Carcinomas of the oro/nasopharynx often present with regional lymph node (LN) metastases before the primary tumour is discovered. Some of the cervical LN metastases feature prominent cyst formation. Solitary cystic LN metastases have often been mistaken for primary squamous cell carcinomas (SCC) originating within a branchiogenic lateral neck cyst (LNC), resulting in the commonly used terms 'branchioma' and 'branchiogenic carcinoma ' (von Volkmann, 1882;Wolff et al, 1979;Khafif et al, 1989;Parks and Karmody, 1992;Carroll et al, 1993;Hall and Dexter, 1993;Flanagan et al, 1994;Knobber et al, 1995). For patients with an isolated finding of SCC in a neck LN, a search for a primary carcinoma in the upper aerodigestive tract is mandatory, including US, MRI and CT, as well as extensive biopsies of the base of tongue, nasopharynx and tonsillectomies in the case of clinically occult tumours (Spiro et al, 1983;Flanagan et al, 1994). This clinical practice has provided overwhelming evidence in recent years that isolated cystic SCC in neck LN are metastases from primary SCC of the palatine tonsils, the base of the tongue and the nasopharynx, tissues also collectively referred to as the Waldeyer's ring (Micheau et al, 1974(Micheau et al, , 1990Flanagan et al, 1994;Thompson and Heffner, 1998). Although this explanation has been slow to gain wide recognition and claims of the first true 'branchiogenic carcinoma' have been made rather recently (Micheau et al, 1974;Jones et al, 1993), cystic SCC in cervical LN is now regarded as a typical presentation of metastatic SCC arising in the oro/nasopharynx. At the same time, the idea of a primary branchiogenic carcinoma has become a vanishing concept (Thompson and Heffner, 1998). Despite the body of literature about this topic, there is little information regarding the frequency of cystic LN metastases from SCC of the Waldeyer's ring. Our goal was to establish the frequency of cystic LN metastases in our series of 123 patients with SCC of Waldeyer's ring origin who had been treated primarily surgically along with neck dissections. Furthermore, we discuss the morphological features and clues for establishing a diagnosis of cystic LN metastases rather than 'branchiogenic carcinoma'. 1984 and 1997, 108 patients with biopsy-proven SCC of Waldeyer's ring origin underwent neck dissections at the ORL Department of the University Hospital in Graz, Austria. Fifteen patients were treated at the Elisabethinen Hospital, Graz, Austria, between 1992 and 1997. Archival formalin-fixed, paraffinembedded haematoxylin and eosin (HE) stained sections of all primary SCC and their corresponding neck dissections were reviewed. SCC were separated into (1) tonsillar origin (palatine tonsil), (2) base of tongue origin and (3) nasopharyngeal origin. Extensive tumours involving the entire oropharynx, and multiple or synchronous intraoral carcinomas were not included in this study, because we were not able to determine the exact origin of the SCC in these cases. Initial diagnosis was established by biopsy and fol...

We report the first case of an extranodal follicular dendritic cell (FDC) tumour localized in the nasopharynx of a 44-year-old male patient. The tumour cells were characterized immunohistochemically by strong expression of CD21, HLA-DR and vimentin and focal expression of CD68 and cytokeratin. Electron microscopic examination revealed desmosomal cell junctions between adjacent cell processes. Molecular genetic analysis using polymerase chain reaction (PCR) showed germline configuration of immunoglobulin and T-cell receptor genes. Epstein-Barr virus (EBV) genomes were detectable by PCR. After complete surgical tumour removal and radiotherapy the patient is disease-free 20 months after the initial diagnosis.

Aspergillosis is not a rare disease of the paranasal sinuses; more than 80 cases were reported from 1976 to 1982 in the University ENT Clinic at Graz, Austria. Of 59 patients studied, 27 presented almost metal-dense x-ray shadows resembling foreign bodies in one of the sinuses. By means of light and electron microscopic investigations as well as x-ray fluorescence analysis, it can be demonstrated that these areas are equivalent to local enrichment of calcium phosphate in the center of the noninvasive fungal masses in the sinuses. A detailed description of the histopathology of Aspergillus fumigatus is given. For clinical diagnosis, the detection of almost metal-dense x-ray shadows in the absence of foreign-body history in our experience may be regarded as almost certain for aspergillosis of the paranasal sinuses.

Wood dust was classified by the IARC as a human carcinogen which causes sinonasal tumours. However, the exposure in different industries varies strongly and the risks of workers depend on the specific situation which can be assessed by the use of biomonitoring methods. The aim of this study was to investigate the workers who are exposed to low dust levels (below the permitted concentrations) with cytogenetic and biochemical methods. Micronuclei (MNi) which are indicative for genomic damage, nuclear buds which reflect gene amplification, binucleated cells which are caused by mitotic disturbances and acute cytotoxicity parameters (pyknosis, karyorrhexis, condensed chromatin, karyolysis) were monitored in buccal and nasal cells of workers of a veneer factory (n = 51) who are exposed to volatile wood-derived compounds, in carpenters of a furniture factory which use no synthetic chemicals (n=38) and in a control group (n = 65). Additionally, markers were measured in blood plasma which reflect inflammations (C-reactive protein, CRP) and the redox status, namely malondialdehyde (MDA) and oxidised low density proteins (oxLDL). No induction of micronucleated cells was observed in both epithelia in the two exposure groups while all other nuclear anomalies except pyknosis were increased; also one health-related biochemical marker (MDA) was significantly elevated in the workers. Taken together, the results of our study show that exposure to low levels of wood dust does not cause formation of MNi indicating that the cancer risks of the workers are not increased as a consequence of genetic damage while positive results were obtained in earlier studies with workers who are exposed to high dust levels. However, our findings indicate that wood dust causes cytotoxic effects which may lead to inflammations.

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The facial canal containing the intratemporal portion of the facial nerve is very important for the otologist and radiologist concerning fractures and other lesions of the temporal bone. Axial and/or coronal standards are sufficient for imaging of the labyrinthine and the mastoidal segment of the facial canal. The sensitivity of visualization (sensitivity = number of identified structures per number of examinations) of the tympanic segment, however, is low and particularly the pyramidal segment (elbow, posterior knee) is not visualized in these standards. Based on anatomical considerations a new plain for imaging both the tympanic and mastoidal segment in continuity was obtained. The pyramido-longitudinal plain is achieved by a twice angulated 2-D-reconstruction based on axial high-resolution CT-scans.

Malignant melanoma of the nasal cavity and paranasal sinuses is a rare entity which is usually rapidly fatal. Effective treatment approaches are not available.

The diagnosis of a stapes injury is despite the use of sophisticated technology, especially the CT-scan of the temporal bone, often very difficult. A sensitive anamnesis seems to be very important. It depends on the kind of injury which operative technique is to be applied in order to re-establish the ossicular chain. In our opinion, it is useful to take - if it is possible - the autolog stapes for the surgical re-establishment of transmission.