Otologic manifestations in chronic lymphocytic leukemia (CLL) are common presentations. However, temporal bone metastasis is rarely described as a sign of relapsing CLL. A 65-year-old male diabetic patient known to have CLL on remission presented to the outpatient otolaryngology clinic with a one month history of progressive bilateral otalgia and right otorrhea, despite multiple courses of antibiotics. He was admitted with suspicion of malignant otitis externa. Left ear showed large hemorrhagic bullae on the posterior segment of tympanic membrane. Left sided facial paralysis developed on the third day of admission. Full recovery of facial paralysis is achieved by 10 days course of corticotherapy. Histological examination of middle ear tissue biopsy showed infiltration by monotonous small lymphoid cells, showing round nuclei, condensed chromatin suggestive of CLL. Although rare, unusual otologic manifestations should raise the suspicion of a temporal bone metastasis as a sign of relapsing CLL.
<p class="abstract"><strong>Background:</strong> Aim and objectives of the study were to analyze and study the diverse presentations of unilateral nasal mass and to identify the suggestive features of neoplastic pathology in adult’s population at a tertiary referral hospital.</p><p class="abstract"><strong>Methods:</strong> A retrospective analysis of 90 patients presented with unilateral sinonasal mass, reported to the Rhinology and Skull Base Clinic at the department of ENT in King Fahad Specialist Hospital, Dammam. The parameters include patient history, clinical assessments and histopathological examinations, which were supplemented with radiological investigations.In addition, demographic information and histopathological examinations for patients, who underwent surgical excision was analyzed for correlation with clinical diagnosis. </p><p class="abstract"><strong>Results:</strong> The reported cases are 55 males and 35 females with a median follow-up period of 12 months, ranging from 2-72 months. Nasal obstruction is the major symptom 34 (38%), 25 (27.8%) cases were reported with nasal mass and clinical diagnosis indicates 18 (20%) cases of malignancy. Type of disease and gender demonstrates low significance (p=0.023), whereas the diagnosis with age is highly significant (p=0.005).</p><p class="abstract"><strong>Conclusions:</strong> Carcinoma, inflammatory polyposis, inverted papilloma and allergic fungal sinusitis were the highest histological diagnosis. The clinical diagnosis and the suggestive features of radiological findings mostly resembled the histological findings. In contrary to the resemblance, the histological finding reveals the general diagnosis of nasal mass to the precise diagnosis, especially the fatal conditions like carcinoma. The high rate of malignancy and its suggestive radiological findings indicates that the specialists should consider the cases with caution to carryout histological analysis to rule out the probability of neoplasm.</p>
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