E. Serrano

Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses.

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow‐up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow‐up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.

Prevalence of nasal polyposis in France: a cross-sectional, case-control study

Background:  The prevalence of nasal polyposis (NP) has never been established in France due to the lack of diagnostic tools for population‐based studies.

Surgical management of paranasal sinus mucoceles: A long-term study of 60 cases

Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, CT is necessary to accurately analyze the regional anatomy and extent of the lesion. MRI is helpful in defining the limited unusual lesions occurring in critical areas. Standard treatment is surgical marsupialization, through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. Our long-term experience with the endonasal endoscopic approach for the treatment of mucoceles led us to subsequently expand our indications to include most mucoceles, either as the sole approach or associated with an external approach. Comprising the surgical experience of two collaborating universities, this paper describes the indications for the endonasal surgical approach and the long-term postoperative followup.

Endoscopic sinus surgery for sinonasal haemangiopericytomas.

Haemangiopericytomas are rare peri-vascular tumours with variable malignant potential. The nasal cavity and the paranasal sinuses are most often involved in the head and neck. Five cases of haemangiopericytomas treated by a strict endonasal endoscopic approach are presented. Bleeding and nasal obstruction are the most frequent symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allowed pre-operative assessment. Angiography with embolization was needed in two of the five cases. None of our patients presented with malignant histology. Our five cases were operated on, and a total tumour excision was performed through the endoscopic endonasal approach. We had one recurrence with a mean follow-up of 4.5 years. We suggest that when the tumour is purely intranasal or strictly located in the ethmoid or sphenoid sinus, it can be removed via an endonasal approach under endoscopic guidance in experienced hands.

Deglutition after supracricoid laryngectomy: compensatory mechanisms and sequelae.

This study is based on the videofluorographic exploration of deglutition in 14 patients who were treated by supracricoid laryngectomy. The choice of this population rests on two criteria: a 1-year postoperative delay, and absence of residual deglutition disorders elicited by patient history. Asymptomatic aspiration was seen in 6 cases. In the cricohyoidoepiglottopexies (CHEP), aspiration occurred uniquely in patients who did not recuperate satisfactorily from epiglottic dynamics. The deglutition sequelae are less invalidating relative to the cricohyoidopexies (CHP), with a possible recuperation of the dynamic sequence of the pharyngeal swallow. On the other hand, in the CHP, a complete reorganization of the stepwise sequence of the different neuromuscular events is necessary.

Nucleotide Sequencing for Diagnosis of Sinusal Infection by Schizophyllum commune, an Uncommon Pathogenic Fungus

ABSTRACT Schizophyllum commune, a basidiomycete fungus, is a rare cause of mycotic disease. We report here a case of sinusitis in a 35-year-old woman that underscores the value of molecular biology for the diagnosis of this fungal infection.

Langerhans Cell Histiocytosis of the Thyroid is a Rare Entity, but an Association with a Papillary Thyroid Carcinoma is Often Described

Comments on “Langerhans cell histiocytosis of the lung and thyroid, co-existing with papillary thyroid cancer” Jamaati HR, Shadmehr MB, Saidi B, Khosravi A, Arab M, Mohammadi F. Endocr Pathol 20:133–136, 2009 and “Incidental langerhans cell histiocytosis of thyroid: case report and review of the literature” Foulet-Roge A, Josselin N, Guyetant S, Gardet JJ, Besancon A, Saint-Andre JP, Fabiani B. Endocr Pathol 13:227–233, 2002. We read with great interest the contributions of Jamaati et al. and Foulet-Roge et al. respectively entitled “Langerhans cell histiocytosis of the lung and thyroid, co-existing with papillary thyroid cancer” and “Incidental langerhans cell histiocytosis of thyroid: case report and review of the literature” [1, 2]. We have had a similar case of coexistent thyroid Langerhans cell histiocytosis (LCH) and papillary thyroid carcinoma (PTC). A 29-year-old male patient presented with a huge neck mass, immobile, and compressive, involving the trachea, the pharynx, the left jugular vein and the left carotid sheath. Bone (mandible), lung, skin and hypothalamo-pituitary LCH lesions had been documented for 6 years, and clinical stability had been obtained with corticosteroids. The transpharyngeal biopsies performed during a panendoscopy revealed a PTC with positive immunostaining for TTF1, HBME1 and CK19. Associated LCH involvement was diagnosed by the presence of Langerhans cells reactive to CD1a and S100 protein (Fig. 1). The cytological examination of a blind transcutaneous thyroid fine needle aspiration biopsy and other surgical biopsies isolated only the LCH section and a lymphocytic thyroiditis. A surgical resection of this advanced disease could not be considered and a multidisciplinary panel proposed a medical treatment (Prednisone 40 mg/day). Given that there was no response 6 months later, chemotherapy with Vinblastine (Velbe® 6 mg/m every 2 weeks) produced a stabilization over 14 months. Then, due to a severe increase in size and the extension from the oropharynx to the mediastinum in a vertical axis and from the cervical rachis to the subcutaneous tissues in a horizontal axis, a treatment with Cladribine was initiated (Leustatin® 0.1 mg/kg/day over 5 days every 2 months). After 7 months without a response, the treatment was stopped and changed to Imatinib (Gleevec® 100 mg/day for 1 month and then 400 mg/day). Three months after the beginning of this targeted therapy and 3 years after the appearance of the cervical mass, a dramatic dyspnea caused by the compression and the infiltration of the trachea occurred. A tracheostomy under local anaesthesia was carried out in difficult technical conditions. Despite this attempt, acute pulmonary distress resulted in the death of the patient. The family refused an autopsy. S. Vergez (*) Department of Head and Neck Surgery, University-Hospital Rangueil-Larrey, 24 chemin de Pouvourville, 31059 Toulouse Cedex 9, France e-mail: vergez.s@chu-toulouse.fr

Value of investigation in the diagnosis of allergic fungal rhinosinusitis: results of a prospective study.

The authors report a prospective study in which the aim was to analyse the usefulness of different criteria in optimizing the diagnosis of allergic fungal rhinosinusitis. From 1995 to 1998, 165 patients were operated on for chronic rhinosinusitis. Investigations used in this study for the diagnosis of allergic Aspergillus rhinosinusitis consisted of an analysis of clinical, radiological, immuno-allergic criteria. Fourteen patients presented with allergic Aspergillus rhinosinusitis. One hundred and fifty-one patients did not present any of the necessary criteria for the diagnosis of allergic Aspergillus rhinosinusitis. The results show that the characteristic macroscopic appearance, the maxillary sinus localization, and the presence of positive specific IgE to Aspergillus fumigatus are arguments that reinforce the diagnostic certitude of allergic fungal sinusitis. No specific clinical or radiological criteria orients a diagnosis of chronic rhinosinusitis toward that of allergic fungal rhinosinusitis. The other immuno-allergic tests do not contribute to the diagnosis of allergic fungal rhinosinusitis. pathological, mycological, and

Expression of nitric oxide synthases in primary ciliary dyskinesia

Nitric oxide is believed to play a central role in nonspecific defense of upper airways. Patients with primary ciliary dyskinesia have very low concentration of nasal nitric oxide, which may contribute to the chronic upper airway diseases encountered by these patients. The mechanisms underlying this drop of nasal nitric oxide in primary ciliary dyskinesia are still unknown. The goal of the present work was to study nitric oxide synthases expression in upper airway tissues from patients with primary ciliary dyskinesia. For this purpose, 5 patients with primary ciliary dyskinesia and 10 nonallergic age-matched patients without primary ciliary dyskinesia undergoing nasal polypectomy were included. Nasal nitric oxide concentration was measured before polypectomy, and nitric oxide synthase expression and function were studied in nasal polyps. The nasal nitric oxide in patients with primary ciliary dyskinesia was lower than that in patients without primary ciliary dyskinesia (13 [9-16] ppb versus 210 [167-254] ppb, P < .0001). Nitric oxide synthase 2 immunostaining was prominent at the apical part of the ciliated epithelial cells and was similar in both groups. Nitric oxide synthase 3 staining was restricted to endothelial cells in both groups. In addition, reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase activity was superimposable to nitric oxide synthases 2 and 3 immunostaining, suggesting a preserved NADPH-activity of nitric oxide synthase. We therefore conclude that the drop in nasal nitric oxide in patients with primary ciliary dyskinesia is not secondary to the loss of nitric oxide synthase expression.

A comparative immunohistochemistry study of diagnostic tools in salivary gland tumors: usefulness of mammaglobin, gross cystic disease fluid protein 15, and p63 cytoplasmic staining for the diagnosis of mammary analog secretory carcinoma?

BACKGROUND Mammary analog secretory carcinoma (MASC) of the salivary gland has been recently described according to morphological, immunohistochemical, and molecular (ETV6-NTRK3 translocation) similarities with the mammary secretory carcinoma. The most important differential diagnostic considerations of MASC are low-grade adenocarcinoma not otherwise specified (NOS), cystadenocarcinoma, and acinic cell carcinoma (AciCC). These tumors may share an overlapping morphology with MASC, and additional immunohistochemical studies are required to reinforce the diagnosis. Mammaglobin, GCDFP-15, and p63 staining have been reported in MASC. Our study was designed to check the specificity of these antibodies in MASC compared to other frequent tumors of salivary glands. METHODS A series of 62 salivary gland tumors [10 MASCs, 5 adenocarcinomas NOS and 2 cystadenocarcinomas with MASC features and without ETV6 rearrangement, one low-grade cribriform cystadenocarcinoma (LGCCC), 9 AciCCs, 10 MECs, 10 adenoid cystic carcinomas (AdeCCs), 5 polymorphous low-grade adenocarcinomas (PLGAs), and 10 pleomorphic adenomas (PAs)] was analyzed by immunohistochemistry with mammaglobin, GCDFP-15, and p63 antibodies. RESULTS Positivity for mammaglobin was observed in all MASCs, cystadenocarcinomas, LGCCC, and PLGAs, in some adenocarcinomas NOS, PAs, and MECs, rarely in AciCCs and never in AdeCCs. Positivity for GCDFP-15 was observed in most of the tumor types except in AdeCCs. Interestingly, cytoplasmic positivity for p63 was observed in most of MASCs and PLGAs while rarely in adenocarcinomas NOS and PAs, and never in the other tumor types. CONCLUSION Our study revealed the usefulness of mammaglobin and p63 cytoplasmic staining to define which tumors are worth to be screened for ETV6 rearrangement.