509 Nasal SCC in a Young Caucasian Male

Introduction Nasal squamous cell carcinoma (SCC) is common in Asian men in their 50s. However, 1 - 2 per million 15–19-year-old Caucasian patients will also develop nasal SCC. This case reports a rare finding of a 19-year-old Caucasian male with nasal SCC. Method Medical records were used to access to all relevant clinical notes for the patient, including blood results, clinical documentation, imaging, and histology. The patient’s clinical journey was reviewed from initial referral to the ENT department to diagnosis with non-keratinising squamous cell carcinoma (NKSCC) stage IV b. Progression of disease: The patient was initially referred to ENT with unilateral tinnitus and temporal headache and diagnosed in clinic with glue ear and hypertrophic adenoidal tissue. He was due to have grommets and EUA, which was postponed due to the COVID-19 pandemic and lack of clinical suspicion of SCC. Patient was later seen in ED for epistaxis, and then for neck swelling after which he was diagnosed with SCC. Conclusions As the patient is a young, caucasian and a non-smoker, the initial diagnosis was lymphoma rather than SCC. This highlights the difficulties of diagnosing this type of cancer in young Caucasian patients.

Effect of topical mometasone furoate on adenoidal lymphoid tissue: a light microscopic study

BackgroundAdenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size.ObjectiveTo study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use.MethodsTwenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically.ResultsAdenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas.ConclusionThe use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.

Adenoid hypertrophy existence in adulthood- a truth revealed

Background and aims: The adenoids (nasopharyngeal tonsils) are part of Waldeyer’s ring of lymphoid tissue. Endoscopic examination of the nasopharynx increasingly recognized that adenoidal tissue in adults is not an uncommon finding. The aims of this study were to determine prevalence of adult adenoid tissue and the possible reasons behind it. Methods: A retrospective study of 1,100 adult patients, who had routine nasal endoscopic examination for nasal obstruction and related pathologies, was undertaken. 84 cases with incidental hypertrophied adenoid were reviewed to determine the probable cause, presenting symptoms, clinical suspicion and final histological diagnosis. Results: The age of patients ranged from 18 years to 77 years. Median age was 32 years. 59 (70.24%) of adenoid hypertrophy patients were smokers and only 25 (29.76%) were nonsmokers suggesting strong association between smoking and adult adenoid hypertrophy with odds ratio=5.3251, χ2value of 54.23 and an extremely significant p value. All the 84 cases were confirmed histopathologically as Reactive adenoid hyperplasia and no signs of malignancy in any of them. Conclusions: The true incidence of adenoidal hypertrophy in adults is unknown. Adenoidal tissue in adults, if present, must always be biopsied or removed irrespective of their macroscopic appearance. The result underlines the importance of considering adenoid hypertrophy as a cause or contributing factor in nasal obstruction and related pathologies in adults. It also supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

Use of narrow-band imaging in detection of nasopharyngeal carcinoma

Aim:To compare narrow-band images of nasopharyngeal carcinoma with those of normal adenoidal tissue.Method:Patients with a nasopharyngeal mass were evaluated using both conventional white light and narrow-band light. Biopsies were performed and Epstein–Barr viral serology was tested for all patients.Results:Thirty consecutive patients were recruited. Twenty-one patients had normal adenoidal tissue and seven had nasopharyngeal carcinoma. One patient with papillary adenocarcinoma was excluded. The features of narrow-band imaging in normal adenoidal tissue were: (1) a regularly arranged follicular pattern, and (2) each ‘follicle’ comprising a pale centre with surrounding dark periphery. The features of narrow-band imaging in nasopharyngeal carcinoma were: (1) absence of surface patterns (n = 7), and/or (2) ‘reverse’, haphazard follicular pattern comprising a dark brown centre and pale periphery (n = 3).Conclusion:Narrow-band imaging of the surface of adenoidal tissue and nasopharyngeal carcinoma appears to identify distinct, characteristic features as described. Narrow-band imaging may be a useful adjunct in differentiating normal adenoidal tissue from malignancy. Further studies are needed to evaluate its diagnostic accuracy.

Relationship between bacteriology of the adenoid core and middle meatus in children with sinusitis

Objective:To assess the correlation between bacterial pathogens in the adenoid core and the middle meatus, in children with hypertrophied adenoids and chronic or recurrent sinusitis.Design:The study was conducted at Alexandria University Hospitals. We included 103 children aged four to 12 years who were scheduled for adenoidectomy and who had clinical and/or radiological evidence of chronic or recurrent sinusitis. Adenoid core specimens and middle meatal swabs were obtained from every patient and were sent for bacteriological evaluation using standard qualitative and quantitative microbiological techniques. The results were statistically analysed.Results:The bacterial species isolated most frequently from the adenoid core were coagulase-negative staphylococci (40.8 per cent),Staphylococcus aureus(22.3 per cent),Streptococcus pneumoniae(18.4 per cent),Haemophilus influenzae(16.5 per cent) and group A streptococci (15.5 per cent). The bacterial species isolated most frequently from the middle meatus were coagulase-negative staphylococci (41.7 per cent),S aureus(32 per cent),S pneumoniae(28.1 per cent),H influenzae(21.6 per cent) and group A streptococci (19.4 per cent). The adenoid core and middle meatal cultures were both positive for at least one bacterial species in 63 cases, and were both negative in 25 cases. In six cases, a positive adenoid core culture was associated with a negative middle meatal culture. In five cases, a negative adenoid core culture was associated with a positive middle meatal culture (for one or more pathogenic species). Thus, adenoid core culture had a positive predictive value of 91.5 in forecasting the middle meatal culture result, and a negative predictive value of 84.3.Conclusion:Apart from its effect on nasal airway patency, adenoidal tissue may function as a bacterial reservoir initiating and maintaining sinus infection in children. These study findings support a potential role for adenoidectomy in the treatment of chronic or recurrent paediatric sinusitis.