bluuebunny/crossref_metadata_2025_split huggingface dataset:
Middle Ear Carcinoma Masquerading as an Aural Polyp
Authors: Yong Doh Jeing , Nasir Abd Majid Md , Goh Bee See 
Published: April 2019

Objective: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology.
Methods:
Design: Case Report
Setting: Tertiary Public Hospital
Patients: One
Result: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.
Conclusion: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible.
Keywords: Middle ear carcinoma; aural polyp; temporal bone carcinoma
Glottal Function Index and GRBAS Scale of Patients Undergoing Vocal Cord Medialization: A Series of Five Patients
Authors: Papa Enrique C. , Samson Emmanuel S. , Victoria Francisco A. 
Published: April 2019

Objectives: Vocal cord paralysis or immobility is a debilitating condition that may result from neural injury or mechanical fixation of the vocal cord (VC). When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre - and post - operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.
Methods:
Study Design: Descriptive Case Series
Setting: Tertiary Government Hospital
Patients: Five
Results: Five patients (3 females, 2 males) consulting due to hoarseness underwent rigid endoscopy. Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord. One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 from thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice. The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated well with the improvement of the patient’s subjective symptoms from the GFI scores. However, case 5 with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.
Conclusion: For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.
Keywords: Hoarseness, unilateral vocal cord paralysis, medialization thyroplasty, Glottal Function Index, Hirano GRBAS Score
Transorbital Removal of Foreign Body in the Sphenoid Sinus
Authors: Mendoza Daniel Jose C. , Chua Antonio H. , Castañeda Samantha S. 
Published: April 2019

Objective: To report a case of foreign body lodged within the sphenoid sinus and its extraction.

Methods:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One

Results: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache, without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized, probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopic-guided removal of the foreign body (a glass marble) were performed with no intra – operative and post – operative complications.
Conclusion: Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Keywords: Sphenoid sinus foreign body, Computed Tomography (CT), Endoscopic-guided, transorbital approach
Polymorphous Low-Grade Adenocarcinoma
Authors: Bernido Joy B. , Carnate Jose M. 
Published: April 2019

A 60-year-old woman with a 3-year history of a gingivoalveopalatal mass underwent an incision biopsy.
Microscopically, the lesion centered in the stroma is infiltrative (Fig. 1) and architecturally diverse, having cystic (Fig. 2), linear or “Indian file” (Fig. 3), solid, and tubular (Fig. 4) patterns. The cells are uniform in size, round to oval, and have bland cytologic features, with vesicular nuclei and inconspicuous nucleoli (Figure 4). The clinical data and histomorphologic features characterized by architectural diversity yet cytologic blandness lead us to the diagnosis of polymorphous low-grade adenocarcinoma.
Polymorphous low-grade adenocarcinoma (PLGA) is a malignant epithelial tumor characterized by cytologic uniformity, morphologic diversity, an infiltrative growth pattern, and low metastatic potential.1 It is the second most common intraoral malignant salivary gland tumor 1 following mucoepidermoid carcinoma. The tumor is found almost exclusively in minor salivary glands and is rare in extraoral locations, including major salivary glands.2 The tumor affects a wide age range (16 – 95 years; mean 60 years), with only 2 pediatric cases reported,1 and has a female predilection.3,4 It usually presents as a painless mass located within the oral cavity,3 60% of which are located in the palate.1 They are characteristically unencapsulated, although well-circumscribed.3

This entity is architecturally diverse (“polymorphous”) even within a single tumor, with solid, tubular, trabecular, cribriform, papillary and linear patterns being described. Perineural invasion is common although it was not seen in this case. The tumor cells are small to medium sized, and uniformly round to polygonal. The nuclei are bland and vesicular, with occasional small inconspicuous nucleoli. Mitotic figures can be found occasionally but are never numerous.3, 8

The morphologic heterogeneity in small biopsies and frozen section samples can be confused with pleomorphic adenoma and adenoid cystic carcinoma.6,7 Glial fibrillary acid protein may help as PLGA is typically non-reactive in contrast to pleomorphic adenoma.2 De Araujo and others site that uniformly positive vimentin, CK7, and S100 staining favors PLGA over adenoid cystic carcinoma.6 Tumor cytology and histology are quite characteristic - recognizing the constant cytological appearance despite the diversity of architectural tumor patterns should aid one in diagnosing PLGA.
PLGA, despite its infiltrative growth pattern and propensity for perineural invasion, usually runs an indolent course. Nodal metastasis and distant spread are rare, occurring in less than 1% of cases.4 Seethala and others report that extrapalatal location is associated with a more aggressive clinical course.5 Complete surgical excision is the primary treatment with neck dissection reserved for nodal metastasis.1 One-third of patients may have a local recurrence and lifelong monitoring is suggested. Re-excision is amenable in these cases.5,6
CNS Imaging is Essential in Acquired Bilateral Vocal Fold Dysfunction in Children
Authors: Berkowitz Robert 
Published: April 2019

Dear Sir,

I greatly enjoyed reading the paper by David and Lim on “Congenital Bilateral Vocal Fold Paralysis”1 and complement the authors on their excellent surgical outcome. They also very appropriately underscored the primacy of careful clinical assessment over costly investigations, particularly in an environment of scarce resources.

We have previously reported on the MRI findings in 23 children with bilateral vocal fold dysfunction (BVFD) as an isolated abnormality that was present at birth. We found MRI abnormalities in 35%, but these were all non-specific.2 This study indicated that MRI was of research and clinical value, but did not identify any major CNS structural abnormalities in this patient group.

However, the case reported by David and Lim involved the delayed onset of symptoms at 2 years of age that may have increased over the next 3 years. This acquired and possibly progressive disease process differs from that of congenital BVFD. The likelihood of Arnold-Chiari malformation or another significant structural CNS abnormality being present would appear to be higher when symptoms of BVFD are acquired later in life compared to when they are present at birth.

Anecdotally, I have been involved with a case of acquired BVFD presenting at a similar age where the underlying cause was found to be a posterior fossa tumour. The 3 year history of symptoms in the child in the case report would very likely preclude this diagnosis, but certainly another CNS cause needs to be considered to explain the development of delayed-onset brainstem dysfunction, and this would require MRI.

Robert Berkowitz
Department of Otolaryngology
Royal Children’s Hospital
Melbourne, Australia
3D Stereolithographic Modeling of Inverted Papilloma
Authors: Bickle Ian C. 
Published: April 2019

This middle-aged woman presented for the first time to ENT clinic with a complaint of nasal stuffiness.
Computed Tomography (CT) of the paranasal sinuses was performed following clinical review that revealed a left intranasal mass.
Due to a radiological suspicion of an inverted papilloma, Magnetic Resonance Imaging (MRI) of the paranasal sinuses was performed.
This, combined with endoscopic biopsy confirmed an inverted papilloma.
Following referral to oral maxillofacial surgery (OMF), 3D modelling was performed using the original CT data to aid surgical planning.
DISCUSSION
Dramatic technological advancements in the fields of medical imaging and computer aided design (CAD) in the past decade have enabled sterolithographic 3D modelling to evolve from a research aspiration to everyday reality.
The widespread availability of high-resolution volumetric data sets, providing isotropic imaging from cross-sectional imaging studies allows for exquisite 3D model production using rapid prototyping techniques.1
Although its domains are ever widening, its use is most established in the fields of oral maxillofacial (OMF) surgery and otolaryngology enabling surgical planning in anatomically complex areas which often require lengthy and complex surgery.2 Similarly, in these fields the 3D modelling assists in prosthesis design and production, with additional professional advantages, such as teaching aids and aiding patient consent.
In this illustrative case a mass occupies the left ethmoidal and frontal sinuses with destruction of the floor of the anterior cranial fossa (Figure 1 A,B) with further delineation on MRI (Figure 2 A,B). This case of an inverted papilloma illustrates the tremendous assistance that 3D modelling offers to the surgeon in examining the anatomical extent of the tumor, visualising their surgical approach and planning the operative procedure. (Figure 3) For example, in this case a combined procedure between the OMF and the neurosurgery departments was undertaken with a bifrontal craniotomy and maxillectomy. Operating times have also been shown to improve following the use of 3D models as preparation prior to surgery is more robust.3
Chemodectoma and Tetralogy of Fallot
Authors: Santiago Kathleen Joy B. , Samio Lian Melissa R. , Roldan Rodante A. , Castañeda Samantha S. 
Published: April 2019

Objectives: To describe a rare case of chemodectoma, its clinical features and management, and to discuss its relationship chronic hypoxia from Tetralogy of Fallot.
Methods:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
Result: A 23-year-old woman presented with a painless, slow growing, movable right submandibular mass, initially diagnosed as a lipoma by fine needle aspiration biopsy. Computed tomography scan showed a solid nodule with ill-defined margins from the angle of the mandible to the level of the hyoid bone along the carotid sheath. There was also an incidental finding of patent ductus arteriosus and Tetralogy of Fallot on pre-operative clearance. Excision of the mass under general anesthesia revealed adherence to the posterior portion of the carotid trunk enveloping both the internal & external carotid artery. Final histopathological diagnosis was chemodectoma.
Conclusion: Although rare, chemodectoma should be considered as one of the differentials in a patient with a submandibular mass. Hyperplastic chemodectoma may result from chronic hypoxia due to Tetralogy of Fallot. Surgical excision is the treatment of choice.

Keywords: Carotid Body Tumor, Chemodectoma, Paraganglioma, Tetralogy of Fallot
Facial Palsy and Mastoiditis from Fibrous Dysplasia
Authors: Bickle Ian C. 
Published: April 2019

This young adult man presented to ENT clinic with a complaint of left facial weakness and persistent left retro-auricular pain. High resolution CT of the mastoids was performed following clinical assessment.
In this case, there is extensive sclerotic bony expansion with a ground-glass appearance involving the left zygoma, sphenoid and petrous temporal bone.
The bony expansion is centred on the medullary bone and has an abrupt zonal transition (Figure 1). The bone involvement encompasses almost complete bony stenosis of the left external auditory meatus down to 1-2mm with consequential fluid in the external auditory canal and middle ears (Figure 2). The bony expansion involves both the tympanic and mastoid segments of the facial canal which are stenosed. The ossicular chain remains intact. The left mastoid air cells are under-pneumatised and completely occupied by fluid.
DISCUSSION
Fibrous dysplasia (FD) is a benign congenital process that typical manifests itself as a localized defect in osteoblastic differentiation and maturation. Normal bone is replaced with haphazard fibrous tissue and immature woven bone.1
Fibrous dysplasia is predominantly a condition of children and young adults (those less than 30 years of age). Disease growth usually halts after the third decade of life. FD may be a monostotic or polyostotic in nature and in some cases is part of a syndrome, such as McCune-Albright.2
The zygomatic maxillary complex is the most commonly reported location for fibrous dysplasia. The temporal bone is a typical site in polyostotic disease, in up to 70%, but less often observed in monoostotic disease. Disease of the temporal bone most typically results in hearing impairment due to bony stenosis of the external auditory canal. Facial nerve involvement is a less frequent feature, resulting in facial nerve paralysis, due to involvement of the nerve as it exits through the petrous temporal bone.2 The anatomical location of the facial nerve compression is hard to access and treat surgically.3
CT is the imaging investigation of choice giving the most exquisite bony definition. Typical CT features (as shown in this case) are:

A diffuse ground-glass appearance to the affected bone
Homogeneously sclerotic bone
Well-defined borders between the diseased and unaffected bone (abrupt zone of transition)
Bony expansion, with overlying cortical bone intact

The CT appearances apply equally to the anatomical site involved, however the combination of imaging appearances can be variable presenting a diagnostic dilemma, which may merit a confirmatory bone biopsy.
Metastasizing Ameloblastoma
Authors: Atun Jenny Maureen L. , Carnate Jose M. 
Published: April 2019

A 27-year-old man presented with an 8 cm diameter left maxillary mass and an enlarged cervical lymph node at levels II to III. There was a reported history of a previous unspecified operation on the maxillary mass which had yielded a diagnosis of ameloblastoma. Total maxillectomy with modified radical neck dissection was subsequently performed.
Microscopic examination of the maxillary mass shows epithelial islands and cords in a fibro-collagenous stroma. (Figure 1) The islands and cords are lined in the periphery by palisaded columnar cells with regular ovoid nuclei exhibiting reverse polarization. The nuclei are uniform with dispersed chromatin and no significant atypia. Towards the center of these islands are loosely arranged spindly to stellate cells (“stellate reticulum”). (Figure 2) Microscopic examination of the largest submitted lymph node shows an epithelial neoplasm with identical histologic features as the maxillary mass and a residual rim of lymphoid tissue at the periphery enclosed by the nodal capsule. (Figure 3) Similarly, there is neither atypia nor pleomorphism and only a few typical mitotic figures are seen in the nodal tumor. (Figure 4) These features support the diagnosis of a metastasizing ameloblastoma (MA).

Metastasizing ameloblastoma is rare with only about 70 reported cases.1-5 Both the gnathic primary tumor and the metastatic foci have typical morphologies of a benign ameloblastoma with bland nuclei and absent to rare mitosis.6,7 There are no morphologic criteria that can predict this metastatic behavior. Thus, this diagnosis can only be made in retrospect upon the appearance of metastasis in a gnathic tumor that would otherwise have been diagnosed as a usual benign ameloblastoma.1-7 Suggested risk factors include rapid tumor growth, large primary tumor, delay in treatment, mandibular site, prior radiotherapy and chemotherapy.4,5 However, what is most consistent in the literature is the history of multiple recurrences and multiple surgical interventions.1,4,5

The differential diagnosis is an ameloblastic carcinoma (AC). Both MA and AC are considered as the malignant counterparts of ameloblastoma.7 However AC is characterized by the presence of the usual cytologic features of a malignant neoplasm, such as nuclear pleomorphism, hyperchromasia and brisk mitotic activilty – features that are lacking in MA.6,7

The literature on metastasizing ameloblastoma lists the lungs (70 to 88% of cases) and the cervical lymph nodes (15-37.8% of cases) as the most common sites of metastasis.1-5 Increased Ki-67 labeling and CD10 immunoreactivity have been reported to have significant correlation with recurrence.8,9 Whether these observations also apply to the risk of metastasis is not known due to the rarity of cases and hence the small subject populations of these studies.

As the risk of metastasis cannot be predicted by morphology, long-term follow-up appears prudent in all cases of ameloblastoma, especially if characterized by recurrences and prior surgical interventions.
Prevalence of Nasopharyngeal Carcinoma among Patients with Nasopharyngeal Mass in a Philippine Tertiary Training Hospital
Authors: Lara Hasmin Hannah R. , Monroy Angelo A. 
Published: April 2019

Objectives: To determine the prevalence and identify the types of Nasopharyngeal Carcinoma (NPCA) among patients with nasopharyngeal mass seen at a tertiary university training hospital in the Philippines from January 2006 – July 2012 and identify possible factors associated with nasopharyngeal carcinoma.
Methods: A retrospective cross-sectional study was performed at a tertiary university training hospital among cases (n=179) seen with nasopharyngeal mass at the ENT outpatient department. Histopathology results and patient medical charts were collected and reviewed after IRB approval. The age at diagnosis, sex, place of residence, occupation and chief complaint was compared among patients with positive histopathology of NPCA only.
Design: Retrospective, cross sectional study
Setting: Tertiary Private University Training Hospital
Participants: 179 patients with nasopharyngeal mass
Results: 96 (54%) cases with nasopharyngeal mass seen at the ENT outpatient department were positive for nasopharyngeal malignancy. The remaining 83 (46%) cases with nasopharyngeal mass had a benign histopathology. NPCA was more common among males (58%) than females (42%). The most common form of NPCA was non-keratinizing undifferentiated NPCA (47%) followed by poorly differentiated squamous cell carcinoma in 18 (19%). The most common chief complaint was a neck mass, followed by decreased hearing.
Conclusion: There was a higher proportion of nasopharyngeal malignancy among male patients with nasopharyngeal mass, and the most common chief complaint was a neck mass. Future research should integrate data with other hospital institutions to obtain more accurate demographic data of the local prevalence of NPCA. A detailed record of the ethnicity, diet, occupation, smoking history and family history of cases should be obtained to correlate possible risk factors of NPCA among patients with nasopharyngeal mass in our setting.

Keywords: Nasopharyngeal carcinoma, nasopharyngeal mass, epidemiology, prevalence
Tumoral Calcinosis in Secondary Hyperparathyroidism
Authors: Bautista Reinzi Luz S. , Lopa Ramon Antonio B. , Cabungcal Arsenio Claro A. , Dela Cruz Anna Pamela C. , Lo Tom Edward N. 
Published: April 2019

Objective: To report a case of tumoral calcinosis from secondary hyperparathyroidism and to describe its surgical management.
Methods:
Study Design: Case report
Setting: Tertiary public university hospital
Patient: One
Results: A 34-year old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal parathyroidectomy, right thyroid lobectomy with isthmusectomy, and transcervical thymectomy. Follow-up revealed marked decrease in parathyroid hormone, and progressive resolution of the tumoral calcinosis.
Conclusion: Subtotal parathyroidectomy and transcervical thymectomy have a role in the management of tumoral calcinosis, and in this case led to excellent post-operative results. The rare presentation of secondary hyperparathyroidism and intervention in this patient may have potential lessons for future management of similar cases.
Keywords: tumoral calcinosis, parathyroid, parathyroidectomy, thymectomy