1/23. Intracranial spread of a giant frontal mucocele: case report.A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltrated the dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the dura were resected. A 12 x 6cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bone graft from the right parietal region was used to repair the anterior frontal bony defect. The result one year later was satisfactory. Spiral computed tomography with thr ee-dimensional reconstructions excluded any recurrence of the tumour and showed good integration of bone grafts.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/23. Cutaneous and paranasal aspergillosis in an immunocompetent patient.A 26-year-old Libyan woman presented with asymptomatic nodulo-ulcerative skin lesions present for 1 year. Three years prior to presentation, she had experienced a nasal discharge followed by the development of a nodule in the nasal cavity and a plaque on the hard palate. These lesions had gradually increased in size and ulcerated, resulting in perforation of the nasal septum and palate. Two years later, the patient noticed the appearance of skin lesions: a nodule on the right thumb and numerous nodulo-ulcerative lesions on the extremities. General physical examination was normal with no significant lymphadenopathy. Examination of the oral cavity revealed perforation of the distal nasal septum, with a perforated nodular plaque involving the entire palate, associated with subluxation of the upper incisors (Fig. 1a). On skin examination, multiple firm nodules and nodulo-ulcerative lesions with a central eschar and raised margins were observed. The lesions ranged in size from 0.5 to 5 cm and were distributed on the right hand and fingers, left upper arm (Fig. 1b), left calf, and right thigh. Routine laboratory investigations (liver function tests, serum calcium, electrolytes, lipid profile, urine and stool culture studies) were normal. immunoelectrophoresis disclosed normal levels of immunoglobulins IgG, IgA, and IgM. Serologic studies for human immunodeficiency virus (hiv) and syphilis, and a tuberculin test, were all negative. A Giemsa-stained tissue smear was negative for leishmania tropica organisms. Radiological studies disclosed a slight haziness of the maxillary sinuses with perforation of the nasal septum. A chest X-ray was normal. Histopathologic examination of biopsies taken from both the palate and from ulcerated and nonulcerated skin lesions was performed, and all showed similar findings. The biopsy of a nonulcerated skin lesion showed pseudoepitheliomatous epidermal hyperplasia with neutrophilic microabscesses (Fig. 2a). A dermal diffuse and nodular granulomatous mixed infiltrate of lymphocytes, histiocytes, giant cells, numerous eosinophils, and neutrophilic microabscesses was seen in all tissues examined. Septate hyphae were present both within giant cells and free in the dermis (Fig. 2b). The hyphae were branching at a 45 degrees angle and were positive on periodic acid-Schiff and Grocott methenamine silver stains (Fig. 2c). Fungal culture studies of material taken from an ulcerated skin lesion grew aspergillus flavus. Blood cultures were negative for Aspergillus sp. or other microorganisms. The patient was treated with intravenous amphotericin b, but the medication was discontinued due to her intolerance to the drug. She was subsequently lost to follow-up.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
3/23. Longterm survival in acute rhinocerebral mucormycosis with giant cell arteritis and foreign body granulomas.A case of rhinocerebral mucormycosis occurring in a 41-year-old man with insulin-treated diabetes mellitus is reported. Microscopically, biopsy samples obtained from the left ethmoid and middle turbinate sinuses contained fungi that formed mycotic granulomas associated with multinucleate giant cell arteritis. The multinucleate giant cells contained broad, infrequently septate hyphase consistent with mucormycosis. The patient received surgical debridement with extenteration of the left orbit, and intravenous liposome-encapsulated amphotericin b. After 12 months, examination of the patient revealed complete healing. Multinucleate giant cell granulomas and arteritis are only exceptionally associated with rhinocerebral mucormycosis, but these histologic findings may be correlated with a progressive disease with better prognosis.- - - - - - - - - - ranking = 1.4keywords = giant (Clic here for more details about this article) |
4/23. cholesterol granuloma of the maxillary sinus.cholesterol granuloma is usually associated with chronic middle ear disease and is common in the mastoid antrum and air cells of the temporal bone. It has also been reported in other parts of the skull, such as the frontal and maxillary sinuses and orbit. cholesterol granuloma is rare in the paranasal sinuses. We report a new case of cholesterol granuloma in the maxillary sinus of a 38-year-old man who underwent surgical excision. We also review the literature and discuss the mechanism of development for this lesion. The resected specimen showed fragments of respiratory mucosa with cholesterol clefts surrounded by multinucleated foreign-body giant cells. Some multinucleated foreign-body giant cells showed asteroid bodies. Hemorrhagic areas, hemosiderin-laden macrophages, chronic inflammatory cells, and dilated lymphatics vessels were seen as well. Increased intrasinus pressure due to drainage obstruction may affect venous and lymphatic drainage from the sinus cavity, leading to venule microhemorrhages while still allowing arterial blood into the sinus mucosa and further contributing to a large localized hemorrhage. Lymphatic drainage may be insufficient to completely remove the lipid components of the red blood cells, and the lipid accumulation may contribute to the formation of cholesterol crystals and their esters.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
5/23. Primary paranasal Aspergillus granuloma: case report and review of the literature.BACKGROUND: Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the sudan and india. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements. CONCLUSION: We describe the first case of PPAG in the united states in an immunocompetent nonatopic woman who had never left missouri.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
6/23. Endoscopic sinus surgery in cases of cholesterol granuloma of the maxillary sinus.cholesterol granuloma is usually associated with middle ear disease and is very rare in the paranasal sinuses. We report a case of cholesterol granuloma originating in the maxillary sinus of a 52-year-old female. Endoscopic sinus surgery was performed on the left maxillary sinus, and the cholesterol granuloma was successfully removed by the middle meatal antrostomy. light microscopic examination showed granulomatous tissue with typical cholesterol clefts, multinucleated foreign body giant cells, small areas of hemorrhage, hemosiderin-laden macrophages and plasma cells. We also describe the details of the endoscopic surgical techniques employed in the treatment of this disorder.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
7/23. Giant frontoethmoid mucocele with intracranial extension: case report.We report the case of a 31-year-old woman who came to us with a giant frontoethmoid mass that had extended into the intracranial region and invaded the left orbit. We removed the lesion in its entirety via a combined intranasal and transcranial approach. We discuss the advantages and disadvantages of different surgical approaches, and we explain why we recommend a combined approach for the type of giant lesion that we encountered.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
8/23. neurofibromatosis 1: a novel NF1 mutation in an 11-year-old girl with a giant cell granuloma.We report an 11-year-old girl who presented with a painless unilateral enlargement of the nasal bridge. Because of multiple cafe-au-lait spots and a positive family history, neurofibromatosis 1was diagnosed. On a computed tomographic scan, a unilocular radiolucency measuring 1.2 x 2 cm was seen in the anterior wall of the maxillary sinus, which was surgically removed. histology revealed a central giant cell granuloma. hyperparathyroidism, which can present with an osseous tumor and similar histology, was excluded. Molecular analysis uncovered a novel splice mutation (A4268G) in this neurofibromatosis 1 family, affecting our patient as well as her mother and brother. This article focuses on the variability of the neurofibromatosis 1 phenotype in this family and the possible relationship between central giant cell granuloma and neurofibromatosis 1.- - - - - - - - - - ranking = 1.2keywords = giant (Clic here for more details about this article) |
9/23. Diagnostic difficulties in a case of isolated sarcoidosis of the nose and sinuses.sarcoidosis still remains a diagnosis of exclusion. It is unusual for the disease to be localised in the nose and sinuses and to manifest its symptoms in this site; the diagnosis in such cases is rather a difficult task. There is no symptom pathognomonic of the disease. A major role in the diagnosis of sarcoidosis is played by histologic evidence on the basis of which additional tests can be used. We present a case of primary sarcoidosis of the nose and sinuses which involved the orbit and had non-specific symptoms in the sinonasal region. The diagnosis of sarcoidosis was made ultimately only after decalcification of sample material taken from the ethmoidal labyrinth. Interspersed among the bone trabeculae there were the typical epithelioid cellular granulomas composed of epithelioid cells with round nuclei and prominent nucleoli, Langhans'-type giant cells, and a tender rim of chronic inflammatory infiltrate in the periphery. After initial beneficial response to the administered cortisone therapy (40 mg prednisolone daily for 6 months and then a daily maintenance dose of 10 mg) the control examination showed that the peri- and retrobulbar infiltrate persisted and the eye symptoms recurred. We therefore increased the dose and proceeded to a pulse therapy (120 mg of urbason daily and a daily maintenance dose of 30 mg). At present the patient is still receiving this therapy which has reduced as a result the local manifestations but Cushing's syndrome has developed as a side effect.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
10/23. Orbitoethmoid aneurysmal bone cyst. Case report and literature review.Aneurysmal bone cyst is a benign, vascular, variable growing and expansive lesion that can occur in any part of the skeletal system, but mainly in long bones and vertebrae. We present a case of orbitoethmoid aneurysmal bone cyst in a 62-year-old female presenting epiphora. Nasal endoscopy was normal. Sinus CTscan revealed an expansive mass in the right ethmoid sinus extending and destroying the right lamina papiracea. The tumor was completely resected through paralateral rhinotomy. Histological analysis showed fibrous septa containing multinucleated giant cells and bone tissue surrounding blood vessel lumens, bordered by endothelial cells. These findings are characteristic of aneurysmal bone cysts. After 30 months of postoperative follow-up the patient remains disease-free and asymptomatic.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
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