Mirian Cabral Moreira de Castro

Sphenoid Sinus Inverted Papilloma: A Case Report and Literature Review

Introduction Inverted papilloma is a rare benign tumor of the nasal fossa, which usually originates from its lateral wall. Only 5% of cases demonstrate exclusive sinus involvement. Primary sphenoid sinus involvement is even rarer. Although considered a benign lesion, the tumor has a potentially invasive nature and has also been found to have an associated malignancy rate of 7 to 15%. Objectives To report a case of inverted nasal papilloma originating in a rare location: the sphenoid sinus. Resumed Report a 56-year-old woman, presented to our outpatient clinic complaining of frontal headache, occasional otalgia and recent forgetfulness. She was initially evaluated by a neurologist and then submitted to a head magnetic resonance imaging. A lesion was found to be filling both sphenoid sinuses. Sinus computed tomography showed an opacified sphenoid sinus with apparent bony integrity. The patient underwent sphenoidotomy through a transnasal endoscopic approach. A bleeding papillomatous lesion was identified. A biopsy was performed and histopathologic study suggested inverted papilloma. The lesion was then completely resected. The patient has been followed for 60 days after surgery; no signs of recurrence were found upon flexible nasofibroscope examination. Conclusion Inverted Papilloma exclusively involving the sphenoid sinus is a rare entity. Non specific symptomatology and Clinical presentation make this kind of tumor a diagnostic and therapeutic challenge. The Endoscopic Sphenoidotomy has been the treatment of choice. Close follow-up is required in order to detect possible recurrences and malignant transformation.

Grafting in Rhinoplasty: Correlation between the Size of Nasal Bone and the Amount of Septal Cartilage Available for Harvesting

Design: We performed nasal size measures in 30 participants (aged 16-45 years). The nasal bone was palpated and its size was measured with a ruler (measure 1). Dorsal nasal length (measure 2), was also obtained through palpation and measured with a ruler. The amount of septal cartilage available for harvesting was estimated by 2 intraoperative measures: distance in straight line from the rhinion to the anterior septal angle (measure 3), and distance in straight line from the osteo-cartilaginous transition to the caudal septal midpoint (measure 4). Our theory is that patients with shorter nasal bones would have greater amount of septal cartilage available for harvesting, based on the premise that if the nasal bone is short, greater amounts of cartilage will make up for the rest of nasal septum length.

Endoscopic transnasal approach for removing pituitary tumors

UNLABELLED To describe a series of 129 consecutive patients submitted to the resection of pituitary tumors using the endoscopic transsphenoidal approach in a public medical center. METHOD Retrospective analysis based on the records of patients submitted to the resection of a pituitary tumor through the endoscopic transsphenoidal approach between 2004 and 2009. RESULTS One hundred and twenty-nine records were analyzed. The tumor was non-secreting in 96 (74.42%) and secreting in 33 patients (22.58%). Out of the secretory tumors, the most prevalent was the growth hormone producer (7.65%), followed by the prolactinoma, (6.98%). Eleven patients developed cerebral spinal fluid (CSF) fistulas, and four of them developed meningitis. One patient died due to intracerebral hemorrhage in the postoperative period. CONCLUSION The endoscopic transsphenoidal approach to sellar tumors proved to be safe when the majority of the tumors were non-secreting. The most frequent complication was CSF. This technique can be done even in a public hospital with financial limits, since the health professionals are integrated.

CYP11B1 Intragenic Polymorphisms Give Evidence for a Different Q356X Allele in an African-Brazilian Patient

The adrenal cortex is responsible for the production of more than 50 different cholesterol-derived steroids. For such complex metabolism, an arsenal of functional enzymes is necessary. Deficiency of the llß-hydroxylase enzyme (llß-OH) results in the interruption of the last step of Cortisol production. It represents the second most frequent cause of congenital adrenal hyperplasia (CAH). Mutations in the l lßOH coding gene (CYP11B1) have been described as the main cause of the llß-OH deficiency. We describe here a nonsense mutation on the CYP11B1 gene in a patient with l lßOH deficiency presenting with ambiguous genitalia at birth and premature pubarche, clitoris enlargement, hypertension and high 11deoxycortisol levels at the chronological age of 2 yr. This patient is the daughter of a consanguineous couple of African descent. Sequencing data indicated a homozygous mutation (Q356X) in the l lß-OH coding gene. Although the same mutation has been described before in two non-related patients of African-American origin, the investigation of intragenic polymorphisms raises the possibility of a different allele in the African-Brazilian patient. In addition, this is the first mutation determined in a patient with l lß-OH deficiency in Brazil.