BACKGROUND AND OBJECTIVES: Unilateral sinus lesions can be caused by many diseases and exact preoperative diagnosis is often difficult to make. The aims of this study were to evaluate the recent trends for prevalence of unilateral sinus lesions and find useful factors in differential diagnosis. MATERIALS AND METHOD: Preoperative clinical diagnosis including computed tomography (CT) images, endoscopic findings and postoperative diagnosis based on pathology were assessed retrospectively in 384 consecutive patients who underwent unilateral sinus surgery from 2004 to 2013. RESULTS: Chronic bacterial rhinosinusitis (40%) was the most common cause of unilateral sinus lesions, followed by fungal sinusitis (21%), benign and malignant tumors (14%), and odontogenic sinusitis (11%). The incidence of odontogenic sinusitis has recently increased and mismatches of pre- and post-operative diagnosis were commonly found among patients with chronic bacterial rhinosinusitis, fungal sinusitis, or odontogenic sinusitis. Microcalcification in fungal sinusitis and dental lesions in odontogenic sinusitis were confirmed as critical factors by logistic regression analysis. CONCLUSION: The incidence of odontogenic sinusitis has been increasing steadily over the last 10 years. The findings of microcalcification and dental lesions on CT could provide crucial information to make a precise preoperative diagnosis among chronic bacterial rhinosinusitis, fungal sinusitis and odontogenic sinusitis.
Diagnosis ; Diagnosis, Differential* ; Humans ; Incidence ; Logistic Models ; Methods ; Pathology ; Prevalence* ; Retrospective Studies ; Sinusitis*

OBJECTIVETo study the clinicopathologic characteristics of IgG4-related sialodacryoadenitis and chronic rhinosinusitis (CRS).

METHODSA total of 13 patients (patient group) were evaluated clinically and biopsy specimens from the lacrimal/salivary glands (n=12) and nasal mucosa (n=8) were reviewed and immunohistochemistry was performed to assess IgG-and IgG4-positive cells. Similarly, nine patients with IgG4-related sialodacryoadenitis without CRS and 10 patients with common CRS were included as controls.

RESULTSThere were 8 male patients and 5 female patients. The age of patients ranged from 32 to 71 years (mean 50.2 years). The patient group had higher serum IgG4 concentration than that of the control group (P<0.05). Lymphoplasmacytic infiltration, lymphoid follicle formation and sclerosis were prominent in lacrimal/salivary glands in both groups; however the magnitude of IgG4-positive plasmacytic infiltration in the patient group was significantly higher than that of the control group (P<0.05). Similarly, evaluation of nasal mucosa revealed greater lymphocytic and plasmacytic infiltration, and lymphoid follicle formation, together with significantly higher amount of IgG4-positive plasma cell infiltration in the patient group compared to the common CRS group (P<0.05).

CONCLUSIONSIgG4-related disease (IgG4-RD) simultaneously involving lacrimal/salivary glands and nasal cavity/paranasal sinuses is rare and characterized by a combination of IgG4-positive plasma cell infiltration involving lacrimal/salivary glands and nasal mucosa along with an increased serum level of IgG4. As a systemic disease, early and accurate diagnosis is therefore of great importance, and unnecessary surgery should be avoided.

Adult ; Aged ; Chronic Disease ; Female ; Humans ; Immunoglobulin G ; blood ; Immunohistochemistry ; Lacrimal Apparatus ; pathology ; Male ; Middle Aged ; Nasal Mucosa ; pathology ; Paranasal Sinuses ; pathology ; Rhinitis ; diagnosis ; immunology ; Salivary Glands ; pathology ; Sialadenitis ; diagnosis ; immunology ; Sinusitis ; diagnosis ; immunology

A 70 years old male patient complained a sense of swelling on right facial, mild pain, and the obstruction of right nasal, no complain of facial numbness and toothache. Physical examination showed the slight bulging on right facial with mild tenderness, purulent nasal secretions on the right middle nasal meatus, and no significant neoplasm. CT scan showed that soft density tissue in the right maxillary sinus,and the high density tissue in some period. Postoperative diagnosis: carcinoma of maxillary sinus with fungal sinusitis.
Aged ; Carcinoma ; complications ; diagnosis ; Humans ; Male ; Maxillary Sinus ; microbiology ; pathology ; Mycoses ; complications ; Nose Neoplasms ; complications ; diagnosis ; Sinusitis ; microbiology

A case of a papillary thyroid carcinoma in a patient with situs inversus with associated bronchiectasis and chronic sinusitis (Kartagener's syndrome) is reported. A 61-year-old male patient has the symptoms of nasal obstruction. nasal purulent discharge and headache for 2 years. Physical examination: right nasal purulent in right nasal cavity and multiple lychee-like opaque mass in right middle meatus. A nodule, one centimeter in diameter, locates in the upper pole of right thyroid. Evidence of full situs inversus viscerum can be confirmmed by chest radiographs and ultrasound doppler. Pathology: right nasal polyps, the right small papillary thyroid cancer. TEM Tip primary ciliary dyskinesia. Clinical diagnosis: Kartagener syndrome, papillary thyroid carcinoma (T1a N0 M0, I period), chronic sinusitis-nasal polyps.
Carcinoma ; complications ; diagnosis ; Carcinoma, Papillary ; Chronic Disease ; Humans ; Kartagener Syndrome ; complications ; diagnosis ; Male ; Middle Aged ; Nasal Obstruction ; pathology ; Nasal Polyps ; pathology ; Radiography, Thoracic ; Rhinitis ; pathology ; Sinusitis ; pathology ; Situs Inversus ; pathology ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; complications ; diagnosis

Supernumerary tooth is a rare case. This report described a case of nasal cavity supernumerary tooth association with maxillary sinusitis. A 28-year-old male patient reported with the chief complaint of nasal obstruction, headache and purulent secretion for the past three months. Clinic examination and CT examination showed that there was a supernumerary tooth in the right nasal bottom, and maxillary sinus was infected in the same side. This patient was performed supernumerary tooth removing and given antibiotics for 3 days. Ten days after the operation, there was no clinical symptoms, and nasal bottom mucosa was normal. After 3 months of follow-up, reexamination of coronal CT scan appeared normal.
Adult ; Anti-Bacterial Agents ; therapeutic use ; Humans ; Male ; Maxillary Sinus ; pathology ; Maxillary Sinusitis ; etiology ; Nasal Cavity ; pathology ; Nasal Obstruction ; Tomography, X-Ray Computed ; Tooth, Supernumerary ; complications ; diagnosis

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.
Aged ; Anti-Bacterial Agents ; chemistry ; Biopsy ; China ; Humans ; Lymphoma, Extranodal NK-T-Cell ; diagnosis ; diagnostic imaging ; pathology ; Male ; Nasal Cavity ; pathology ; Nose Neoplasms ; complications ; diagnosis ; radiotherapy ; Prognosis ; Radiography ; Radiotherapy ; Sinusitis ; complications ; diagnosis ; Treatment Outcome

IgG4-related disease (IgG4-RD) is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasmacytes. We experienced a case of IgG4-RD developed in a patient with bronchial asthma (BA) and chronic rhinosinusitis (CRS). A 55-yr-old female patient with BA and CRS complained of both eyes and neck swelling as well as a recurrent upper respiratory infection in recent 1 yr. The serum levels of IgG4, creatinine, and pancreatic enzymes were elevated. A biopsy of the submandibular gland showed an abundant infiltration of IgG4-positive plasmacytes. Her symptoms remarkably improved after the treatment of a systemic steroid that has been maintained without recurrence. We report a rare case of IgG4-RD developed in a patient with BA and CRS.
Asthma/complications/*diagnosis ; Chronic Disease ; Creatinine/blood ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pancreas/enzymology ; Plasma Cells/physiology ; Prednisolone/therapeutic use ; Republic of Korea ; Rhinitis/complications/*diagnosis/drug therapy ; Sinusitis/complications/*diagnosis/drug therapy ; Submandibular Gland/pathology ; Tomography, X-Ray Computed

PURPOSE: To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome. MATERIALS AND METHODS: We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade. RESULTS: There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611). CONCLUSION: Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.
Adult ; Aged ; Asthma/complications ; Chronic Disease ; Endoscopy/*methods ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Nasal Polyps/complications/diagnosis/*surgery ; Odds Ratio ; Otorhinolaryngologic Surgical Procedures/*methods ; Paranasal Sinuses/pathology ; Prednisone/*administration & dosage ; Retrospective Studies ; Rhinitis/complications/diagnosis/*surgery ; Sinusitis/complications/diagnosis/*surgery ; Treatment Outcome

OBJECTIVETo study the prevalence of IgG4-positive plasma cells in inflammatory disease of nasal cavity and paranasal sinuses and its association with IgG4-related sclerosing disease (IgG4-SD).

METHODSThe expression of IgG4 and IgG in plasma cells of 103 cases diagnosed as inflammatory disease of nasal cavity and paranasal sinuses with dense lymphoplasmacytic infiltrate was studied by immunohistochemistry (EnVision) and quantitatively analyzed by medical image analysis system.

RESULTSImmunohistochemical study showed marked infiltration by IgG4-positive plasma cells (>50 per high-power field) in 28 cases, moderate infiltration (30 to 50 per high-power field) in 23 cases, mild (10 to 29 per high-power field) in 30 cases and negative (<10 per high-power field) in 22 cases (P < 0.05). Twenty-two cases studied fulfilled the diagnostic criteria of IgG4-SD (>50 IgG4-positive plasma cells per high-power field and IgG4-to-IgG ratio > 40%), including 3 cases of chronic sinusitis (3/20), 3 cases of nasal polyps (3/18), 3 cases of inflammatory pseudotumor (3/17), 4 cases of fungal sinusitis (4/20), 1 case of rhinoscleroma (1/12), 7 cases of Wegener's granulomatosis (7/11) and 1 case of Rosai-Dorfman disease (1/2).

CONCLUSIONInflammatory disease of nasal cavity and paranasal sinuses fulfilling the diagnostic criteria IgG4-SD is not uncommon. Definitive diagnosis of IgG4-SD requires correlation with other clinical and laboratory findings. Some cases of unexplained inflammatory disease of nasal cavity and paranasal sinus may represent a member of the IgG4-SD spectrum. IgG4 carries diagnostic value in differential diagnosis of inflammatory disease occurring in nasal cavity and paranasal sinuses.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Granuloma, Plasma Cell ; metabolism ; pathology ; Granulomatosis with Polyangiitis ; metabolism ; pathology ; Histiocytosis, Sinus ; metabolism ; pathology ; Humans ; Immunoglobulin G ; metabolism ; Immunohistochemistry ; Male ; Middle Aged ; Nasal Cavity ; immunology ; pathology ; Nasal Polyps ; metabolism ; pathology ; Nose Diseases ; immunology ; pathology ; Paranasal Sinus Diseases ; immunology ; pathology ; Paranasal Sinuses ; immunology ; pathology ; Plasma Cells ; immunology ; Rhinoscleroma ; metabolism ; pathology ; Sinusitis ; metabolism ; pathology ; Young Adult

OBJECTIVETo compare the differences in clinicopathologic features of invasive fungal rhinosinusitis caused by Aspergillus and Mucorales, and to discuss the pathogenesis of tissue injury induced by these two kinds of fungi.

METHODSThe clinical and pathologic features of 19 patients with invasive fungal rhinosinusitis due to Aspergillus (group A) and 16 patients with invasive fungal rhinosinusitis due to Mucorales (group M) were retrospectively reviewed. HE, PAS and GMS stains were performed on all the paraffin-embedded tissues. The diagnosis was confirmed by histologic examination and microbiological culture results.

RESULTSAmongst the group A patients, the clinical course was acute in 4 cases and chronic in 15 cases. Thirteen cases had underlying predisposing conditions, including diabetes (number = 4), malignant tumor (number = 5), history of trauma (number = 1) and radical maxillary sinus surgery (number = 3). Follow-up information was available in 13 patients. Seven of them died, 4 due to fungal encephalopathy and 3 due to underlying diseases. Amongst the group M patients, the clinical course was acute in 14 cases and chronic in 2 cases. Fourteen cases had underlying predisposing conditions, including diabetes (number = 8), malignant tumor (number = 5) and history of wisdom tooth extraction (number = 1). Follow-up information was available in 14 patients. Four of them died of fungal encephalopathy. There was significant difference in clinical onset between the two groups (P = 0.01). There was however no difference in terms of underlying predisposing conditions and disease mortality. Histologically, the microorganisms in group A patients formed fungal masses and attached to the mucosal surface, resulting in necrotic bands (11/19). Epithelioid granulomas were conspicuous but multinucleated giant cells were relatively rare. Deep-seated necrosis, granulomatous inflammation against fungal organisms (3/19) and vasculitis with thrombosis (4/19) were not common. On the other hand, large areas of geographic necrosis involving deep-seated tissue could be seen in group M patients (13/16). Isolated multinucleated giant cells were commonly seen. Granulomatous inflammation against fungal organisms were identified (16/16). Vasculitis and thrombosis were also observed (10/16).

CONCLUSIONSThe invasiveness of Mucorales is remarkable; and when it causes invasive fungal rhinosinusitis, the clinical course is often acute and large areas of tissue necrosis can be seen. The invasiveness of Aspergillus in tissue is relatively mild. Granulomas are more common and the disease often runs a chronic clinical course. There is however no significant difference in long-term mortality. The pathogenesis may be related to the different components of the fungi.

Adolescent ; Adult ; Aged ; Aspergillosis ; diagnosis ; microbiology ; pathology ; Aspergillus ; isolation & purification ; pathogenicity ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mucorales ; isolation & purification ; pathogenicity ; Mucormycosis ; diagnosis ; microbiology ; pathology ; Retrospective Studies ; Rhinitis ; diagnosis ; microbiology ; pathology ; Sinusitis ; diagnosis ; microbiology ; pathology ; Young Adult