Claude Ghorra

Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively?

IntroductionThe role of cervical ultrasonography (US)-guided surgery for intrathyroid parathyroid adenoma in primary hyperparathyroidism is rarely reported. The aim of this study was to elucidate the role of cervical US in identifying this entity.MethodsFrom 1996 to 2003, cervical explorations were performed in 178 patients (mean age 57 years) with primary hyperparathyroidism. High-resolution cervical US was performed in all of the patients. Patients’ characteristics were reviewed to identify predictive factors for intrathyroid adenoma.ResultsCervical US identified abnormal parathyroid glands in 163 of 178 patients, with a positive predictive value (PPV) of 100%. Six patients (3.4%) were found to have intrathyroid parathyroid adenomas (two in the superior parathyroid and four in the inferior parathyroid). Cervical US predicted this anomaly in four of six patients (67%) in whom the thyroid gland was not nodular and allowed total enucleation of the adenoma to be performed in three and subtotal thyroid loboisthmectomy in three; these operations were performed uneventfully and rapidly. The PPV in this anomaly was 80%. Thirteen patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at the time of the last clinic visit, with follow-up varying from 12 to 96 months. On multivariable analysis, no factor predicted intrathyroid localization of parathyroid adenoma.ConclusionsThe PPV of high-resolution cervical US for identifying an abnormal parathyroid gland was 100% in this series. It was 80% for predicting intrathyroid localization of the adenoma. This method allows us to shorten the operating time by guiding the exploration immediately toward the thyroid gland.

Safety of thyroidectomy and cervical neck dissection without drains

BACKGROUND Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. METHODS The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. RESULTS We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. CONCLUSION Thyroidectomy without drains is safe and effective, even in combination with CND.

Growing Teratoma Syndrome: First Case Report in a 4-Year-Old Girl

Growing teratoma syndrome (GTS) consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. It typically affects young adults and adolescents. Here we describe the youngest case reported in a 4-year-old girl with an ovarian mixed germ cell tumor who underwent an oophorectomy. Her tumor markers normalized by the end of her chemotherapeutic treatment; however, she developed a retroperitoneal mass that was subsequently resected. Histopathology revealed a mature teratoma, consisting of a GTS. We stress the need for early recognition and treatment of GTS to avoid the subsequent morbidity and mortality associated with it. Although GTS has an excellent prognosis when completely resected, it is essential that the patient be regularly followed-up with serum tumor markers and imaging.

Treatment of Tracheal Mucoepidermoid Carcinoma by Argon Plasma Coagulation During Pregnancy

Mucoepidermoid carcinoma of the tracheobronchial tree is a rare airway tumor (<1% of all lung tumors). In adults, the majority of primary tracheal tumors are malignant. Management during pregnancy is complex and requires weighing maternal and fetal prognosis. Reported cases describe surgical resection following cesarean section. We report the first case to be treated by Argon-Plasma Coagulation (APC) in pregnancy. A 35-year-old Caucasian woman G1P0, at 27 weeks of gestation was admitted to the emergency department because of hemoptysis and severe dyspnea. Bronchoscopy and biopsies diagnosed primary tracheal mucoepidermoid carcinoma. Following an episode of tracheal bleeding, she was intubated. After thorough explanations to the family and obtaining informed consent, therapeutic bronchoscopy, under general anesthesia using a rigid bronchoscope, was performed. The tumor was cored out with the tip of the bronchoscope and removed with an alligator forceps. The tumor bed was coagulated with APC. The obstetrical team was ready to intervene in case of maternal emergency. Immediate follow-up was good, and she left the hospital 4 days later. She delivered at 39 weeks of gestation by cesarean section because of dystocia. Five years later, the patient is doing well without any signs or symptoms of recurrence. Pediatric follow-up is normal. Argon Plasma Coagulation for treatment of mucoepidermoid tracheal carcinoma is feasible during pregnancy. Reporting this case could lead to less aggressive management of mucoepidermoid carcinoma in pregnant patients.

Febuxostat-associated eosinophilic polymyositis in marginal zone lymphoma

Febuxostat is an orally administered selective inhibitor of xanthine oxidase approved for the treatment of gout and prevention of tumor lysis syndrome. It is a relatively safe medication. Hypersensitivity reactions associated with the use of febuxostat are quite rare with only one reported case of DRESS syndrome. Recently, two case reports of rhabdomyolysis following the initiation of febuxostat were published. We hereby present the first case of rhabdomyolysis with hypereosinophilia following the administration of febuxostat to a 50-year-old patient newly diagnosed with marginal zone lymphoma. Three weeks after the initiation of febuxostat for tumor lysis syndrome prophylaxis, the patient presented with generalized weakness, diffuse myalgia and low-grade fever. Initial studies showed creatinine kinase level of 4471, hypereosinophilia of 1900/mm3, and LDH of 2691. All infectious and autoimmune diseases were ruled out. TSH level was normal. Muscle biopsy showed myonecrosis in addition to an eosinophilic inflammatory infiltrate in the endomysium and perimysium. Discontinuation of febuxostat led to prompt symptom resolution and normalization of blood tests eight days later.

Aggressive Grade 2 Neuroendocrine Tumor Salvaged by Temozolomide- Based Therapy: A Case Report and Literature Review

We are reporting a 59-year-old woman with a grade 2 (G2) moderately differentiated metastatic neuroendocrine (NET) tumor of unknown origin with Ki67 rate of 15%. First-line treatment with etoposide and cisplatin failed with evidence of rapid disease progression. However, second-line therapy with temozolomide associated to capecitabine proved an unexpected efficacy resulting in a consistent partial response. Immunohistochemistry staining for O-6methylguanine-DNA methyltransferase (MGMT) expression was performed retrospectively and was negative, which could predict response to temozolomide. Systematic treatment strategies of non-well differentiated NETs are reviewed, as well as the role of MGMT as predictive factor for the efficacy of temozolomide. differentiated (G2) neuroendocrine tumor was confirmed. Gallium scan showed the same pattern of disease extension but failed to identify a primary lesion. Chromogranin serum assessment was not done. 24hour urine 5-hydroxyindoleacetic acid was within normal range. The patient received cytotoxic chemotherapy with etoposide 100 mg/m2 intravenously (IV) on days 1 to 3 and cisplatin 75 mg/m2 day 1 of a 21 day cycle for four cycles, associated with zoledronic acid 4 mg IV. Pain and weight loss increased after the second cycle, along with progression of the lesions by more than 75% on subsequent disease assessment. She received second-line therapy with temozolomide 150 mg/m2 divided into two doses daily on days 1 to 5, and capecitabine 600 mg/m2 orally twice daily on days 1-14 of a 21-day cycle. After the completion of her second cycle, the patient presented with a complete disappearance of her pain, regain of appetite and weight, as well as a decrease in disease extension of more than 30%. Actually, the disease remains in sustained partial response while the patient is receiving the eighth cycle. MGMT IHC was subsequently performed (Caris Life Sciences) and was negative (2% staining).

Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in Crohn's disease: The controversy remains

Crohn’s disease (CD) is an incurable inflammatory bowel disease that is characterized by mucosal inflammation and ulceration anywhere along the gastrointestinal tract. The pathology of CD includes inflammatory cell infiltration and excessive pro-inflammatory cytokine production [1]. Apart from C-reactive protein and erythrocyte sedimentation rate, a growing body of evidence suggests that the neutrophil-tolymphocyte and platelet-to-lymphocyte ratios (NLR and PLR, respectively) could be potential inflammatory biomarkers of systemic inflammation in chronic diseases [2]. However, the studies investigating this matter are sparse in CD. Therefore, we conducted a study to evaluate the potential roles of NLR and PLR as biomarkers for CD. This is an institutional review board approved observational case-control diagnostic study to evaluate the value of PLR and NLR as biomarkers for CD. Patients with endoscopically confirmed diagnoses of CD were included in this study and were ageand sex-matched to a control group of subjects with irritable bowel syndrome (IBS) symptoms and normal endoscopy and mucosal biopsy. All subjects signed an informed consent form and had a complete blood count at diagnosis before the initiation of treatment. We calculated PLR and NLR by dividing the absolute counts of platelets and neutrophils by that of lymphocytes of the patients. The activity of CD was evaluated using the endoscopic index of the severity of CD [3]. We excluded patients with active infections, infections within the last month, and ongoing prednisone treatment. All statistical analyses were performed using SPSS v.20.0 (IBM Corporation, New York, USA). Quantitative data were presented as means and standard deviations (mean ± SD). Univariate logistic regression models with either subject diagnosis (either CD or control)

Giant cell granuloma: Report of a rare location in the hard palate and review of the literature

Abstract Giant cell granulomas (GCG) are rare tumors affecting the head and neck region and other sites of the body. Their occurrence in the hard palate is highly uncommon. We present the case of a 15-year-old female patient who presented with a hard palate mass that was confirmed to be a GCG following surgical excision. A review of all cases of GCG in the hard palate reported in the literature till date is presented with an update on differential diagnosis and treatment modalities.

Parotid Tumors : Is Surgery Always the Only Way ?

AIM OF THE STUDY To analyze the characteristics and management of parotid tumors in a tertiary care center. STUDY DESIGN Retrospective cohort study. METHODS All cases of parotid tumors (or masses) in our department between Jan 1, 1999 and December 31st, 2012 were studied. Demographic data, clinical characteristics, histopathology and management were analyzed. We also evaluated the diagnostic value of fine needle aspiration cytology (FNAC) in our center. RESULTS Of the 216 parotid tumors, 164 underwent parotidectomy and 52 were not managed surgically; 73.1% had a benign tumor (36.6% had Warthins tumor) and 16.7% had a malignant one. In our center, FNAC was found to have a sensitivity for reporting malignancy of 71.4% and a specificity to rule in malignancy of 100%. CONCLUSION In our series, Warthins tumor was the most frequent mass probably related to the high tobacco use. The prevalence of malignant tumors was relatively high in our series. Primary malignant tumors and pleomorphic adenomas should always be treated surgically, however, lymphomas, metastatic and benign inflammatory masses and cases of Warthins tumors could be managed nonsurgically.

Histologic Distribution of Pulmonary Tumors in Lebanon: A 5-Year Single Institution Experience.

BACKGROUND To compare the current histologic distribution of lung cancer in Lebanon to the worldwide trends, according to the 2004 WHO Classification. MATERIALS AND METHODS 1,760 patients with a pulmonary pathology examination at Hotel-Dieu de France University Hospital between July 2009 and July 2014 were included. RESULTS Some 676 out of the total investigated patients (38.4%) had a lung tumor. In 665 (98.4%) the tumors were malignant, with a mean age at diagnosis of 63.8 years and a male/female (M/F) sex ratio of 1.7:1. Among the malignant tumors, 86.2% were epithelial tumors with a mean age at diagnosis of 64.8 years and an M/F sex ratio of 1.9. Other malignant tumors consisted of metastatic tumors (10.2%), lymphoproliferative tumors (2.1%) and mesenchymal tumors (1.5%). Most common carcinoma subtypes were adenocarcinoma (48.0%), squamous cell carcinoma (23.0%) and small cell carcinoma (13.3%). Carcinoid tumors were the only carcinoma subtype with an M/F sex ratio below 1 (0.7). Salivary gland tumors were the carcinoma with lowest mean age at diagnosis (45.5 years). CONCLUSIONS The histologic distribution of lung tumors in Lebanon is similar to that in developed countries. We believe this resemblance is due to common smoking habits, known to be responsible for the increase of lung adenocarcinoma at the expense of other subtypes.