OLFACTORY
ANOSMIA—ABSENCE OF OLFACTION
-3% DISABILITY
SAFETY ISSUES—RANCID FOOD, SMOKE, CHAMICALS, TOXINS
TASTE (90%)
ACUTE ANOSMIA
ENDOSCOPY
AST (ALCOHOL SNIFF TEST)
NASAL STEROIDS X 8 WEEKS
IF NORETURN TO FUNCTION—-THIN CUT CT SCAN / CORONAL
PAROSMIA = PHANTOSMIA = CHANGES
DYSOSMIA = UNPLEASANT CHANGES
CACOSMIA (KAKOSMIA) = FECAL SMELL WHEN NONE IS PRESENT
OLFACTORY NEUROBLASTOMA–
ESTHESIONEUROBLASTOMA, ESTHESIONEUROEPTHELIOMA OLFACTIF, NEUROESTHESIOMA
ONLY -300 CASES REPORTED
IN DIFFERENTIAL FOR CONG NASAL MASS
OF NEUROECTODERMAL ORIGIN (NEUROCREST CELLS)
+ S100, +NEURON SPECIFIC ENOLASE
HISTO–PSEUDOROSETTES, SHEETS, OR CLUSTERS
PRESENT WITH SINUSITIS LIKE SYMPTOMS
VERY VARIABLY AGRESSIVE
MALE = FEMALE
BIMODAL INCIDENCE (11-20, 51-60)
BARNES (HISTO CLASSIFICATION)
40% NEUROCYTOMA–SHEETS OF CLUSTERS
40% NEUROEPITHELIOMA—TRUE ROSETTES
20% NEUROBLASTOMA–PSEUDOROSETTES
KADISH (CLINICAL CLASSIFICATION)
A–NC ONLY 100% 5 YEAR SURVIVAL
B–NC AND PARANASAL SINUSES 75% 5 YEAR SURVIVAL
C–BEYOND 10-20% 5 YEAR SURVIVAL
Rx SURGERY (CRANIOFACIAL RESECTION) AND POST OP RT +/- CHEMO
LEIOMYOSARCOMA
SMOOTH MUSCLE NEOPLASM THOUGHT TO ORIGINATE FROM THE WALLS OF BV’S
MENINGIOMA
USUALLY OF THE ARACHNOID CELLS
USUALLY ADJACENT BONEY HYPEROSTOSIS
= 20% OF CNS NEOPLASMS
ONLY 2% ECTOPIC
2/100,000, FEMALE 2:1, INCREASED INCIDENCE WITH AGE AND RT EXPOSURE
PRIMARILY MET TO LUNGS
CLASSIC PATH: PSAMMOMA BODIES (LIKE PAPILLARY THYROID CA)
FOUR HISTO PATTERNS: SYNCYTIAL(POSYGONAL), TRANSITIOAL(PSAMMOMATOUS), FIBROUS, ANGIOBLASTIC
+ S-100, VIMENTIN, EMA(EPITHELIAL MEMBRANE ANTIGEN)
Rx—-SURGERY, RU-486 (PROGESTERONE INHIBITOR) MAY HELP
FOSTER-KENNEDY SYNDROME(SPHENOID MENINGIOMA OF THE OLFACTORY OR OPTID GROOVE)
IPSI OPTIC ATROPHY–MARCUS GUN PUPIL
CONRALATERAL PAPILLEDEMA (ICP FROM MASS EFFECT)
CAN PRESENT WITH ATYPICAL BEHAVIOR AND PERSONALITY CHANGES AND ANOSMIA/PAROSMIA
KALLMAN’S SYNDROME
AUTO D
VARIABLE PENETRANCE
ANOSMIA, CONG. HYPOGANADOTROPIC EUNICHOIDISM, RENAL ABNL
+/- DEAFNESS, DM, MIDLINE FACIAL DEFECTS, CRYPTORCHIDISM
(AGENESIS OF OLFACTORY BULBS—SEEN ON MRI AXIAL SCANS, HYPOTHALAMUS, AND OLFACTORY EPITHELIUM)