarcoma located in maxillary sinus is presented. The patient was 62 years old women who complained of nasal obstruction, epistaxis and headache. Results of physical examination showed a giant mass filling the nasal cavity and maxillary sinus. The lesion was completely resected by lateral rhinotomy way. After the operation histopathological diagnosis was difficult, one pathologist recognised schwannoma benignum other one sarcoma. Finally postoperative diagnosis was schwannoma benignum, it was misdiagnosis. Two years later the patient was surgically treated again because of tumor recurrence. These time pathological diagnosis was neurosarcoma. Radiotherapy was done as well. The patient died 18 months after treatment, tumor regrowth and generalization metastases was reason of the death.

[Extended translabyrinthine approach in treatment of vestibular schwannomas]

Results of removal of vestibular schwannomas using translabyrintine approach were presented. 12 unilateral neuromas were operated. Large neuromas with diameter above 2 cm constituted 75% of all cases. The total resection of tumors was achieved in 10 patients. In all cases anatomical integrity of facial nerve was conserved. In 7 patients facial nerve function was in stage I-III (House Brackmann classification). There were not life threatening complications. Authors underline, that the translabyrintine approach permits to obtain enough wide insight to ponto-cerebellar angle to remove safely, both little and large, vestibular schwannomas.

[Evolution of vestibular schwannoma: radiological evaluation]

Objective evaluation of natural history of vestibular schwannomas can be performed based on the modern radiological investigations, mainly MR. This study included 7 vestibular schwannomas. The average observation period was 28 months. Tumor growth was calculated based on the comparison of volume on the first and subsequent MR image using a special dedicated software. All tumors in this study were growing. The average growth rate was 143 mm3/month. Among 7 primarily observed tumors, 4 schwannomas were already removed surgically. The remaining 3 tumors are still observed. The authors pointed out that longer were the radiological observations of vestibular schwannomas greater was the conviction about progression of majority of these tumors.

[Metastasis of the cutis malignant melanoma of the parotid gland]

The authors presented a rare case of metastases of the cutis malignant melanoma to the parotid nodes. The attention was directed towards clinical aspects and diagnostic difficulties. Basing on data from the literature frequency and possibilities of cutis malignant melanoma metastases were analysed.

[Tumors of the parotid glands in the material of the Department of otolaryngology of the Medical Academy in Warsaw in 1986-1995]

In the Department of Otolaryngology, Medical Academy in Warsaw, 332 patients were surgically treated between 1986 and 1995 because of parotid gland tumors. In 275 cases benign tumors, in 57 cases--malignant tumors were observed. The majority of benign tumors were pleomorphic adenoma (61.45%) and lymphadenoma (22.54%); the majority of malignant tumors were adenocarcinoma (28%), adenoid cystic carcinoma (21%), mucoepidermoid carcinoma (15.78%). All patients with benign tumors were surgically treated, patients with malignant tumors were operated on and irradiated. The surgical procedure used superficial parotidectomy and total parotidectomy with preservation of facial nerve where possible. Ten patients required total parotidectomy with facial nerve resection because of malignant tumors, six patients had neck dissection performed. Of the 57 patients treated on account of malignant tumors 43 survived; 14 patients died of a local recurrence or generalization neoplasm disease.

[The surgical treatment of malignant tumors of the maxillo-ethmoid complex]

Forty-seven patients were treated in the Department of Laryngology, Medical Academy in Warsaw between 1980 and 1989. Twenty-seven patients had squamous cell carcinoma. All cases were advanced. The patients were treated by combination of surgery and postoperative radiotherapy. Nineteen patients (40.4%) survived five years.

[The maxillary artery embolization in the management of recurrent epistaxis]

The management of recurrent epistaxis, especially posterior epistaxis, is difficult. Anterior and posterior nasal packing constitutes the initial treatment. Ligation of the ethmoid arteries and maxillary artery is the next step if the previous methods fails. We have described three cases with recurrent epistaxis; all underwent successful diagnostic angiography and therapeutic embolization of the maxillary artery. The role of embolization in the management of persistent epistaxis has been discussed.

[Advanced nasopharyngeal tumor]

Nasopharyngeal cancer is a rare neoplasm in most parts of the world, it is the most common cancer the Chinese. Nasopharyngeal cancer is often misdiagnosed because of the variety of subtle signs and symptoms and the difficulty of examining this region. The most common neoplasms of the nasopharynx are epithelial malignancies originates from epithelial cells in the nasopharynx. The authors has presented a rare case of advanced nasopharyngeal adenocarcinoma.