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Resumen Antecedentes y objetivo La migrana vestibular (MV) es una de las causas de sindrome vestibular episodico. Existen muchos farmacos disponibles para su profilaxis y actualmente su eleccion se realiza mayoritariamente segun las comorbilidades del paciente. El objetivo de este articulo es medir la concordancia de un grupo de otorrinolaringologos en la eleccion de profilaxis y evaluar el papel que ejerce sobre esta un algoritmo asistido para la eleccion de profilaxis. Material y metodo Las historias clinicas de 10 pacientes con MV fueron ofrecidas a 10 otorrinolaringologos, a los que se les pidio que seleccionasen para cada paciente el farmaco que considerasen mas adecuado entre 5 opciones posibles. Se calcularon los indices κ de Fleiss entre los 10 otorrinolaringologos solos y se recalcularon incluyendo al algoritmo como undecimoevaluador, y la κ de Cohen entre cada otorrinolaringologo y el algoritmo. Se ofrecio a los otorrinolaringologos la opcion de cambiar su respuesta tras conocer la respuesta del algoritmo, y ambos indices fueron calculados nuevamente. Resultados El indice κ de Fleiss fue de 0,302. Dicho indice se elevo a 0,343 tras introducir al algoritmo como evaluador. Tras ofrecer las soluciones propuestas por el algoritmo, se mejoro la κ de Cohen en 9 de los 10 evaluadores y la κ de Fleiss subio a 0,711. Conclusiones La concordancia entre otorrinolaringologos para elegir profilaxis para la MV se define como «justa». Las respuestas del algoritmo para la eleccion de profilaxis se situaron proximas a la opinion media de los otorrinolaringologos, elevando la concordancia entre ellos a «sustancial».

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Incidenza della vertigine parossistica benigna bilaterale e monolaterale in caso di positività alla manovra Dix-Hallpike a destra e sinistra: modello basato sul verso del nistagmo rotatorio.Frequentemente nella pratica clinica si valutano pazienti che mostrano alle manovre di Dix-Hallpike (DHM), verso destra e verso sinistra, il nistagmo tipico della vertigine posizionale parossistica benigna (BPPV). In questi casi la BPPV può essere unilaterale o bilaterale. Lo scopo del presente studio è quello di descrivere l’incidenza della BPPV unilaterale e bilaterale, quando entrambe le DHM sono positive, considerando il verso della componente torsionale del nistagmo. In questo studio prospettico multicentrico i pazienti sono stati suddivisi in tre gruppi: pazienti con solo una DHM positiva (gruppo di controllo, CG), pazienti con DHM positiva bilateralmente e con nistagmo battente nello stesso verso evocabile in entrambe le manovre (gruppo stesso verso, SSG), pazienti con DHM positiva bilateralmente e con nistagmo avente componente torsionale con verso opposto nelle due manovre (gruppo verso opposto, OSG). La manovra di Epley (EM) è stata condotta su tutti i pazienti. Considerando i risultati ottenuti dalla EM e il tasso di risoluzione della BPPV nel CG, è stato sviluppato un modello predittivo dell’incidenza della BPPV unilaterale e bilaterale negli SSG e OSG. Il CG comprendeva 234 pazienti, 20 erano inclusi invece nel SSG e 23 nell’OSG. Il modello ha stimato che la percentuale di BPPV unilaterale ammonterebbe a 89,5% nel SSG e 38,7% nel OSG. In conclusione, se entrambe le DHM sono positive, la BPPV può essere sia unilaterale che bilaterale. Se la componente torsionale dei nistagmi batte nello stesso verso, è più probabile che la BPPV sia unilaterale; se invece tale componente ha verso opposto alle DHM, le due condizioni possono considerarsi ugualmente probabili.Patients presenting with nystagmus indicative of benign paroxysmal positional vertigo (BPPV) during the left and the right Dix-Hallpike manoeuvres (DHMs) are frequently seen in clinical practice. In such cases, BPPV may be unilateral or bilateral. The aim of this study is to describe the incidence of unilateral and bilateral BPPV when both DHMs are positive, taking into account the sense of the torsional component of nystagmus. This is a prospective multicentre study. BPPV patients were classified into three groups: patients with only one positive DHM (control group, CG), patients showing positive bilateral DHM with nystagmus in the same sense in both DHMs (same sense group, SSG) and patients showing positive bilateral DHM with the torsional component of nystagmus beating in opposite senses in each DHM (opposite sense group, OSG). Only one Epley Manoeuvre (EM) was performed on all patients. Based on the ipsilateral result of the EM, the contralateral result of the same EM and the BPPV resolution rate in the control group, a model was developed to predict the incidence of unilateral and bilateral BPPV in the SSG and the OSG. There were 234 patients in the control group, 20 in the SSG and 23 in the OSG. The model estimated that the percentage of unilateral BPPV would be 89.5% in SSG and 38.7% in OSG. Using these findings, we conclude that when both DHMs are positive, BPPV may be unilateral or bilateral. If the torsional components of both nystagmuses beat in the same sense, it is more likely to be unilateral BPPV. If the torsional components beat in opposite senses, both situations can be considered equally likely.

OBJECTIVES To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN Multicenter observational prospective study. SETTING Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips.We performed an experimental study at the Minimally Invasive Surgery Centre Jesus Uson in Caceres (Spain). We used a swine model, performing clipping, unclipping, and extirpation of different segments of sympathetic chain with clips and after clip removal, following a chronogram of 10, 20, and 30 days. Pathologic studies of specimens and statistics were done at the University of Seville.Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible.There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.

Abnormal Wnt signaling and impaired cell–cell adhesion due to abnormal E-cadherin and b-catenin func tion have been implicated in many cancers, but have not been fully explored in nasopharyngeal carcinoma. The aim of this study was to analyze b-Catenin cellular location and E-cadherin expression levels in nasopharyngeal carcinoma. E-cadherin expression levels were also correlated with clinical data and underlying pathology. b-Catenin and E-cadherin expression were examined in 18 nasopharyn geal carcinoma and 7 non-tumoral inflammatory pharynx tissues using immunohistochemical methods. Patient clin ical data were collected, and histological evaluation was performed by hematoxylin/eosin staining. b-catenin was detected in membrane and cytoplasm in all cases of naso pharyngeal carcinoma, regardless of histological type; in non-tumoral tissues, however, b-catenin was observed only in the membrane. As for E-cadherin expression levels, strong staining was observed in most non-tumoral tissues, but staining was only moderate in nasopharyngeal carci noma tissues. E-cadherin expression was associated with b-catenin localization, study group, metastatic disease, and patient outcomes. Reduced levels of E-cadherin protein observed in nasopharyngeal carinoma may play an important role in invasion and metastasis. Cytoplasmic b-catenin in nasopharyngeal carcinoma may impair cell– cell adhesion, promoting invasive behavior and a metastatic tumor phenotype.

It It is widely held that solid cell nests (SCN) of the thyroid are ultimobranchial body remnants. SCNs are composed of main cells and C cells. It has been suggested that main cells might be pluripotent cells contributing to the histogenesis of C cells and follicular cells, as well as to the formation of certain thyroid tumors. The present study sought to analyze the immunohistochemical profile of SCN and to investigate the potential stem cell role of SCN main cells. Tissue sections from ten cases of nodular hyperplasia (non-tumor goiter) with SCNs were retrieved from the files of the Hospital Infanta Luisa (Seville, Spain). Parathormone (PTH), calcitonin (CT), thyroglobulin (TG), thyroid tran scription factor (TTF-1), galectin 3 (GAL3), cytokeratin 19 (CK 19), p63, bcl-2, OCT4, and SALL4 expression were evaluated by immunohistochemistry. Patient clinical data were collected, and tissue sections were stained with hematoxylin–eosin for histological examination. Most cells stained negative for PTH, CT, TG, and TTF-1. Some cells staining positive for TTF-1 and CT required discussion. However, bcl-2, p63, GAL3, and CK 19 protein expression was detected in main cells. OCT4 protein expression was detected in only two cases, and SALL4 expression in none. Positive staining for bcl-2 and p63, and negative staining for PTH, CT, and TG in SCN main cells are both consistent with the widely accepted minimalist definition of stem cells, thus supporting the hypothesis that they may play a stem cell role in the thyroid gland, although further research will be required into stem cell markers. Furthermore, p63 and GAL-3 staining provides a much more sensitive means of detecting SCNs than staining for carcinoembryonic antigen, calcitonin, or other markers; this may help to distinguish SCNs from their mimics.

Resumen El fibrohistiocitoma maligno (FHM) es una tumoracion infrecuente en cabeza y cuello, y todavia mas en la laringe. Es mas prevalente en varones de mediana edad, pudien-do aparecer a cualquier edad. La presentacion mas habitual laringea es en forma de nodulos subepiteliales. El comportamiento clinico es variable e impredecible. Microscopicamente, es un tumor con dos componentes diferenciados: histiocitico y fibroblasti-co, con diferentes patrones estructurales que pueden dificultar el diagnostico histologico. Se presentan dos casos de FHM laringeos y se revisa la bibliografia

En el presente trabajo se revisa la patología tumoral otorrinolaringológica propia de la infancia. Se incide sólo en aquellos aspectos más sobresalientes, pues la variedad de entidades en estudio es restringida. En el 50 % de los papilomas puede demostrarse la infección por virus del papiloma humano (tipos 6 y 11) mediante técnicas de biología molecular, siendo menor la capacidad demostrativa de la inmunohistoquímica. En el angiofibroma nasal se ha puesto en evidencia la naturaleza miofibroblástica y su incidencia es 25 veces más frecuente en poblaciones de pacientes con poliposis adenomatosa familiar del colon. En el carcinoma nasofaríngeo ocurre sobreexpresión de p53 en los estadios iniciales y la sobreexpresión de c-myc se correlaciona con peor pronóstico. Recientemente se ha demostrado que el neuroblastoma olfatorio no expresa la proteína producto del gen MIC2 (anticuerpo 12E7), por lo que no se confirma la hipótesis de que puede ser miembro de la familia del tumor de Ewing (tumores neuroectodérmicos periféricos), aunque sí es un tumor neural primitivo. El rabdomiosarcoma de cabeza y cuello con mejor pronóstico es el orbitario, y los estudios citogenéticos han señalado la translocación cromosómica t(2;13) en el 50% de estos tumores infantiles cuando son de tipo alveolar, mientras que la trisomía del cromosoma 2 o del 20 es más peculiar del tipo embrionario. Por otro lado, cualquier asunto clasificatorio de los linfomas del área otorrinolaringológica, actualmente tiene que basarse en la clasificación REAL (Revised European-American Classification of Lymphoid Neoplasms).Entre los tipos histológicos de carcinoma de tiroides, el papilar y el medular son los que más relieve poseen en la edad infantil y en la génesis de ambos, las alteraciones del protooncogén ret desempeñan un papel importante. : In the present study we review ENT tumor pathology in childhood. Only the most salient aspects are emphasized and the variety of entities reviewed was restricted. Molecular biology techniques reveal infection by human papilloma virus (types 6 and 11) in 50 % of papillomas, while immunohistochemical techniques are less effective in papilloma virus detection. The myofibroblastic nature of nasal angiofibroma has been demonstrated and its incidence is 25 times more frequent in patients with familial polyposis of the colon. Overexpression of p53 occurs in the initial stages of nasopharyngeal carcinoma, while overexpression of c-myc is correlated with an unfavorable prognosis. Recently, olfactory neuroblastoma has been shown not to express the protein product of the MIC-2 gene (antibody 12E7), thus the hypothesis that it could be a member of the Ewing tumor family (neuroectodermal peripheral tumors) has not been confirmed, although it is a primitive neural tumor. The head and neck rhabdomyosarcoma with the best prognosis is that located in the orbit, and cytogenetic studies have shown chromosomic translocation t(2;13) in 50 % of these childhood tumors when they are of the alveolar-type, while trisomy of chromosome 2 or 20 is more characteristic of the embryonic-type. Currently, any classifying features of ENT lymphomas must be based on the Revised European-American Classification of Lymphoid Neoplasms (REAL).Papillary and medullary carcinomas are the most common histological types of thyroid carcinoma in childhood. Alterations in ret/PTC play a significant role in the pathogenesis of both.

BACKGROUND: Although mucoepidermoid carcinoma is considered a very rare, low grade thyroid neoplasm, in two patients a very rapid and aggressive outcome occurred. We describe the cytologic, histologic and immunohistochemical findings of a high grade mucoepidermoid carcinoma that evolved into an anaplastic carcinoma. CASE: A 57-year-old man was admitted with dysphagia, dysphonia and odynophagia. The patient had begun to develop symptoms over the previous two months. Ultrasound and computed tomography revealed diffuse enlargement of the thyroid gland with multiple, bilateral, palpable lymph nodes in the cervical, supraclavicular, paratracheal and retrocaval chains. The patient died four weeks after receiving the first cycle of treatment with adriamycin and cisplatin. The smears were highly cellular, with a background rich in neutrophilic, inflammatory infiltrate and necrotic debris. Two main types of tumor cell were identified: squamoid and mucus secreting. Squamoid cells were polygonal, with well-defined borders and dense cytoplasm. Nuclei varied greatly in shape and size and displayed clumped chromatin and prominent nucleoli. Mucus-secreting cells were ring shaped and dispersed among the squamoid cells; they contained a large vacuole, with condensed acid and neutral mucins, that peripherally displaced the nucleus. Small and large clusters oflarge, polygonal cells with single or multiple bizarre nuclei and less-dense cytoplasm were also present. Histology revealed tumor cells distributed in irregular nests, with necrosis surrounded by a fibrous stroma. The predominant cells were squamoid, but dispersed mucus-secreting cells were frequently seen in the better-differentiated areas. Sparse anaplastic spindle cells were observed adjacent to the squamoid focus. Immunohistochemistry revealed a reaction positive for cytokeratin (AE3/AE1) in tumor nests and negative staining for thyroglobulin and neuroendocrine markers. CONCLUSION: Although mucoepidermoid carcinoma of the thyroid is a very rare neoplasm, its peculiar cytomorphologic features in fine needle aspiration cytology may contribute to its correct diagnosis.

Resumen La Displasia Ectodermica Hipohidrotica (DEH) es una rara enfermedad genetica recesiva ligada al cromosoma X, que se caracteriza porque produce la afectacion de estructuras derivadas principalmente del ectodermo, como piel y anejos (pelo y unas), aunque tejidos no-ectodermicos tambien pueden verse comprometidos. El cuadro clinico esta dominado por la disminucion del numero de glandulas su-doriparas, y sus mas inmediatas consecuencias, escasa sudoracion y aumento de la temperatura corporal. Las manifestaciones otorrinolaringologicas derivan de la hipoplasia de las glandulas mucosas del tracto aerodigestivo superior, y destacan por la frecuencia de presentacion las infecciones cronicas, como rinitis, faringitis y otitis, y tambien epistaxis, disfagia, anodontia y ocena, entre otras. Se presenta el caso clinico de un paciente varon joven con DEH que se remite al Servicio de Otorrinolaringologia con clinica de faringitis cronica y ocena, y a proposito del cual se revisa la bibliografia.

This is a case report of a papillary thyroid carcinoma metastatic to the parapharyngeal space, that presented with local obstructive symptoms (dysphagia and displacement of the ipsilateral tonsil). The diagnosis was suspected by imaging studies (CT and MRI) but not confirmed until histological examination. It is not common for such tumors to metastasize to the parapharyngeal space. This is the reason why, to our knowledge, there have been described only five similar cases previously.

This is a case report of a 69-year-old male patient referred to the ENT out patients with right-sided epistaxis and hipoacusis. Fibroptic examination reveals a cystic lesion at the exit of the right eustachian. A CT scan is informed as a well delimited and rounded-shaped tumour compatible with lymphoma. Excisional biopsy by a nasal rigid endos- copy is practiced and the histology result is Warthins tu- mour. The nasopharynx is a rather unusual location for this type of tumours, almost exclusive in origin of major sali- vary glands. Its highlighted the unforeseeable histological diagnosis in this particular anatomical region, where the cli- nical differential diagnosis is broad and the access difficult.

A study was conducted on histological patterns and biomolecular changes in Goitrogen-induced experimental rat thyroid tumors. The link between the histological types observed and N-ras, B-raf, and PI3KCA gene mutations widely reported in human thyroid cancers was explored.An analysis was done on paraffin-embedded tumor tissue sections from Wistar rats receiving 1% potassium perchlorate (KClO(4)) added to the ad libitum drinking-water supply over an 18-month period. Three experimental subgroups were formed, each comprising 10 thyroids: subgroup I (control) consisted of thyroids from untreated controls; subgroups II and III (experimental) consisted of thyroids from KClO(4)-treated rats, displaying capsular, vascular, or both invasion but no metastasis (II), or distant metastasis (III). DNA was extracted from paraffin-embedded tissues. To test for the genetic mutations most widely reported in human thyroid cancers, exon 1 of the N-ras gene, exons 9 and 20 of the PI3KCA gene, and exon 15 of the B-raf gene were amplified and sequenced.All tumors were of the follicular type. None of the 20 experimental rat thyroids displayed the expected gene mutations reported in humans. However, 90% of them contained four new B-raf gene mutations and all were silent and did not cause an amino acid substitution in the protein chain.Biomolecular analysis suggested that N-ras, PI3KCA, and B-raf gene mutations may not be involved in thyroid tumor formation using the experimental procedure applied in this study. But the four mutations in B-raf, though without functional repercussions, may be a specific marker for this tumor type.

Haemangiopericytoma and glomus tumours are infrequent neoplasms in otorrhinolaryngology. A case of glomus tumour with haemangiopericytomatous features of the left amygdalar fossa is reported. Its clinical, surgical and histological features are described. This case report supports the unitary concept of smooth muscle tumours of the small vascular wall.

This is the case of a middle-aged male with a slow growing lateral cervcal painful tumour, and without previous history of local trauma. Radiological testing reveals an ossifying soft tissue lesion without any osseous compromise. The lesion is completely resected, and the histological result is of ossifying myositis. It is an osseous tumour non neoplastic that originates within muscle and in particular the flexors of the inferior extremities and thigs or in the soft tissues. The incidence within the head and neck region is low (20%). There is an hereditary progressive form, Munchmeyer's disease, and another circumscribed, which can be subdivided in traumatic or atraumatic.

This is a case report of a 69-year-old male patient referred to the ENT out patients with right-sided epistaxis and hipoacusis. Fibroptic examination reveals a cystic lesion at the exit of the right eustachian. A CT scan is informed as a well delimited and rounded-shaped tumour compatible with lymphoma. Excisional biopsy by a nasal rigid endoscopy is practiced and the histology result is Warthin's tumour. The nasopharynx is a rather unusual location for this type of tumours, almost exclusive in origin of major salivary glands. It's highlighted the unforeseeable histological diagnosis in this particular anatomical region, where the clinical differential diagnosis is broad and the access difficult.

Hypohidrotic Ectodermal Dysplasia (HED) is a rare recesive genetic disease linked to chromosome X whose main characteristic is the reduction of sweat glands, leading to a deficient sweating and an increase in body temperature. In HED mainly the ectodermal structures are involved such, as epidermis and its anexes (hair and nails), although non-ectodermal tissue may also become involved. Otolaryngologicalmanifestations are related to hypoplasia of the mucous glands of the upper aerodigestive tract, as chronic infections, like rhinitis, pharyngitis, bronchitis and otitis, and also epistaxis, dysphagia, anodontia and, ozena, among others. A case of a young adult male affected with HED who is referred to the Otolaryngology Departament with a history of chronic pharyngitis and ozena, is presented and the literature reviewed.

Laryngeal presentation of Malignat Fibrous Histiocytoma (MFH) is uncommon. It is more prevalent in elderly males. The most frequent form of laryngeal presentation is as subepithelial nodules, and its clinical behaviour is variable and unpredictable. Microscopically, it is a tumour with two well differentiated components: histiocitic and fibroblastic, with several different structural patterns that can make histologic diagnosis a difficult one. We present two cases of MFH of the larynx, and a review of the literature.

In the present study we review ENT tumor pathology in childhood. Only the most salient aspects are emphasized and the variety of entities reviewed was restricted. Molecular biology techniques reveal infection by human papilloma virus (types 6 and 11) in 50 % of papillomas, while immunohistochemical techniques are less effective in papilloma virus detection. The myofibroblastic nature of nasal angiofibroma has been demonstrated and its incidence is 25 times more frequent in patients with familial polyposis of the colon. Overexpression of p53 occurs in the initial stages of nasopharyngeal carcinoma, while overexpression of c-myc is correlated with an unfavorable prognosis. Recently, olfactory neuroblastoma has been shown not to express the protein product of the MIC-2 gene (antibody 12E7), thus the hypothesis that it could be a member of the Ewing tumor family (neuroectodermal peripheral tumors) has not been confirmed, although it is a primitive neural tumor. The head and neck rhabdomyosarcoma with the best prognosis is that located in the orbit, and cytogenetic studies have shown chromosomic translocation t(2;13) in 50 % of these childhood tumors when they are of the alveolar-type, while trisomy of chromosome 2 or 20 is more characteristic of the embryonic-type. Currently, any classifying features of ENT lymphomas must be based on the Revised European-American Classification of Lymphoid Neoplasms (REAL). Papillary and medullary carcinomas are the most common histological types of thyroid carcinoma in childhood. Alterations in ret/PTC play a significant role in the pathogenesis of both.

Myxomas are rare benign connective tissue tumours of unclear histogenesis. In this case a lateral neck tumour initially behaved, both clinically and radiographically as a lipoma, and was therefore managed conservatively. Subsequently the lesion caused pressure symptoms and therefore a surgical approach was taken with subsequent histology confirming a myxoma. Only five cases of soft tissue myxoma of the lateral neck have been reported in the English literature of which two were extramuscular. This is the largest reported myxoma of the head and neck region and was treated with simple enucleation. There has been no evidence of recurrence five years after surgery.

Radiation-associated (RA) osteosarcomas (OS) are exceptional in children, presenting more frequently in middle-aged and elderly patients. This is a case report of RA-OS of the sinonasal cavities in a 13-yr-old girl after combined therapy for rhabdomyosarcoma (RMS) of the nose diagnosed at the age of five. The treatment of choice is radical surgery with wide margins and postoperative adjuvant chemotherapy and radiotherapy. Despite an episode of recurrence, at the present time the patient is alive and free of disease 5 yr after the initial treatment of OS. The association between radiation, chemotherapy and sarcomas is reviewed and discussed.

To determine whether ploidy patterns are related to prognosis in sympathoadrenal paragangliomas (SAP) using flow cytometry.DNA flow cytometric analysis of formalin-fixed, paraffin-embedded tumor samples from 36 patients with SAP was performed. Eight cases fulfilled at least one of the following malignancy criteria: (1) extensive invasion of adjacent structures (5 cases), (2) local recurrence (3 cases), or (3) metastases (4 cases).Of the 36 tumors, 22 (61%) showed nondiploid patterns (12 aneuploid, 10 tetraploid). All diploid tumors were benign, while all malignant cases showed nondiploid patterns (P = .0131). The differences between diploid and aneuploid tumors and between diploid and tetraploid tumors, with regard to the malignancy of the disease, were statistically significant (P = .03311 and .01976, respectively). Only one malignant tumor had a DNA index1.75 (P = .00259).Anomalous DNA ploidy patterns are frequent in SAP, without necessarily implying malignancy. However, diploid DNA content may be a marker of a good prognosis. The likelihood of malignancy is greater in the tetraploid and peritetraploid range.

A solitary fibrous tumor (SFT) of the parapharyngeal space presented with local symptoms (hearing loss, nasal obstruction, and paralysis of the soft palate and tongue). SFT, originally described as a mesothelial tumor of the pleura, now is recognized as a mesenchymal tumor that occurs in different locations. In the head and neck region, about 50 cases have been reported. This is the fifth published report of an SFT of the parapharyngeal space. The diagnosis was confirmed by immunohistochemical (positivity for vimentin, CD34, and CD99) and ultrastructural markers (fibroblastic characteristics).

To determine if there are subvisual differences (quantitation of DNA and study of chromatin texture) that distinguish single-gland parathyroid disease (adenoma) from multiple-gland disease (hyperplasia).Forty-eight parathyroid glands from 41 patients with primary hyperparathyroidism were studied. Cytometric differences between the chief cells and clear cells were sought. An image cytometer was used to study histologic sections stained with DNA stain reagent. In each case a total of 200 cells were measured in consecutive fields. To distinguish chief cells from clear cells, a sample of 15,600 cells collected in consecutive fields in 78 histologic sections was analyzed.The results indicated that none of the continuous variables differentiated between single-gland and multiple-gland parathyroid disease. The most common ploidy pattern was diploid (25/45), followed by hypodiploid (7/45) and polyploid (5/45). A tetraploid population3% was found in 18/45 of the cases and was more frequent in single-gland lesions (15/34) than in multiple-gland lesions (3/11). The most significant discrete variables were growth pattern and binucleation or multinucleation. Clear and chief cells were classified correctly in 61.3% of the crossover validation tests using the standard deviation of nuclear shape karyometric variable and in 76.3% using the standard deviation of maximal correlation coefficient karyometric variable. Although ploidy pattern did not show significant differences, polyploidy, aneuploidy and tetraploidy3% were slightly more common in chief cells.In primary hyperparathyroidism there are no subvisual differences that can distinguish adenoma from hyperplasia. Nonetheless, by cytometry, most parathyroid cells can be classified correctly as clear or chief cells.

Abnormal Wnt signaling and impaired cell–cell adhesion due to abnormal E-cadherin and β-catenin function have been implicated in many cancers, but have not been fully explored in laryngeal squamous cell carcinoma. In this study, β-catenin cellular location and E-cadherin expression levels were analyzed in 16 laryngeal squamous cell carcinomas (LSCCs) (9 glottic and 7 supraglottic) and 11 samples of non-tumoral inflammatory larynx tissue, using immunohistochemical methods. All non-tumoral tissues showed equally strong membranous expression of β-catenin, while cytoplasmic expression was found in only 3 of the 11 samples. By contrast, whereas 8/9 glottic LSCCs exhibited only membranous expression of β-catenin, 6/7 supraglottic LSCCs displayed both membranous and cytoplasmic expression (p = 0.003). Strong E-cadherin staining was observed in 9/11 non-tumoral tissues and 7/9 glottic LSCCs, whereas 4/7 supraglottic LSCCs exhibited weak expression. Reduced membrane expression of E-cadherin and cytoplasmic retention of β-catenin in supraglottic LSCC seems to be related with more aggressive biological behavior which has been described in clinical studies. Further research is required to clarify the involvement of β-catenin in the mechanism associated with malignant transformation in laryngeal tissues.

A case of melanotic neuroectodermal tumour of infancy is decribed. The pre-operative diagnosis was made on cytological material obtained by fine needle aspiration. The patient was a three-month-old male infant with a rapidly growing maxillary tumour mass that also involved the pterygomaxillary fossae and the floor of the orbit. In addition to the typical clinical presentation, the cytology is also distinctive showing a dual population of small neuroblastic cells and large melanin-containing epithelial cells. Histological, immunohistochemical and electron microscopic examination of the excised mass confirmed the initial diagnosis. The pre-operative distinction of this tumour from other small round cell tumours of infancy (rhabdomyosarcoma, neuroblastoma, melanoma and lymphoma), is essential in order to plan the most complete resection therefore reducing the possibilities of tumour recurrence. This tumour belongs to a field of pathology with which many otolaryngologists may not be familiar.