Introduction Schwannoma of the olfactory groove is an extremely rare tumor that can share a differential diagnosis with meningioma or neuroblastoma. Objectives The authors present a case of giant schwannoma involving the anterior cranial fossa and ethmoid sinuses. Case Report The patient presented with a 30-month history of left nasal obstruction, anosmia, and sporadic ipsilateral bleeding. Computed tomography of the paranasal sinuses revealed expansive lesion on the left nasal cavity extending to nasopharynx up to ethmoid and sphenoid sinuses bilaterally with intraorbital and parasellar extension to the skull base. Magnetic resonance imaging scan confirmed the expansive tumor without dural penetration. Biopsy revealed no evidence of malignancy and probable neural cell. Bifrontal craniotomy was performed combined with lateral rhinotomy (Weber-Ferguson approach), and the lesion was totally removed. The tumor measured 8.0 4.3 3.7 cm and microscopically appeared as a schwannoma composed of interwoven bundles of elongated cells (Antoni A regions)mixed with less cellular regions (Antoni B). Immunohistochemical study stained intensively for vimentin and S-100. Conclusion Schwannomas of the olfactory groove are extremely rare, and the findings of origin of this tumor is still uncertain but recent studies point most probably to the meningeal branches of trigeminal nerve or anterior ethmoidal nerves.

Introduction Warthin tumor is described as papillary cystadenoma lymphomatosum and is the second most common tumor of the parotid glands. Bilateral synchronous incidence is rare, occurring in 7 to 10% of the cases. It is more common in males between 60 and 70 years of age and is closely related to smoking. There is slow growth and the condition is a delimited nodule of regular outlines; it has low rates of malignant progression and recurrence. Objective Report a case of synchronous bilateral Warthin tumor occurring in an elderly patient, and review incidence and peculiarities of this tumor. Case Report A 78-year-old man who used to smoke had a history of mild pain in the topography of right parotid three weeks ago. Patient with hypertension, diabetes and a longtime smoker (smoking a pack per day for 32 years) noticed a progressive bulging in the right parotid region for about 2.5 years ago, and noticed another progressive bulging (althought in the left parotid region), for about one year ago. Patient denied fever, redness, skin lesions and pain during this period until last three weeks, when he sought medical attention for a mild pain in the right facial region. The patient underwent cervical magnetic resonance imaging that showed tumor lesions in both parotids. Fine needle aspiration revealed a typical lesion of epithelial oxyphilic cells associated with reactive lymphoid proliferation, suggesting Warthin tumor. The patient underwent two superficial parotidectomies, and the histopathologic result from both tumors of parotid glands showed papillary cystadenoma lymphomatosum. Conclusion The occurrence of synchronous bilateral Warthin tumor is extremely rare, and anamnesis and physical examination, as well as some complementary examinations, are important means for diagnostic evaluation. Confirmation of the diagnosis can only be obtained through a histopathologic study. A superficial or total parotidectomy is the recommended treatment for the disease.

Introduction  Pleomorphic adenoma, also known as mixed tumor, is the most common benign tumor of the major and minor salivary glands. The occurrence of pleomorphic adenoma of the tongue base is very rare, and very few cases have been reported in the literature. Objective  The authors present a rare case of pleomorphic adenoma of the tongue base and a review of the literature. Case Report  A 55-year-old woman had an extensive cervical mass, with little pain, from the submental level to the level below the hyoid bone. Fiberoptic endoscopic examination showed an extensive mass at the base of the tongue with considerable reduction in the airway. Magnetic resonance image scan revealed a contrast-enhancing mass of heterogeneous density over the base of the tongue of 8 × 8 × 7 cm and a reduction of the hypopharyngeal airway. Biopsy of the lesion was performed along with a tracheostomy due to the bulging tongue base and acute respiratory failure. Histologic examination with an immunohistochemistry study revealed a diagnosis of pleomorphic adenoma. The excision of the tumor was performed by a lateral pharyngotomy approach and the total mass was excised. Conclusion  The authors consider the rarity of this case and show that this is the 11th and the largest pleomorphic adenoma reported in the English-language medical literature.

INTRODUCTION: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. OBJECTIVE: To describe a case of Eagle's syndrome. CASE REPORT: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. FINAL COMMENTS: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical.

Después de la cirugía oncológica, el paciente portador de tumor facial encuentra un desafío tan difícil como la propia enfermedad. Tal problema tiene que ver con la reducción de autoestima provocada por su nueva imagen corporal. Siendo así, el presente artículo describe una técnica de simple confección que puede solucionar problemas vividos por el paciente portador de prótesis nasal, sujetada mecánicamente por las gafas, pues por la noche el paciente se ve imposibilitado de usar ese aparato, por existir la posibilidad de estropearse. Para estos pacientes, la prótesis nasal de uso nocturno, a pesar de ser un aparato no estético se vuelve extremamente satisfactorio proporcionando así una mejoría significativa en la cualidad de vida de estos pacientes.

After an oncological surgery, a patient who has a facial tumor encounters a challenge as hard as his own illness. This problem is related to the reduction of his self-esteem, caused by his new body image. Therefore, the following article describes a simple technique that may solve problems experienced by the patient that wears nasal prosthesis mechanically retained to glasses. During his rest, the patient is unable to normally wear his prosthesis because of the risk of breaking them up. For those patients, the night-wear prosthesis, in spite of not being an esthetical prosthesis, becomes extremely satisfying, thus providing a improvement in his quality of life.

OBJETIVO: Revisão dos achados clinicopatológicos dos tumores de glândulas salivares diagnosticados no período de 1980 a 1997 no Departamento de Patologia da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp). MÉTODO: Foi realizado estudo retrospectivo de 205.967 diagnósticos anatomopatológicos e encontrados 119 casos de neoplasias de glândulas salivares, sendo 93 (78%) neoplasias benignas e 26 (22%) malignas. RESULTADOS: A idade variou de 6 a 74 anos (média de 40 anos), sendo 71 (60%) pacientes do sexo feminino e 48 (40%) do sexo masculino. Com relação à topografia, 84 (70,6%) casos foram de parótida, 23 (19,3%) de glândula submandibular, 11 (9,24%) de glândulas salivares menores e um (0,86%) de glândula sublingual. Quanto ao tipo histológico, os tumores corresponderam a 59,7% de adenomas pleomórficos, 10% de cistoadenomas papilíferos linfomatosos (tumor de Warthin), 9,3% de carcinomas adenóides císticos e 8,4 % de carcinomas mucoepidermóides. CONCLUSÃO: O padrão de distribuição dos tumores de glândulas salivares foi semelhante ao encontrado em outras séries. A análise desta distribuição permite identificar variáveis como localização e padrão histológico, subsídios importantes que devem ser considerados no tratamento e em estudos de marcadores prognósticos.

BACKGROUND: The purpose of this study was to review clinicopathological aspects of salivary glands tumours from 1980 through 1997 at Departament of Pathology of Paulista School of Medicine - Federal University of São Paulo - Unifesp. METHODS: We retrospectively evaluated 205.967 pathological reports and we found 119 salivary gland tumours, 93 benign neoplasms (78%) and 26 malignant tumours (22%). RESULTS: The age range was 6-74 years (mean age 40 years), 71 cases were in female (60%) and 48 cases were in male (40 %). The distribution of tumours in various sites were 84 cases of parotid tumours (70.6%), 23 cases of submandibular (19.3%), 11 cases of minor (oropharyngeal) glands (9.24%) and just one case of sublingual gland tumour (0.86%) . Pleomorphic adenoma forming 59.7% of the total salivary gland tumours, Warthin's tumour forming 10% of the series, adenoid cystic carcinoma forming 9.3% and mucoepidermoid carcinoma forming 8.4%. CONCLUSIONS: Some aspects like distribution of tumour in relation to the site and histopathological pattern are very important to considered in the treatment of the disease and prognosis.

CONTEXTO: O câncer dos seios paranasais é considerado raro com uma incidência menor que 1 por 100.000 por ano. O seio frontal é o sítio primário em apenas 0,3% dos casos. A seguir relatamos um caso de adenocarcinoma do seio frontal. TIPO DE ESTUDO: Relato de caso. RELATO DO CASO: Paciente do sexo feminino, 59 anos, secretária, com queixa de quatro meses de cefaléia frontal de leve intensidade (fevereiro de 1998). Negava contato com serragem. Ao exame notava-se um abaulamento frontal à direita, adjacente a borda medial da órbita direita, de característica endurecida. A tomografia computadorizada mostrava um tumor com densidade de partes moles preenchendo o seio frontal com invasão intracraniana através da parede posterior. O seio etmoidal anterior e a borda medial da órbita direita também estava envolvida. A ressonância nuclear magnética demonstrava espessamento dural em comunicação com o tumor. A paciente foi submetida a exérese tumoral em bloco através de craniotomia bicoronal incluindo exenteração orbitária à direita. O exame histopatológico revelou adenocarcinoma. Após a cirurgia a paciente apresentou recidiva tumoral com resposta parcial a radioterapia e quimioterapia.

CONTEXT: Paranasal sinus cancer is considered rare, with an incidence of less than 1 per 100,000 per year, with the frontal sinus being the primary site in only 0.3%. We report a case of adenocarcinoma arising in the frontal sinus. DESIGN: Case report. CASE REPORT: A 59-year-old woman, secretary, came in February 1998 with a 4-month history of low intensity frontal headache. She denied contact with wood dust. On examination a non-tender swelling was noted over her right forehead next to the medial aspect of the right orbit. CT scan showed a soft-tissue mass involving frontal sinus with intracranial invasion through the posterior wall. The anterior ethmoid sinus and the medial aspect of the right orbit were also involved. MRI demonstrated dural thickening in communication with the frontal mass. She underwent an en-bloc tumor resection by craniotomy including orbital clearance. Histology revealed an adenocarcinoma. After surgery she had tumor recurrence, and chemotherapy and radiotherapy were started resulting in partial improvement.