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This was also performed on normal turbinate control specimens. Nine tumors were diagnosed as either verrucous or squamous cell carcinoma. Of these, 5 of 69 6. One of nine No normal turbinate tissue contained HPV. HPV types 6b and 11 accounted for all cases of fungiform papillomas. HPV 16 may rarely play a role in cases of inverting papillomas, and HPV 16 and 18 may be involved in a subset of cases of carcinomas originating in an inverting papilloma.
This study represents the largest study to date. Blocks were chosen for sectioning which well represented the papillomatous neoplasm. Epidemiology Tuberculosis TBC of the head and neck occurs infrequently, and involvement of the nose is rare, representing in most cases a secondary event to pulmonary involvement [ 94 ]. Macroscopy In most cases, there is a polyp of the nasal septum or an ulcerated granular lesion.
Microscopy TBC is characterized by caseating and confluent granulomas with surrounding epithelioid cells palisading and Langhans-type giant cells. Lack of caseation is uncommon. Histologically, acid-fast bacilli may be occasionally identified by the Ziehl-Neelsen stain.
Differential diagnosis It includes all other granulomatous diseases, mainly those with caseating type of necrosis. The presence of intracranial extension may lead to a clinical diagnosis of malignancy [ 95 ]. Treatment and prognosis Administration of tuberculostatic drugs is usually curative. The upper aerodigestive tract is occasionally involved.
Epidemiology Besides the lung, hilar and mediastinal lymph nodes, skin, liver, and other systems and organs, several head and neck territories may be affected. The sinonasal mucosa is rarely involved, and most patients have generalized disease [ 96 — 99 ]. Microscopy Discrete non-caseating and non-confluent granulomas are a distinguishing feature.
Sarcoid granulomas are composed predominantly of epithelioid histiocytes with multinucleated giant cells and a peripheral rim of lymphocytes. Stains for acid-fast bacilli and for other infectious agents are negative. Although no microorganisms are found in sarcoid granulomas, cell wall-deficient forms of mycobacteria have been detected by PCR [ ].
Differential diagnosis Includes other granulomatous disorders, like tuberculosis, leprosy, granulomatosis with polyangiitis, inhalant granulomatous processes, and cholesterol granuloma [ 85 ]. Treatment and prognosis Corticosteroids are recommended for treatment of clinically active disease. Outcome is usually favorable. Low-dose corticosteroid treatment may be required to maintain remission and prevent fibrosis.
Central and upper South American countries are also endemic areas [ ]. Etiology Klebsiella rhinoscleromatis is a capsulated gram-negative bacillus [ 83 , ]. Macroscopy Large nodular tumorlike masses are found in the nasal cavity Hebra nose. Less often, RNS nodules are found in other parts of the upper respiratory tract. Microscopy RNS nodules contain large macrophages with abundant clear or vacuolated cytoplasm, known as Mikulicz cells Fig.
In addition, there is fibrosis and heavy infiltration by chronic inflammatory cells, mainly plasma cells showing numerous Russell bodies. The mucosal epithelium may show squamous metaplasia and occasionally prominent pseudoepitheliomatous hyperplasia. Exceptional examples of squamous cell carcinoma have been reported, in association with RNS [ 83 , — ]. Rogov, Minsk, Belarus Full size image Differential diagnosis RNS must be ruled out from leprosy, syphilis, yaws, TBC, leishmaniasis, rhinosporidiosis, and paracoccidioidomycosis [ ].
Treatment and prognosis Prolonged treatment by tetracycline and ciprofloxacin is recommended. Surgery may be used for debulking the obstruction. In Central and South America, leishmaniasis is mostly seen in the form of mucocutaneous leishmaniasis caused by Leishmania braziliensis [ , ]. Disseminated anergic cutaneous leishmaniasis develops in hosts lacking specific cell-mediated immune responses to the distinct species of Leishmania. The parasites are transmitted through the bites of blood-sucking female sand flies of the genus Phlebotomus [ ].
Microscopy The protozoan parasite amastigote is seen in the cytoplasm of histiocytes or, extracellularly, measures 1. The kinetoplast is more readily identified in Giemsa-stained smears of exudates or scrapings than in paraffin sections. The lesions, commonly found in the nasal mucosa and facial skin, are associated with chronic inflammatory reaction and granuloma formation. In anergic cutaneous leishmaniasis, the nodules show enormous amounts of histiocytes repleted with leishmania [ ].
Differential diagnosis Nasal leishmaniasis must be differentiated from other granulomatous diseases such as rhinoscleroma, paracoccidioidomycosis, yaws, leprosy, syphilis, TBC, and histoplasmosis. Treatment and prognosis Antimonial compounds remain the treatment of choice.
Prognosis is good in oriental sore, resistant to healing in the mucocutaneous form, and unfavorable in anergic leishmaniasis. Endoscopically, there is atrophy of the inferior and middle turbinates and ulceration of the nasal septum. Histologically, areas of necrosis are admixed with acute and chronic inflammation; giant cells embracing birefringent foreign body particles are often present; however, vasculitis is minimal or absent. There is a central deposition of amorphous material bordered by histiocytes and foreign body giant cells.
Occasional particles of birefringent crystalline material may be present. Special stains should be performed to exclude the presence of microorganisms. The first are covered by the epithelium of the skin surface.
The latter are lined by the respiratory mucosa of the nasal cavity and paranasal sinuses referred to as the Schneiderian membrane and comprise three histopathological types: exophytic, inverted, and oncocytic. The histopathologic features that clearly differentiate between the three types of Schneiderian papillomas have been well documented [ ].
Human papillomavirus HPV types 6 and 11 are involved in the pathogenesis of exophytic papillomas but not so consistently in the other two variants of Schneiderian papillomas [ — ]. All oncocytic papillomas examined have been HPV negative [ , , ].
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