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Personal experience in the diagnosis and management of two patients, one adult and one child, with pathologically proven bronchogenic cysts is described. Both patients presented with a solitary neck mass that proved to be bronchogenic cysts on histological examination. Aim of the review is to define the cytology, histopathological and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. Definitive treatment requires surgical excision.

Follicular dendritic cell tumour/sarcoma is a rare tumour involving lymph-node or extra-lymph-node sites; review of the literature reveals very few cases of follicular dendritic cell tumour, probably since, in the past, the disease has often been mistaken for other neoplasms: low differentiated carcinomas and fusate cell carcinomas, sarcomas, melanomas, thymic neoplasms, Castle carcinoma and other dendritic cell tumours (especially interdigital cell tumour/sarcoma). In the case described here, attention is focused on the diagnostic difficulties and on the therapeutic profile, comparing data with those reported in the international literature.

Muscular pharyngeal structural changes, as fibre type disproportion, have been described in patients affected by Obstructive Sleep Apnea (OSA) and in an animal experimental OSA model. The unsolved question is whether these muscular abnormalities are either secondary to a compensatory increased activity or due to a constitutionally determined reduction of slow-alpha motor neurons. In the present study Medium Pharyngeal Constrictor Muscles (MPCM) of OSA (n = 13) and non-OSA (n = 9) patients have been morphologically evaluated. In addition a needle biopsy of Vastus Lateralis Muscle (VLM) was performed in 5 randomly selected patients of each group. Our results confirmed a specific fibre type disproportion of MPCM of OSA patients compared to non-OSA ones with a type II predominance and aspecific myopathic changes such as fibrosis and central nuclei. No difference was found in the VLM of the two groups. This finding could be explained by a secondary adaptive transformation consequent to nocturnal upper airway resistance in OSA. In fact, it has been demonstrated in human muscle that heavy-resistance training may produce preferential type II fibre hypertrophy in stimulated muscle.

Epistaxis is a very common disease. Fortunately it occurs most commonly in the anterior septal network of blood vessel and is therefore readily controlled with simple local measures. Severe posterior epistaxis is less frequent but is still a common and much more serious clinical problem and usually requires hospitalization. The classic treatment of these epistaxis is combined anterior-posterior nasal packing. Occasionally, however, this treatment does not control bleeding. The most popular alternative for these patient is arterial ligation. Initially only carotid ligation was performed. Later further advances in surgical technique and instrumentation, permitted internal maxillary and etmoid artery ligation to be carried out. However often arterial ligation cannot be easily performed in some ent departments and furthermore, surgical failure rate is not exceptionally high if one consider the numerous hypsilateral-contralateral arterial anastomoses present in the etmoid-nasal region. Fifteen patients with recurring nasal bleeding were treated with embolization between 1991 and 1993. Ten of them suffered of essential epistaxis while the other five had chronic local and/or systemic diseases (hereditary haemorrhagic teleangectasia and angiomas). Analysis of the results show a good control of bleeding in the first group of patients (90% after one embolization) and a satisfactory control in patients with haemorrhagic teleangectasia. In conclusion, owing to its efficacy, speed and safety therapeutic embolization with PVA particles may be considered treatment of choice in recurrent persistent epistaxis.

Mucoepidermoid carcinomas (MEC) make up 32% of the heterogeneous cases of malignant epithelial neoplasm of salivary glands observed in our Department. From 1980 to 1990, 270 patients with salivary gland tumefaction, which had previously been treated surgically, were studies. Thirty-four proved to be cases of malignant epithelial neoplasms while 12 oh these 34 were MEC. The biological behaviour of MEC appears to be closely linked to histological grading: a tumor with a low grading has good prognosis while in the case of tumors with a high grading there is a rapid development of local as well as distant metastases. At appears that, with regard to malignancy, localization is an important factors as well submandibular neoplasms are more aggressive the other cancers, probably because they attack periglandular tissue so promptly.