K. Bouzouita

Papillary carcinoma arising in a thyroglossal duct cyst: case report and discussion of management modalities

A case of papillary carcinoma arising in the wall of a thyroglossal duct cyst is described. These cancers are very rare and rather adult-specific. Preoperative diagnosis may be enhanced using fine-needle aspiration cytology and computing tomography findings. The standard treatment of thyroglossal duct cyst carcinoma is the sistrunk procedure. The concept of prognostic risk groups should be used to identify patients who would additionally undergo total thyroidectomy.

Les lymphomes T des fosses nasales et des sinus

INTRODUCTION Extra-nodal T lymphomas of the ear, nose, and throat (ENT) are unusual in Western countries, with differential diagnosis from other destructive and necrotizing lesions of the sino-nasal tract often difficult. MATERIAL AND METHODS Eleven cases of extra-nodal lymphomas of the upper aerodigestive tract tract managed in the ENT department of F. Hached hospital in Sousse, Tunisia, were retrieved over a 10-year period (1995-2004). The aim of our study was to report the clinical and pathological data and the outcome for each patient. RESULTS The median age of patients was 41-years. The most frequent site of involvement was the nasal cavity. Clinically, the symptoms were not specific. Histological examination identified two cases of T/NK lymphoma and nine cases of T-lymphoma not otherwise specified. Immunohistochemistry and in situ hybridization techniques positively detected Epstein-Barr virus in tumoral cells, in seven cases. Tumor staging, in 10 patients, found distant metastasis in three. Nine patients underwent the following treatment: exclusive radiotherapy (one patient), radiochemotherapy (three patients), and exclusive polychemotherapy (five patients). The two remaining patients had no treatment because of a rapidly unfavorable progression. After a median follow-up of 11-months, clinical outcome consisted in death in seven patients and remission in three patients; one patient was lost of follow-up. CONCLUSION Extra-nodal lymphomas of the ORL tract are rare in Tunisia. Clinical presentation is not specific, depending on the lymphoma location. Diagnosis relies on clinical presentation and immunophenotypic and molecular characteristics; morphological features are not specific. These are aggressive lymphomas, often requiring multidisciplinary management.

Lymphomes T/NK du nasopharynx

OBJECTIVE: Discussion of the clinical and paraclinical features of a rare tumor in the nasopharynx, the NK/T-cell lymphoma, with an emphasis on the implications of Epstein Barr Virus (EBV) in its pathogenesis and prognosis. CASES REPORT: We report the cases of a woman and a man aged 34 and 48, respectively. Clinical presentation was non-specific and diagnosis was established with deep biopsies under general anesthesia. Immunochemistry and in situ hybridization were positive for Epstein Barr virus in tumor cells in both cases. The patients were first treated with chemotherapy (CHOP regimen), then underwent radiotherapy. The first patient achieved complete response at twenty months follow-up. The second patient presented two recurrences which were treated by chemotherapy. He died from acute renal failure during treatment of the second recurrence. CONCLUSION: Diagnosis of NK/T-cell lymphoma may be delayed in the event of non-specific symptoms. Deep biopsies outside necrotic tissue must be obtained. Search for EBV is important as its presence is a factor of poor prognosis.

Rosai-Dorfman disease of the nasal cavities: A CO(2) laser excision.

Background Rosai-Dorfman disease (RDD) is a rare nonneoplastic histiocytic proliferative disorder characterized by painless massive lymphadenopathy. Extranodal manifestations frequently occur in the head and neck area. Methods We report the clinical and histological features of nasal cavities and cervical lymph node RDD in a 72-year-old woman, who complained of major nasal obstruction and hyposmia. Results Nasal endoscopy revealed polypoid masses arising from the turbinates; the septum was intact. Immunohistochemical analysis revealed staining for S-100 protein, CD68, and alpha-1 antitrypsin. The presence of the Epstein-Barr virus was revealed by serology and also by in situ hybridization. The general examination and systemic evaluation did not find other extranodal localization. Conclusions Because the disease is known for not responding to local or systemic steroids, CO2 laser excision was used to clear the nasal obstruction with a satisfactory result. This is, to the best of our knowledge, the first description of the use of laser excision for nasal cavities RDD.

Tumeur carcinoïde du larynx

OBJECTIVE Carcinoid tumors are among the exceptional neoplasms of the larynx. The literature is reviewed and the problems with diagnosis and management of this rare tumor are discussed. METHODS The authors report a case of a carcinoid tumor of the larynx. RESULTS This paper describes the case of a well-differentiated carcinoid tumor of the aryepiglottic fold in a 59-year-old woman who presented with hoarseness lasting eight months. After surgical excision, the patient developed recurrence of the disease 14 years later. CONCLUSION Carcinoid tumors require accurate diagnosis because of their varied clinical behavior and prognosis. The typical carcinoid treatment of choice is conservative surgery.

Kyste parotidien rétentionnel révélateur d’un carcinome mucoépidermoïde

OBJECTIVES To describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid retention cyst. PATIENT AND METHODS A 21-year-old woman presented with a 5-cm cystic swelling in her left parotid region. Ultrasound examination and a computerized tomography scan showed a clearly outlined parotid cyst. Through a conventional parotidectomy incision, the cyst was excised with parotid gland tissue around the lesion. The patient had an uncomplicated recovery. RESULTS Histopathological examination of the resected parotidectomy material showed a parotid retention cyst and a mucoepidermoid carcinoma measuring 5mm in diameter. CONCLUSION Among acquired cysts of the parotid gland, retention cysts are the most frequent. They may be the presenting symptom in patients with occult cancer of the parotid. In this case report, a mucoepidermoid carcinoma played a significant role in the obstruction of a salivary gland duct and caused a parotid retention cyst. Thus, a wide excision of the parotid retention cyst is necessary, as is a careful review of the histology searching for malignant lesion.

Prise en charge de l’hyperparathyroïdie secondaire. Étude rétrospective à propos de 31 observations

cas et une hyperplasie triple dans un cas. Une normalisation d s chiffres de la parathormone était obtenue dans tous les cas. Le recul moyen était de sept ans. Conclusion.— L’échec de la chirurgie parathyroïdienne est rare. Il est essentiellement dû à la méconnaissance d’un adénome ectopique ou une résection insuffisante du tissu hyperplasique. Le couple scintigraphie MIBI-échographie est le plus performant dans le diagnostic de localisation préopératoire.

Les lithiases de la glande submandibulaire. À propos de 50 observations

But de la présentation.— Préciser les caractéristiques cliniques, paracliniques des tumeurs des glandes salivaires ainsi que les résultats du traitement chirurgical. Patients et méthodes.— Deux cent huit cas de tumeurs des glandes salivaires opérés et suivis sur une période de 19 ans de 1994 à 2012. Résultats.— Notre population comporte 208 patients (104 hommes et 104 femmes), d’âge moyen de 42 ans. La localisation parotidienne est la plus fréquente, retrouvée dans 88,5 % des cas, la localisation submandibulaire a été notée dans 7,7 % des cas et au niveau des glandes salivaires accessoires dans 3,8 % des cas. Les tumeurs bénignes représentent 89,9 % des cas, histologiquement dominées par l’adénome pléomorphe (52 %). Les tumeurs malignes (10,1 %) sont dominées par les carcinomes. Le traitement est chirurgical dans tous les cas, complété par une radiothérapie pour les tumeurs malignes. Une chimiothérapie a été préconisée dans deux cas. Des récidives sont survenues dans deux cas d’adénome pléomorphe et chez trois patients porteurs de carcinome. Tous les patients ont été repris chirurgicalement. Le taux de survie est de 99 % à cinq ans pour les tumeurs malignes. Conclusion.— Les tumeurs des glandes salivaires sont peu fréquentes, dominées par la localisation parotidienne (90 %) et sont, dans la majorité des cas, en rapport avec un adénome pléomorphe. Les tumeurs malignes restent rares et représentent 1 à 3 % de l’ensemble des cancers cervicofaciaux. L’IRM et la cytoponction sont d’un apport considérable dans la démarche diagnostique ainsi que dans l’attitude thérapeutique.

Les lymphomes de l’anneau de Waldeyer traitement et pronostic

Les lymphomes non Hodgkiniens (LNH) qui prennent naissance au niveau de l’anneau de Waldeyer constituent une entite bien particuliere tant sur le plan clinique, therapeutique que pronostique. Les auteurs rapportent une etude retrospective de 44 observations de LNH de l’anneau de Waldeyer colligees entre 1995 et 2002. Une chimiotherapie exclusive a ete indiquee chez 80,6% des malades et une association chimio-radiotherapie a ete realisee chez 19,4%. Le taux de survie globale etait de 42% a 5 ans. Dans notre etude quatre facteurs de mauvais pronostic ont ete individualises : un âge ≥ a 40 ans, les stades d’Ann Arbor II, III et IV, un taux de LDH ≥ 1,5 fois la normale et la survenue de rechute. Mots-cles : Lymphome, anneau de Waldeyer, chimiotherapie, radiotherapie, pronostic

Cas cliniqueKyste parotidien rétentionnel révélateur d’un carcinome mucoépidermoïdeParotid retention cyst revealing a mucoepidermoid carcinoma

OBJECTIVES To describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid retention cyst. PATIENT AND METHODS A 21-year-old woman presented with a 5-cm cystic swelling in her left parotid region. Ultrasound examination and a computerized tomography scan showed a clearly outlined parotid cyst. Through a conventional parotidectomy incision, the cyst was excised with parotid gland tissue around the lesion. The patient had an uncomplicated recovery. RESULTS Histopathological examination of the resected parotidectomy material showed a parotid retention cyst and a mucoepidermoid carcinoma measuring 5mm in diameter. CONCLUSION Among acquired cysts of the parotid gland, retention cysts are the most frequent. They may be the presenting symptom in patients with occult cancer of the parotid. In this case report, a mucoepidermoid carcinoma played a significant role in the obstruction of a salivary gland duct and caused a parotid retention cyst. Thus, a wide excision of the parotid retention cyst is necessary, as is a careful review of the histology searching for malignant lesion.