Moncef Sellami

Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience

INTRODUCTION The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy. OBJECTIVE The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results. METHODS This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated. RESULTS The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p=0.02, Odds-Ratio=2.35). CONCLUSION Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.

Parapharyngeal space pleomorphic adenoma: a case report

Parapharyngeal space masses account for 0.5% of all head and neck neoplasms. Pleomorphic adenoma arising from the epithelial rests of the salivary tissue in the parapharyngeal space is rare. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) allows a precise topographical localization of the mass and the diagnosis of its nature in the majority of cases. Treatment of parapharyngeal pleomorphic adenoma is primarily surgical excision. Tumor recurrence occur in less than 10% of patients. We report a case of a 37-year-old man presented with dysphagia and disturbed sleep during night since last 6 months. The intraoral examination found a bulging submucosal mass underneath the right oropharynx crossing the midline and pushing the uvula to left side. CT and MRI scan revealed a heterogeneously enhancing tumor in the right parapharyngeal space measuring 4.5×5×6.4 cm and causing luminal narrowing of oropharynx. The patient was operated through a transcervical approach to gain entry into parapharyngeal space without osteotomy of the mandible. The tumor was completely resected without rupture. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of a pleomorphic adenoma. At the 3 years follow-up the patient was free from disease.

Une polypose naso-sinusienne révélant une mucocèle du sinus maxillaire

La mucocele est une formation pseudo kystique benigne qui se developpe rarement au niveau du sinus maxillaire. La mucocele est secondaire a des situations diverses ayant en commun une inflammation et une obstruction de l’ostium du sinus. Cette derniere peut etre primitive mais souvent secondaire a un (traumatisme, tumeur, inflammation chronique). Le diagnostic repose sur l’imagerie. La tomodensitometrie est indispensable pour apprecier les modifications osseuses et planifier la chirurgie endonasale sous controle endoscopique et l’IRM permet de preciser les rapports de la mucocele. La prise en charge therapeutique de ces mucoceles doit dans un meme temps operatoire realiser une marsupialisation de la mucocele et traiter le facteur local en cause. Nous rapportons le cas d’un homme âge de 21 ans, sans antecedents pathologiques notables qui consultepour obstruction nasale bilaterale associee a une anosmie. L’examen clinique a trouve une douleur exquise de la paroi anterieure du sinus maxillaire, une polypose nasosinusienne bilaterale et une voussure au niveau du palais osseux. La tomodensitometrie du massif facial a permis de mettre en evidence une masse hypodense homogene bien limitee ne prenant pas le produit de contraste comblant tout le sinus maxillaire gauche associee a une lyse osseuse reguliere de ses parois associe a un comblement ethmoido-nasal bilateral. Le patient a ete opere par voie endonasale et a eu une ethoidectomie fonctionnelle associee a un abord du sinus maxillaire par meatotomie moyenne permettant la marsupialisation de la mucocele. Les suites operatoires etaient simples sans recidive.Mucocele is a benign pseudo-cyst formation that rarely develops in the maxillary sinus. Mucocele is secondary to various conditions having in common an inflammation and an obstruction of the sinus ostium. The latter may be primary but it is often secondary to a trauma, tumor, chronic inflammation. Diagnosis is based on imaging. CT scan is essential for assessing osseous changes and for planning endonasal surgery under endoscopic control. MRI allows to specify the relations of mucocele. Therapeutic management of these mucoceles should be based on mucocele marsupialization performed at the same time as the treatment of the local factor involved. We report the case of a 21-year old man with no pathological history presenting with bilateral nasal obstruction associated with anosmia. Clinical examination showed exquisite pain in the anterior maxillary sinus wall, bilateral nasal sinus polyposis and swelling at the level of the hard palate. CT scan of the facial skeleton showed a welldefined homogeneous hypodense mass with no enhancement, involving the entire left maxillary sinus associated with regular bone lysis of its walls and a bilateral opacification of ethmoid cells and nasal cavities. The patient underwent endonasal surgery and functional ethmoidectomy associated with intranasal middle meatus antrostomy allowing the marsupialization of the mucocele. The postoperative course was uneventful and not associated with recurrence.

Cystic lymphangioma in a 44-year-old woman

Cystic lymphangioma is a congenital malformation of the lymphatic system. This condition is usually observed among children and very rarely among adults. The aetiology in adults is likely dueto delayed proliferation of cell rests due to physical injury or infection. Clinically, cystic lymphangioma is asymptomatic in adults. Treatment is generally surgical, although other methods, such as aspiration, radiation and sclerotherapy have been used. We report a case of a 44-year-old woman presented with one-year history of slowly enlarging cervical swelling at the right side of the neck. The patient has no medical problems or history of trauma to the neck. Examination showed a 4 cm smooth, soft swelling of right supraclavicular fossa. Moreover, there was no erythema or tenderness on palpation. The general examination revealed normal findings. Computed tomography (CT) showed a supraclavicular cyst-like structure of 5×3×3 cm. The patient was operated through an external approach and a complete cyst excision was achieved without complications. Histopathological examination was consistent with the diagnosis of cystic lymphangioma. The patient made an uneventful recovery with no recurrence noted one year after the surgery.

Branchial cleft cyst: a case report

Brachial cleft cysts are rare congenital malformations of the lateral neck and typically present in the second and third decades of life. Many theories have been proposed to explain the aetiology of these cysts including incomplete obliteration of branchial mucosa, persistence of vestiges of the precervical sinus and cystic lymph node origin. Preoperative imaging investigations show a fluid-filled cyst and evaluate anatomic relationships. Differential diagnosis includes metastatic squamous cell carcinoma, lymphadenitis, lymphoma, cervical dermoid cyst, cystic hygroma and parotid pathology. Surgical excision is the treatment of choice and results in a good prognosis. We present the case of a 37-year-old woman referred to our department for assessment of a neck swelling that had gradually increased in size during the previous nine months. The clinical examination found a 6 cm non-tender mass of the upper-left neck. The MRI revealed a cystic lesion measuring 4×5×6 cm, displacing the sternocleidomastoid muscle posterolaterally, and the carotid and internal jugular vein medially. The mass was completely resected through a lateral cervicotomy. The histological examination revealed a cystic wall lined with stratified squamous epithelium consistent with the diagnosis of a branchial cleft cyst. The postoperative course was uneventful. Long-term follow-up has shown no evidence of recurrence.

Giant laryngeal polyp: an unusual indication of tracheostomy

Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.

Unusual presentation of an antrochoanal polyp: a case report

Antrochoanal polyps are benign lesions originating from the mucosa of the maxillary sinus and gradually prolapse through the medial wall of the maxillary sinus into the nasal cavity increasing in size to the choana and nasopharynx. Surgery is the usual treatment for antrochoanal polyps. We present the case of a 41-year-old woman who presented with a history of a progressive right nasal obstruction associated with a five-month history of sensation of a foreign body in the throat. Oral examination revealed a polypoid mass hanging from the nasopharynx into the oropharynx. Nasal endoscopy showed that the mass arose from the right middle meatus and extended into the nasal cavity and then into the nasopharynx. The computed tomography showed a complete opacification of the right maxillary sinus and a soft-tissue mass filling the low part of the right nasal cavity extended posteriorly through the right choana, filling up the nasopharynx and extending to the oropharynx. The polyp was removed under general anesthesia using a functional endoscopic sinus surgery and a large middle meatus antrostomy was performed. The patient made an uneventful post-operative recovery and was discharged home the following day. Histologic analysis confirmed that the mass was an antrochoanal polyp. The patient remained asymptomatic and disease-free at follow-up 12 months later.

Localized ENT Amyloidosis – Literature Overview

Amyloidoses from a group of disorders characterized by extracellular tissue accumulation of amorphous hyaline material. They are categorized in two main forms: systemic and localized (Zhuang YL, 2005). Localized forms involve a single organ, whereas systemic amyloidosis involves multiple organ systems. Localized forms often involve the head and neck. The aerodigestive tract is a common location, the nasopharynx or soft palate are rarely envaded (Panda NK, 2007) (Pitkaranta A, 2000). The distinction between localized and systemic disease is important because localized amyloidosis can be managed conservatively with an excellent prognosis, whereas systemic amyloidosis is associated with significant morbidity and mortality (Kyle RA, 1975). Although the pathogenesis is not completely understood, soluble protein subunits undergo a conformational change to become insoluble and aggregate in an antiparallel β-pleated sheet conformation (Panda NK, 2007). The diagnosis of amyloidosis is made based on Congo red staining on tissue biopsy which leads to apple-green birefringence on polarized microscopy (Patel A, 2002). Amyloidomas are benign tumorlike lesions consisting of localized deposits of amyloid and are the rarest form in the group of amyloidosis-related lesions (Parmar H, 2010). Amyloidosis should not be considered as a single clinical entity, but rather as a nonhomogeneous group of diseases characterized by the common presence of a fibrillar structure of linear, aggregated fibers with a cross β-pleated sheet conformation, and evidenced by x-ray diffraction. In primary amyloidosis, a monoclonal population of marrow cells produces either fragments of light chains that may be processed to form amyloid. Secondary amyloidosis is characterized by a defect in the metabolism of the precursor protein (Comenzo RL, 2006). Our objective is to study the epidemioloclinical characteristics of ENT amyloidosis and the management of those localizations.