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A Rare Case of Nasal Glial Heterotopia Presenting as Sphenochoanal Polyp  [PDF]
Pavol Surda, Jonathan Hobson
International Journal of Otolaryngology and Head & Neck Surgery (IJOHNS) , 2015, DOI: 10.4236/ijohns.2015.42014
Abstract: Objective: This paper reports a rare case of nasal glial heterotopia presenting as sphenochoanal polyp. So far, literature has revealed only few cases. Case Report: A 55-year-old woman presented with a 2-month history of left sided nasal obstruction. Rigid endoscopy showed greyish left nasal polyp and anterior discharge. Subsequently, CT scan of the sinuses revealed sphenochoanal polyp filling the left nasal cavity, without signs of expansion, or destruction and no obvious connection with intracranial tissue. Mass was removed endoscopically and histology confirmed glial nature of the mass. Conclusion: Any mass arising from sphenoid sinus should be carefully evaluated on CT scan for existence of fibrous stalk, or connection with brain tissue and needs to be considered in the differential diagnosis of the sphenochoanal mass. Complete surgical excision is the treatment of choice, which is curative.
Primary myelolipoma presenting as a nasal cavity polyp: a case report and review of the literature
Smiley Annie George, Marie Therese Manipadam, Regi Thomas
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-127
Abstract: We report a case of primary myelolipoma occurring in the nasal cavity of a 48-year-old Asian woman. We describe the etiology, pathology and differential diagnosis of extra-adrenal myelolipomas, and review the literature.We chose to present this case because of its unusual location. Although myelolipomas are rare, we conclude that they it should be considered in the differential diagnosis of lesions in this site.
Wegener's Granulomatosis presenting with an abscess in the parotid gland: a case report
Marcel Geyer, Gautham Kulamarva, Anne Davis
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-19
Abstract: We report a case of Wegener's Granulomatosis in a 69-year-old Caucasian female presenting initially with an isolated parotid abscess and only subsequently developing nasal, paranasal sinus and respiratory symptoms. We describe the clinical course, diagnostic difficulties, imaging and histopathology of this case.Major salivary gland infection is not an uncommon ENT disorder, but the clinician should be wary of the patient who fails to respond appropriately to adequate therapy. In such cases a differential diagnosis of Wegener's Granulomatosis should be considered, as early recognition and treatment of this potentially fatal disease is paramount.Heinz Klinger was first to describe the disease process of Wegener's Granulomatosis (WG) in 1932.[1]. Subsequently, Frederick Wegener published his two papers in 1936 [2] and 1939 [3] describing post-mortem studies of two patients who died of disseminated vasculitis. WG usually presents as a triad of airway necrotising granulomas, systemic vasculitis and focal necrotising glomerulonephritis. The diagnosis of WG is based on clinical findings and positive anti-neutrophil cytolplasmic antibody against proteinase 3 (cANCA-PR3) serology. A biopsy is rarely histologically diagnostic [4]. Our case is unusual in that the patient presented initially solely with a parotid abscess in the absence of typical signs or symptoms of rhinologic or systemic WG.A 69-year-old Caucasian female presented with a 10-day history of worsening pain and swelling over the region of the left parotid gland. She had been unsuccessfully treated with a 7-day course of oral penicillin by her general practitioner, but with no improvement. She denied any precipitating cause, though she had been feeling 'under the weather' and had lost her appetite over some weeks; there was no history of parotid disease. There was no other significant medical history and she was a non-smoker.Clinically she was pyrexial (37.7°C), dehydrated and in discomfort due to left facial swel
A Case of Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) Presenting with Marked Inflamed Tracheobronchial Mucosa  [PDF]
Teruaki Nishiuma,Hisashi Ohnishi,Sho Yoshimura,Saori Kinami,Susumu Sakamoto
Case Reports in Medicine , 2013, DOI: 10.1155/2013/208194
Abstract: A 70-year-old man was admitted to our hospital because of weight loss and persistent dry cough. Chest radiograph and CT showed multiple infiltrates in the bilateral upper lobes and the remarkably thickened bronchial walls. Bronchoscopy revealed diffuse erythema and edema of the tracheobronchial mucosa without any ulcerous legions. Serum MPO-ANCA was positive (155 EU). Transbronchial biopsy was performed and revealed necrotic granulomas with multinucleated giant cells in the bronchial/bronchiolar and parenchymal lesions. Thus, we diagnosed it as a localized form of granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis). After treatment with corticosteroid and cyclophosphamide, the bronchial findings were entirely resolved. We report here a rare case of GPA presenting with markedly inflamed tracheobronchial mucosa. 1. Introduction Granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis) is one of the systematic vasculitides involved in various organs such as the upper respiratory tract, the lungs, and the kidneys, characterized pathologically by necrotizing granulomatous inflammation [1, 2]. Although the pulmonary involvement of GPA is well described, the lower airway findings are not frequently remarked, and various descriptions have been reported [1, 3]. The most common airway abnormality in GPA consists of mucosal edema, erythema, thickening, and granularity of mucosal surface [1]. In this paper, we present a case of GPA with markedly inflamed bronchial mucosa that was characteristically found in chest CT scan and bronchoscopic examination. 2. Case Report A 70-year-old man was admitted to our hospital because of weight loss, general fatigue, and abnormal findings of the chest radiographs. He had a smoking history of 20 pack-year and suffered from cerebral infarction twice (2 and 25 years ago). Three months before admission, he developed occasional dry cough, nasal bleeding, taste disturbance, and refractory otitis media. He did not notice high fever more than 38.0°C. His primary physician did not detect any abnormal findings in the chest radiographs at that time. Two months later, he consulted the doctor again due to his persistent cough and approximately 10?Kg weight loss within the last two months. Since the chest radiographs showed multiple small infiltrates in both lungs (Figure 1), he was admitted to our hospital. Figure 1: (a) Chest X-ray showed multiple small infiltrates in both lungs. ((b), (c)) Chest CT showed multiple nodules in the apex and the remarkable bronchial wall thickening in lower areas of both lungs. On
The Development of Nasal Polyp Disease Involves Early Nasal Mucosal Inflammation and Remodelling  [PDF]
Juan Meng, Peng Zhou, Yafeng Liu, Feng Liu, Xuelian Yi, Shixi Liu, Gabriele Holtappels, Claus Bachert, Nan Zhang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082373
Abstract: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by both a chronic inflammation and tissue remodelling; as indicated by extracellular matrix protein deposition, basement membrane thickening, goblet cell hyperplasia and subepithelial edema, with reduced vessels and glands. Although remodelling is generally considered to be consequence of persistent inflammation, the chronological order and relationship between inflammation and remodelling in polyp development is still not clear. The aim of our study was therefore to investigate the pathological features prevalent in the development of nasal polyps and to elucidate the chronological order and relationship between inflammation and remodelling, by comparing specific markers of inflammation and remodelling in early stage nasal polyps confined to the middle turbinate (refer to as middle turbinate CRSwNP) obtained from 5 CRSwNP patients with bilateral polyposis, mature ethmoidal polyps from 6 CRSwNP patients, and normal nasal mucosal tissue from 6 control subjects. Middle turbinate CRSwNP demonstrated significantly more severe epithelial loss compared to mature ethmoidal polyps and normal nasal mucosa. The epithelial cell junction molecules E-cadherin, ZO-1 and occludin were also expressed in significantly lower amounts in mature ethmoidal polyps compared to healthy mucosa. Middle turbinate CRSwNP were further characterized by significantly increased numbers of subepithelial eosinophils and M2 type macrophages, with a distinct lack of collagen and deposition of fibronectin in polyp part. In contrast, the turbinate area of the middle turbinate CRSwNP was characterized by an increase in TGF-β activated myofibroblasts expressing α-SMA and vimentin, an increase in the number of pSmad2 positive cells, as well as increased deposition of collagen. These findings suggest a complex network of processes in the formation of CRSwNP; including gross epithelial damage and repair reactions, eosinophil and macrophage cell infiltration, and tissue remodelling. Furthermore, remodelling appears to occur in parallel, rather than subsequent to inflammation.
Heterotopic Pancreas Presenting as Gastric Polyp  [PDF]
Devinder P. Singh, Rohit Bansal
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.54024
Abstract:

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. We report an unusual case of a 25-year-old male patient with pain epigastrium caused by a polyp at the body of stomach along greater curvature revealed at endoscopy. Endoscopic biopsy was s/o inflammatory pathology. Wide excision of polyp was done and a histological diagnosis of heterotopic pancreas was established. The difficulty of making an accurate preoperative diagnosis is highlighted.

Nasal Polyp With Heterotopic Bone Formation (Osseous Metaplasia): A Case Report
Minoo Shafii,Minoo Saatian,Farid Aliehyai,Ehsan Jangholi
Galen Medical Journal , 2013,
Abstract: Osseous metaplasia is defined by the presence of heterotopic normal bone tissue in a soft tissue. Metaplastic ossification is a rare event in nasal polyps.The authors describe a rare case of bone formation in nasal polyp of a 28-year-old man with chronic right-sided nasal obstruction without history of trauma or allergy symptoms.To our knowledge, this finding has been reported in a few cases in the English medical literature.
Herpes Simplex Virus Type 1 Infection Facilitates Invasion of Staphylococcus aureus into the Nasal Mucosa and Nasal Polyp Tissue  [PDF]
XiangDong Wang, Nan Zhang, Sarah Glorieux, Gabriele Holtappels, Mario Vaneechoutte, Olga Krysko, Luo Zhang, Demin Han, Hans J. Nauwynck, Claus Bachert
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039875
Abstract: Background Staphylococcus aureus (S. aureus) plays an important role in the pathogenesis of severe chronic airway disease, such as nasal polyps. However the mechanisms underlying the initiation of damage and/or invasion of the nasal mucosa by S. aureus are not clearly understood. The aim of this study was to investigate the interaction between S. aureus and herpes simplex virus type 1 (HSV1) in the invasion of the nasal mucosa and nasal polyp tissue. Methodology/Principal Findings Inferior turbinate and nasal polyp samples were cultured and infected with either HSV1 alone, S. aureus alone or a combination of both. Both in turbinate mucosa and nasal polyp tissue, HSV1, with or without S. aureus incubation, led to focal infection of outer epithelial cells within 48 h, and loss or damage of the epithelium and invasion of HSV1 into the lamina propria within 72 h. After pre-infection with HSV1 for 24 h or 48 h, S. aureus was able to pass the basement membrane and invade the mucosa. Epithelial damage scores were significantly higher for HSV1 and S. aureus co-infected explants compared with control explants or S. aureus only-infected explants, and significantly correlated with HSV1-invasion scores. The epithelial damage scores of nasal polyp tissues were significantly higher than those of inferior turbinate tissues upon HSV1 infection. Consequently, invasion scores of HSV1 of nasal polyp tissues were significantly higher than those of inferior turbinate mucosa in the HSV1 and co-infection groups, and invasion scores of S. aureus of nasal polyp tissues were significantly higher than those of inferior turbinate tissues in the co-infection group. Conclusions/Significance HSV1 may lead to a significant damage of the nasal epithelium and consequently may facilitate invasion of S. aureus into the nasal mucosa. Nasal polyp tissue is more susceptible to the invasion of HSV1 and epithelial damage by HSV1 compared with inferior turbinate mucosa.
A rare cause of nasal obstruction: Sphenochoanal polyp
Musa ?zbay,Ediz Yorganc?la,Vefa K?n??,Salih Bak?r
Journal of Clinical and Experimental Investigations , 2012,
Abstract: Choanal polyps mostly arise from the antrum of maxillary sinus. Sphenochoanal polyp arising from the sphenoid sinus is extremely rare. It presents with similar symptoms of antrochoanal polyps. Radiological examination is important in differentiation of these two types of choanal polyps. Inadequate surgery that leaves some part of the polyp has a high risk of recurrence. We present a case of sphenochoanal polyp treated successfully with endoscopic sinus surgery. The patient is symptom free for 1 year. J Clin Exp Invest 2012; 3 (3): 435-437Key words: Polyp, sphenoid sinus, endoscopic sinus surgery
Wegener’s Granulomatosis Presenting with Bilateral Excavated Nodules  [PDF]
Emna Braham, Hajer Racil, Houda Ben Rejeb, Moncef Hamdane, Abdellatif Chabou, Faouzi El Mezni
Open Journal of Pathology (OJPathology) , 2012, DOI: 10.4236/ojpathology.2012.22006
Abstract: Wegener’s granulomatosis (WG) is a systemic inflammatory disease whose histopathologic features often include necrosis, granuloma formation, and vasculitis of small-to-medium-sized vessels. We report a new case of Wegener’s granulomatosis occurring in a 41-year-old man who was admitted for respiratory symptoms, fever, asthenia, night sweats and weight loss since one month. Chest X-ray and computed tomography showed multiple bilateral pulmonary excavated lesions. A trransparietal lung biopsy was performed. Histological examination showed an area of necrosis, surrounded by a palisade of histiocytes. Some of the histiocytes were multinucleated and formed true granulomas within the wall of the adjacent pulmonary artery. Serology was strongly positive for ANCA. A diagnosis of Wegener granulomatosis was conducted and the patient was started on cyclophosphamide and methylprednisolone as an initial treatment, with a favorable evolution.
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