Schwannomas arising in the nasal cavities and paranasal sinuses are rare entities, with only sporadic cases appearing in the world literature. The lesion most commonly arises in the ethmoid and maxillary sinuses, with two cases having been reported in the sphenoid sinus. There are no reported cases of frontal sinus schwannoma. Four illustrative cases are presented which demonstrate the clinical features. The radiological investigation should include plain films and anteroposterior and lateral polytomography. Computerized tomography appears to be useful in planning surgery. An operative approach is approach is proposed which emphasizes a meticulous and complete removal of the lesion with preservation of adjacent structures and repair of any resultant dural defect.
The fourth branchial cleft anomaly has long been postulated. A case in which a lower neck sinus tract extended under the clavicle near the subclavian vessels is presented. The distinguishing features of bronchogenic and branchogenic anomalies are discussed. It appears that unless a complication (e.g., abscess, inflammatory process) of the fourth branchial cleft sinus tract occurs within the mediastinum, mandating full exploration, the complete form of the anomaly may continue to remain undocumented.
Alternaria is a fungus of the class Deuteromycetes and the family Dematiaceae. Fungi of this genus have generally been regarded as nonpathogenic and as contaminants when isolated from clinical specimens. Hypersensitivity to Alternaria spores, however, has long been recognized as a cause of allergic pulmonary disease. More recently, the organism has also been demonstrated to have potential for opportunistic invasion of immunosuppressed and debilitated patients. Presented is a case in which this organism was repeatedly isolated from naso-oral tissue specimens from an otherwise healthy patient. The organism was seen in biopsies from a granulomatous hyperplastic destructive disease of the maxilla and soft tissues of the face which extended to the ethmoid sinus and fistulized through the hard palate. The clinical course, pathophysiology and therapeutic approach are discussed. The management of this disease requires a multidisciplinary approach involving the otolaryngologist, infectious disease specialist and pathologist.
An in vitro human tumor cell assay was used in an attempt to culture head and neck tumors from patients with squamous cell carcinomas. Initially, specimens from nine head and neck tumors were disaggregated by mechanical methods and assayed in soft agar. Five of nine tumors grew in the soft‐agar system yielding a cloning success rate of 56%. Plating of 5 x 105 cells resulted in 12 to 255 colonies per plate after 21 days in culture, with a cloning efficiency between 0.002% and 0.08%. Recently, the authors replaced the agar with an agarose culture matrix. Of 10 specimens with positive pathology, 9 have shown colony growth (> 20 cells). Cloning efficiency in agarose improved approximately 2‐fold. Morphologic assessment of tumor colonies in culture showed the same characteristics as those of the original tumor. Overall success rate of growing head and neck tumors in agar and agarose has been 14 of 19 patients (74%). The development of a soft agarose assay for head and neck tumor cells should provide an in vitro technique for predicting in vivo response to anticancer drugs and other therapeutic modalities such as radiotherapy and hyperthermia.
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