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Conditions of the External Ear
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Ayeshah Abdul-Hamid, Samuel MacKeith
Progression of disease can result in cranial neuropathies, including facial and bulbar nerves. Diagnosis is clinical combined with radiological assessment which may utilise CT (showing bone erosion) and contrast magnetic resonance imaging (MRI) and bone scans. Biopsy of granulation tissue should be considered to exclude malignancy. Treatment should be guided by microbial sampling. P. aeruginosa is the most common pathogen and therefore agents should target this. Anti-microbial treatment is usually prolonged, typically lasting 6–12 weeks, and may benefit from a multidisciplinary guidance by microbiology colleagues. Rarely NOE can be fungal. Treatment response is assessed clinically (most importantly resolution of pain), with inflammatory markers and in some units with imaging (nuclear medicine scans or MRI). The role of surgery is limited to obtaining microbiological samples, removing bony sequestra, and draining abscesses. There is evidence from cases series for the therapeutic benefit of hyperbaric oxygen in NOE.
Atypical Teratoid / Rhabdoid Tumors – AT/RT
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Michael C. Frühwald, Jaclyn A. Biegel, Susan N. Chi
Warmuth-Metz et al. reported the results of computed tomography (CT) and magnetic resonance imaging (MRI) in a series of 33 consecutive AT/RT.59 They describe a distinct pattern of band-like enhancement surrounding a central hypointense tumor in 38% on contrast-enhanced images (Figure 17.3a). Jin and Feng list peripheral cysts, signs of hemorrhage, and hyperintense diffusion-weighted images as typical for AT/RT (Figure 17.3b, d).60 The solid parts of AT/RT are hypointense on T2 and severe restricted diffusion is observed on ADC (Figure 17.3a, b). The deposition of hemosiderin appears to be characteristic (Figure 17.3c). Commonly the borders of the lesion are surrounded by varying degrees of perifocal edema. The amount of edema may help in differentiating AT/RT from CNS PNET. Interestingly, a relatively high percentage of bone destruction in the vault or skull has been detected. In 91 consecutively imaged patients with AT/RT five revealed bone erosion.61 This is an unusual feature in other primary tumors of the CNS. AT/RT seem to be more often located in the cerebellopontine angle,62 but often extend beyond anatomical borders (Figure 17.3a).
Malignant tumors
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Carcinoma cuniculatum is a very slow-growing neoplasm and virtually never metastasizes. It is most frequently found in the webspace between the toes where it causes channels and sinuses often releasing a smelly material upon pressure. Some cases were observed in the nail apparatus with distal-lateral onycholysis and paronychia, nail bed inflammation, and discharge of a foul-smelling yellow-white cheese-like material from the nail bed with loss of the nail plate,41 verrucous tumor of the distal part of the thumb, and subungual tumor with deep holes in the nail bed.42 The big and the little toes were involved with loss of the nail. Even though metastases do not occur (except for lesions developing after radiotherapy), bone erosion is frequent probably because of the long duration before treatment.43 The etiology of this particular type of low-grade carcinoma is not known, but one patient was an internist who had performed X-ray screening examinations over a period of more than 20 years.42 The clinical differential diagnosis includes warts and keratoacanthoma, papillomatosis, eccrine porocarcinoma, and a variety of sinus-forming and fistulating processes.
Sphenoid sinus mucocele causing ptosis with pupil-spared ophthalmoplegia: a hint on carotid artery doppler ultrasound
Published in International Journal of Neuroscience, 2023
Aldo F. Costa, Paula Martínez A., Nazaret Peláez V., Alejandro Peral Q., José C. Estévez
The initial evaluation of SSM should include direct visualization of the nasal cavities and sinuses (e.g. anterior rhinoscopy or nasal endoscopy) and/or sinuses imaging. MRI and CT findings in our case were consistent with other cases reviewed in the literature presenting with SSM showing [8]. Although bony erosion is not noted in the majority of patients, CT is the preferred diagnostic imaging modality [9]. CT could not determine invasiveness in the present case. Nevertheless, Doppler ultrasound findings were compatible with an intracranial carotid artery distal compression that could not be seen on MR angiography, as noted in a similar report [10]. Despite the Doppler ultrasound findings are compatible with vascular compression, nerve compression can be assumed given the proximity of oculomotor and abducens nerves as demonstrated in this case.
Sinonasal intestinal- and non-intestinal-type adenocarcinoma in China: a retrospective study of 14 cases
Published in Acta Oto-Laryngologica, 2023
Guangyao Li, Yuxuan Shi, Quan Liu, Huankang Zhang, Kai Xue, Xiaole Song, Ye Gu, Xicai Sun, Qi Dai, Hongmeng Yu
Imaging evaluation of the paranasal sinuses involves a combination of CT and MRI. Bone erosion can be observed on CT, whereas MRI can distinguish adjacent soft tissue structure involvement from sinus retention. Herein, the most commonly involved sites were the posterosuperior septum, middle turbinate, and anterior ethmoid sinus. Squamous cell carcinoma is the most common malignant tumour of the maxillary sinus, whereas adenocarcinoma is the dominant malignancy of the ethmoid sinus [11]. This is consistent with a previous hypothesis that toxic exposure is concentrated in the olfactory cleft which anatomically belong to the ethmoid [14]. Importantly, the ethmoid sinus is the most vulnerable area for nasal cavity and paranasal sinus malignant tumours, including the anterior (85.7%) and posterior (78.6%) ethmoid sinuses, followed by the sphenoid (64.3%) and maxillary (64.3%) sinuses.
Cystic squamous cell carcinoma of the orbit
Published in Orbit, 2021
H. Oliphant, J. Wall, L. Abbeel, K. Allan, S. N. Rajak
An 86 year old male presented with a 3 month history of a rapidly enlarging, fluctuant mass at the medial aspect of the right upper lid and upper medial canthus, which was inducing an ipsilateral ptosis (Figure 1). No signs of optic nerve dysfunction were present on examination and specifically there was no evidence of hypoaesthesia on examination of the first, second or third division of the trigeminal nerve. The patient did not complain of paraesthesia. Additionally, no regional lymphadenopathy was present. The patient was not immunosupressed. Three months prior the patient had undergone an excision of a moderately differentiated SCC at the border of the tear trough and the orbitomalar groove. This was reported to have a deep clearance of 2mm, radial clearance of 1mm and no perineural infiltration (PNI). No bone erosion was seen on computed tomography (CT) (Figure 2).