A case of nasopharyngeal tuberculosis with cervical lymph node tuberculosis is reported. The patient was a 20-year-old female immigrant from Vietnam and cook apprentice. Her chief complaint was left neck swelling with pain for three months. She was diagnosed with left neck lymphadenitis at a previous hospital, which suspected malignant lymphoma and referred her to our hospital. At the time of the first visit, she had left lymph swelling with tenderness and granuloma-like masses in the nasopharynx. PET-CT showed accumulations in both the swollen left neck lymph and nasopharynx. The diagnosis of this case would appear to be nasopharyngeal cancer with left and neck lymph node metastasis or nasopharyngeal tuberculosis with cervical lymph node tuberculosis in addition to malignant lymphoma. Based on some examinations (biopsy, bacteria culture, and imaging), it was diagnosed as nasopharyngeal tuberculosis with cervical lymph node tuberculosis. Therefore, she was treated with anti-tuberculosis agent in respiratory medicine.
We experienced a case of huge chronic thyroiditis with malignant lymphoma that caused dyspnea with tracheal stenosis, dysphagia with esophagus stenosis and recurrent nerve paralysis. In this case, thyroidectomy was performed and, after the surgery, there was no sign of breathing or swallowing difficulties, and it was confirmed by the postoperative computed tomography that the tracheal stenosis had improved. We considered two possible explanations for the preoperative right recurrent nerve paralysis. In the first, the right recurrent nerve could have suffered from mechanical stimulation such as compression and traction to the recurrent nerve due to enlargement of the malignant lymphoma together with chronic thyroiditis. The second possible explanation was that malignant cells had invaded neurons. We could not distinguish between the two possibilities, since this right recurrent nerve was spared and could not be examined histopathologically.
Purpose Allergic rhinitis (AR) is associated with obstructive sleep apnea (OSA) and nasal obstruction causes decreased adherence to continuous positive airway pressure (CPAP). The purpose is to evaluate the effects of antiallergic agents on CPAP adherence and sleep quality. Methods A longitudinal study was made of patients who use CPAP for OSA and treated with antiallergy agents for spring pollinosis. We compared the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), nasal symptoms scores (NSS), and data from CPAP before and after treatment. Then, we classified the subjects into two groups based on the baseline PSQI score: one group without a decreased sleep quality (PSQI < 6) and the other group with decreased sleep quality (PSQI ≥ 6). Results Of 28 subjects enrolled, 13 had good sleep quality and 15 had poor sleep quality. PSQI showed significant improvements after medication (p = 0.046). ESS showed no significant differences after AR medication (p = 0.565). Significant improvement was observed after the prescription of antiallergy agents in all items of NSS (sneezing, p < 0.05; rhinorrhea, p < 0.01; nasal obstruction, p < 0.01; QOL, p < 0.01). The percentage of days with CPAP use more than 4 h increased significantly after the administration of rhinitis medication (p = 0.022). In the intragroup comparisons of PSQI ≥ 6 group, PSQI decreased significantly (p < 0.05). For the NSS in intragroup comparisons of PSQI ≥ 6 group, all parameters showed significant improvement (sneezing, p = 0.016; rhinorrhea, p = 0.005; nasal obstruction, p < 0.005; QOL, p < 0.005). ConclusionThe use of antiallergy agents can improve CPAP adherence and sleep quality in patients with OSA on CPAP.
Background: A basal cell adenocarcinoma (BCAC) is a low-grade malignancy of the salivary glands. A BCAC of the minor salivary gland is a rare disease, which is extremely rare in the maxillary sinus without invading from the palate and buccal mucosa. The histopathological characteristics of a BCAC are similar to those of a basal cell adenoma (BCA). However, BCAC can be differentiated from BCA based on its tendency to invade surrounding tissues. Surgical resection is the first-line treatment for BCACs. We report a case of a BCAC arising from the maxillary sinus minor salivary glands in an 82-year-old man.Case presentation: In 2016, the patient presented with recurrent epistaxis, and he was referred to our department because a tumor was found in his left nasal cavity. Gross resection using the Denker operation was performed. Histopathological examination revealed no surrounding tissue invasion; therefore, BCA was diagnosed. In 2017, the recurrent lesion was resected using endoscopy as much as possible, and the histopathologic findings again revealed a BCA.In 2019, he developed diplopia, frequent epistaxis, and buccal swelling. The recurrence of maxillary sinus tumor was shown again with invasion of surrounding tissues, and we presumed a clinical diagnosis of a left maxillary carcinoma (suspected BCAC). When we performed partial maxillary resection by the Weber–Ferguson incision, we found that the tumor had partially invaded the bone of the orbital floor; thus, the floor of the orbit and orbital fat were partially resected. Finally, the tumor was diagnosed as a BCAC. Conclusion: We report a BCAC arising from the maxillary sinus. This is an extremely rare sinus tumor, and differentiation of BCAC and BCA is important from a clinical or histopathological examination. A partial maxillectomy with a Weber–Ferguson incision was required for complete resection. When a malignancy is suspected in the recurrent maxillary sinus tumor, it is important to have a wider surgical field than that of the previous surgery to ensure complete resection.
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