Browsing by Author "Folić, Miljan (56497240500)"

Angiomyolipoma is a benign, mesenchymal, hamartomatous lesion often described in the kidney and may be associated with tuberous sclerosis. Nasal angiomyolipoma is an extremely rare tumor with fewer than 20 cases reported in the literature. We report a case of angiomyolipoma arising in the right nasal vestibule in a 68-year-old male with mild, recurrent right-sided epistaxis, and nasal obstruction. With the exception of arterial hypertension, the patient did not have any comorbidities. Gross examination showed a well-circumscribed, lobulated mass. On the microscopic level, it was composed of mature smooth muscle cells, thick-walled blood vessels of varying sizes, and islands of mature adipose tissue. Angiomyolipoma should be considered as a differential diagnosis for unilateral nasal masses, especially those situated in the nasal vestibule. © The Author(s) 2021.

Purpose: Otitis media with effusion (OME) associated with Samter’s triad (ST) is a difficult entity to treat. The aim of study was an investigation of the middle ear and nasal production of inflammatory mediators (IM) in patients with ST and analysing differences between them and controls. Methods: Prospective case–control study. Nineteen patients with OME (five had allergic rhinitis, four had nasopharyngeal lymphoid hyperplasia, five had no evident sino-nasopharyngeal disease and five had confirmed ST) and 15 healthy participants were included. The concentrations of IM interleukin–1 beta (IL-1β), interferon-alpha 2 (IFN-α2), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23 and IL-33 were measured in nasal and middle ear secretions. Results: There was a difference that was close to a level of statistical significance only for IL-1β levels in middle ear fluid (p = 0.052) between the ST subgroup and the other patients with OME. Also, we found a significant difference for IL-23 in nasal secretions between these subgroups (p = 0.040), whereas the difference in nasal fluid IL-33 was close to a level of statistical significance (p = 0.052). There was a significant difference in nasal concentrations of IL-1β, IFN-α2, MCP-1, IL-8, IL-18 and IL-33 (p < 0.001, p = 0.005, p = 0.008, p = 0.011, p = 0.011 and p = 0.011, respectively) between the OME group and the healthy subjects. There were significant positive correlations between concentrations of IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-17A, IL-18 and IL-33 (p < 0.001, p < 0.001, p = 0.002, p = 0.028, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively) in nasal and middle ear secretions. Conclusion: This preliminary report showed some differences in IM production between the patients with OME associated with ST and those without it. Our results suggest a uniformity of the production of nasal and middle ear IM and supported the concept of a united airway respiratory disease. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

Introduction. A hibernoma is a rare benign tumor derived from vestigial remnants of brown adipose tissue. In neonates this tissue makes up about 5% of the body mass and its amount greatly decreases after birth, persisting only in scattered subcutaneous areas. In rare cases, brown fat continues to grow leading to a hibernoma that may be located in the head and neck. We present an illustrative case of a large hibernoma of the neck with infraclavicular extension and discuss about diagnostic and treatment difficulties. Case report. A 29-year-old male presented with large, slowly progressive, painless neck mass that was noticed 6 months earlier. Computed tomography (CT) and magnetic resonance (MR) showed a well-vascularized, soft tissue tumor of the lateral region of the neck and supraclavicular fossa with extension below clavicle. Treatment included arterial embolization followed by challenging surgical removal of the tumor. Dissection was performed at III, IV and V levels of the neck, making complete resection possible without the tumor fragmentation or major blood vessels and cranial nerves injuries. The final diagnosis of the hibernoma was made by histopathological analysis. The patient had no signs of recurrence during three-year follow-up. Conclusion. Although the CT scan and MR may raise the suspicion, hibernoma is definitely diagnosed by a pathologist. It is very important to exclude the malignant processes, foremost liposarcoma. The tumor fragmentation during surgery should be avoided because the high vascularity of the tumor tissue carries a substantial risk for hemorrhage. Our experience with preoperative embolization and complete tumor resection in this case showed positive impact on the final outcome. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background: The major clinical dilemma managing acute rhinosinusitis (ARS) in pediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention. However, factors associated with severe orbital complications and the optimum management strategy remains controversial. The objectives of this study were to characterize the clinical outcomes of children with orbital complications of ARS and to identify risk factors associated with disease severity. Methods: This retrospective cohort analysis evaluated the clinical outcomes of 61 children admitted for orbital complications between January 1, 2002 and December 31, 2017. Descriptive statistics were performed to examine the demographics and clinical findings. We compared groups using Mann-Whitney U test for continuous variables and χ2 for categorical variables. Results: Although two-thirds of children had received prehospital antibiotics, half of the cohort presented with post-septal orbital complications. While 83% of isolates obtained from the same patients were susceptible to the prehospital antibiotics given, the majority of those who received prehospital antibiotics nevertheless required surgical intervention. We observed significant association between the age of presentation and disease severity. Children >5 years of age presented with more severe orbital complications despite prehospital antibiotics and were more likely to require surgical intervention (P < 0.001). Conclusions: In this study, stage II/III orbital complications at presentation and older age were the most important determinants of medical treatment failure. Early referral to eye, nose and throat (ENT) should be considered for children >5 years with ARS due to worse orbital complications despite prehospital antibiotics. © 2019 Pediatric Infectious Disease Journal. All rights reserved.

Granulomatosis with polyangiitis is a systemic vasculitis of unknown etiology, characterized by necrotizing granulomas. It is an autoimmune disease affecting small- and medium-sized vessels of upper and lower respiratory tract, kidneys, and other organs. We described a case of a patient with otitis media with effusion as the first manifestations of granulomatosis with polyangiitis. A 54-year-old female presented as an urgent case with history of a severe otalgia, hearing loss, vertigo, and fever. The patient was treated with diagnosis of otitis media with effusion and acute rhinosinusitis, but without significant success. She developed an acute kidney dysfunction as a sign of glomerulonephritis with rapidly progressive renal failure. Diagnosis of granulomatosis with polyangiitis was confirmed after the histopathological analysis of kidney tissue, not by analysis of middle ear and paranasal sinus mucosa specimens. The patient was treated according to generally accepted protocol, and over time, there was an almost complete recovery. © The Author(s) 2021.

Introduction/Objective New World Health Organization Classification of Head and Neck Tumors from 2017 has introduced significant changes, mainly considering tumors in the oropharyngeal region. New entities of HPV-positive and-negative squamous cell carcinomas have been acknowledged, not only based on the presence of an active viral infection and different tumor markers expression, but also because of their different histopathology, staging assessment, and prognosis. A retrospective study has been conducted, in order to determine p16 positivity in squamous cell carcinomas in oropharynx and in the oral cavity, and to see whether they differ in sex and age distribution. Methods The presence of viral infection was verified based on p16 immunochemistry staining, p16 being the surrogate marker for HPV infection. A total of 177 cases of squamous cell carcinomas in the oropharynx and the oral cavity, found in the archives of the Histopathology Laboratory of the Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, have been revised. Results Out of 177 cases, 50 (28.2%) were p16-positive. Compared with carcinomas in the oral cavity, p16 carcinomas were significantly more common in the oropharynx (34.3% in the oropharynx, compared to 10.3% in the oral cavity). Carcinomas in both regions were mostly associated with male sex (88.1% of all cases were in males), but p16 positivity was more common in females (11 out of 21 cases, 52.4%). The most common location of p16-positive carcinomas were palatine tonsils (41.03% of tonsillar carcinomas were p16-positive). Conclusion P16-positive squamous cell carcinomas were the most numerous in the oropharynx, i.e. palatine tonsils, and were more common in females. © 2020, Serbia Medical Society. All rights reserved.

Introduction Primary sarcomas are uncommonly seen in the larynx and comprise around 1% of all laryngeal malignant tumors. We present three cases of patients with different types of laryngeal sarcomas and discuss about diagnostic and treatment difficulties. Case outline Each patient presented with hoarseness and shortness of breath. Computed tomography scans showed large transglottic tumors of the larynx with no signs of cervical lymphadenopathy and definitive diagnoses of sarcomas were made by pathologists. Each patient underwent total laryngectomy with clear resection margins. Patient with laryngeal leiomyosarcoma developed large locoregional relapse of malignant disease and pulmonary metastasis four months after surgery and patient with laryngeal osteosarcoma was diagnosed with inoperative locoregional relapse of malignant disease three months after surgery. Both patients died within six months after surgery. On the other hand, patient with laryngeal chondrosarcoma was disease-free during the three-year follow-up. Conclusion Primary laryngeal sarcomas have low incidence and they differ from squamous cell carcinoma by their biological characteristics and behavior. Radical surgical resection remains the mainstay of treatment with uncertain outcome due to their high potential for recurrence or metastatic spread. © 2022, Serbia Medical Society. All rights reserved.

Introduction Renal cell carcinoma is the most frequent infraclavicular primary tumor metastasizing in the sinonasal region, although these metastases are not common. We present an unusual case of recurrent epistaxis as the initial sign of renal carcinoma sinonasal metastasis and discuss the diagnostic and treatment options. Case outline A 66-year-old patient was admitted to the hospital due to recurrent and severe epistaxis. The patient underwent nephrectomy due to renal cell carcinoma, with no signs of relapse during a three-year follow-up. Nasal endoscopy and computed tomography revealed a large mass in nasal cavity, spreading to the anterior and posterior ethmoid cells, sphenoid sinus, orbit, and anterior cranial fossa. Definite diagnosis of renal cell carcinoma metastasis in sinonasal region was made by a pathologist after biopsy and further radiological examination showed no signs of malignant disease in the abdomen, thorax, or pelvis. Although the patient had received 50 Gy of radiation therapy, the malignant disease was evaluated as progressive with further extension in anterior cranial fossa and maxilla, and the patient died five months after the occurrence of epistaxis. Conclusion In patients with recurrent epistaxis who also had a history of renal carcinoma, endoscopic finding of tumefaction in the nasal cavity should raise a suspicion of sinonasal metastasis. In such cases, biopsy is mandatory to differentiate a metastasis from primary sinonasal tumors. Histological confirmation should be followed by radiological examination of the abdomen, thorax, and pelvis to evaluate the possibility of renal cell carcinoma recurrence or metastatic dissemination elsewhere. © 2019, Serbia Medical Society. All rights reserved.

Introduction Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone and scull base. This condition is also known as malignant otitis due to an aggressive behavior and poor treatment response. Early diagnosis of malignant otitis is a difficult challenge. We present an illustrative case of necrotizing otitis externa and suggest some strategies to avoid diagnostic and treatment pitfalls. Case Outline A 70-year-old patient presented with signs of malignant otitis externa, complicated by peripheral facial palsy. Adequate diagnostic and treatment procedures were performed with clinical signs of resolution. The recurrence of malignant infection had presented three months after previous infection with multiple cranial nerve neuropathies and signs of jugular vein and lateral sinus thrombosis. An aggressive antibiotic treatment and surgery were carried out, followed by substantial recovery of the patient and complete restoration of cranial nerves’ functions. Conclusion Necrotizing otitis externa is a serious condition with uncertain prognosis. The suspicion of malignant external otitis should be raised in cases of resistance to topical treatment, especially in patient with predisposing factors. Evidence-based guideline for necrotizing otitis externa still doesn’t exist and treatment protocol should be adjusted to individual presentation of each patient. © 2016. Srpski Arhiv za Celokupno Lekarstvo. All right reserved.