Ethmoid tumor and oncogenic osteomalacia: Case report and review of the literature

INTRODUCTION

Oncogenic osteomalacia is a very rare disease usually caused by a phosphaturic mesenchymal tumor, particularly the "mixed connective tissue type", secreting FGF-23 hormone.

OBJECTIVE

The authors report a case of ethmoid tumor associated with oncogenic osteomalacia and discuss management based on a review of the literature.

CASE SUMMARY

A 41-year-old woman with multiple fractures causing major disability was diagnosed with early-onset osteoporosis. CT scan followed by MRI, performed due to the concomitant presence of nasal obstruction, showed a right ethmoid tumor in contact with the dura mater and periorbital tissues, but with no signs of invasion. Endoscopic resection was performed with reconstruction of the defect of the cribriform plate by a nasoseptal flap. Nasal and bone symptoms subsequently resolved. Histological examination revealed a phosphaturic mesenchymal tumor.

DISCUSSION

Twelve cases of mesenchymal tumor of the ethmoid sinus associated with oncogenic osteomalacia have been reported to date. FGF-23 assay and whole-body MRI with STIR sequence are useful for the diagnosis. A very favorable outcome is observed after surgical treatment in the majority of cases.

Sentinel lymph node biopsy in cutaneous head and neck melanoma

PURPOSE

Sentinel lymph node biopsy (SLNB) is now a standard of care for cutaneous melanoma, but it is still controversial for cutaneous head and neck melanoma (CHNM). This study aims to confirm the feasibility, accuracy and low morbidity of SLNB in CHNM and evaluate its prognostic value.

METHODS

A monocentric and retrospective study on patients with CHNM treated in our tertiary care center (Gustave Roussy) between January 2008 and December 2012 was performed. The feasibility, morbidity and prognostic value of this technique were analysed.

RESULTS

One hundred and twenty-four consecutive patients were included. SLNB was realized in 97.6% of the cases. No significant post-operative morbidity was observed. Nineteen percents of patients had a positive SN while only 14.3% of complete lymph node dissections (CLND) had additional nodal metastasis. The risk of recurrence after positive SN was significantly higher (69.2 vs 30.8%, p = 0.043). The false omission rate was low with 7.1%. Overall survival and disease-free survival were better in the negative SN group (82 vs 49%, p < 0.001 and 69.3 vs 41.8%, p = 0.0131). The risk of recurrence was significantly higher in the positive SN group (p = 0.043) and when primary tumour was ulcerated (p = 0.031). Only the mitotic rate of the primary tumour was associated with SN positivity (p = 0.049).

CONCLUSION

As in other sites, SLNB status is a strong prognostic factor with comparable false omission rate and no superior morbidity.

Association of Krouse Classification for Sinonasal Inverted Papilloma With Recurrence: A Systematic Review and Meta-analysis

Importance

The risk factors for the recurrence of sinonasal inverted papilloma are still unclear.

Objective

To investigate the potential association between the Krouse classification and the recurrence rates of sinonasal inverted papilloma.

Data Sources

The EMBASE and MEDLINE databases were searched for the period January 1, 1964, through September 30, 2016, using the following search strategy: (paranasal sinuses [Medical Subject Headings (MeSH) terms] OR sinonasal [all fields]) AND (inverted papilloma [MeSH terms] OR (inverted [all fields] AND papilloma [all fields]).

Study Selection

The inclusion criteria were (1) studies including sinonasal inverted papilloma only and no other forms of papillomas, such as oncocytic papilloma; (2) minimum follow-up of 1 year after the surgery; and (3) clear report of cases (recurrence) and controls according to the Krouse classification system or deducible from the full-text article. Literature search was performed by 2 reviewers. Of the 625 articles retrieved in the literature, 97 full-text articles were reviewed. Observational cohort studies or randomized controlled trials were included, and the following variables were extracted from full-text articles: authors of the study, publication year, follow-up data, and number of cases (recurrence) and controls (no recurrence) in each of the 4 stages of the Krouse classification system.

Data Extraction and Synthesis

The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Odds ratios (ORs) and 95% CIs were estimated, and data of included studies were pooled using a random-effects model.

Main Outcomes and Measures

The main outcome was recurrence after surgical removal of sinonasal inverted papilloma according to each stage of the Krouse classification system.

Results

Thirteen studies comprising 1787 patients were analyzed. A significant increased risk of recurrence (51%) was highlighted for Krouse stage T3 disease when compared with stage T2 (pooled OR, 1.51; 95% CI, 1.09-2.09). No significant difference in risk of recurrence was found between Krouse stages T1 and T2 disease (pooled OR, 1.14; 95% CI, 0.63-2.04) or between stages T3 and T4 (pooled OR, 1.27; 95% CI, 0.72-2.26).

Conclusions and Relevance

Inverted papillomas classified as stage T3 according to the Krouse classification system presented a 51% higher likelihood of recurrence. Head and neck surgeons must be aware of this higher likelihood of recurrence when planning and performing surgery for sinonasal inverted papilloma.

Plasma Cell Granuloma of the Jaw and the Infratemporal Fossa: A Clinical Case

Plasma cell granuloma or inflammatory pseudotumor (IPT) is diagnosed by a process of elimination. The precise etiology is unknown, although it can occur after a bout of periodontal infection. This report describes the various stages of progression for this ailment. A 49-year-old woman with no noteworthy medical history presented with a recurrent periodontal abscess accompanied by progressive and severe destruction of the right maxilla. There was invasion of the infratemporal fossa and very tight trismus. Histologic examination indicated a reactive plasma cell granuloma. IPT is an entity recognized by the World Health Organization. A triggering infectious or inflammatory factor is often present. In the maxilla, progression is very aggressive. Treatment relies on corticotherapy, with or without radiotherapy, and administration of cyclosporine.

Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi

The latest generation Da Vinci^® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci^® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci^® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.

Management of orbital invasion in sinonasal malignancies

BACKGROUND

Indications for preservation of orbital contents in case of malignant sinonasal tumors invading the orbit remain controversial.

METHODS

A retrospective consecutive review was conducted of patients in a tertiary care center over a 15-year period.

RESULTS

Ninety-three patients were diagnosed with a malignant tumor invading the orbit. Eighty-three were treated with curative intent of which 58 underwent surgery. Mean follow-up was 45 months. Orbital preservation was feasible in 66% of cases, whereas orbital clearance was performed in cases of locally advanced disease (invasion of extraocular muscles, ocular globe, or orbital apex). Local control rate was 70% for patients treated with orbital clearance and 74% for those with orbital preservation, with no statistical difference. Five-year survival and 5-year relapse-free survival were similar in both groups.

CONCLUSION

Using our strategy, the eye can be spared in more patients than what is currently proposed, without oncologic or survival disadvantages. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

[Recurrent syncope in head and neck cancer: a case report]

The repeated syncopes in case of head and neck cancer are a complication rarely described in the literature. They occur when the tumor invade the carotid sinus or the afferent fibers of the glossopharyngeal nerve. We report the case of a 62-year-old man presented episodes of syncope synchronous of a recurrent hypopharyngeal tumor scheduled for chemotherapy and gastrostomy. A computerized tomography showed a voluminous tumor expanded to the carotid and parapharyngeal spaces. After treatment by isporenaline chlorhydrate in intensive care unit, a pacemaker was implanted to prevent syncopes and allowed the beginning of the chemotherapy.

[Management of patients with melanoma]

Management of patients with metastatic melanoma has been revolutionized over the last few years with targeted anti-BRAF therapies for BRAF-mutant melanomas (in about 50% of the cases) and immunotherapy with anti-CTLA-4. Several new drugs are now authorized and available. Because of their new mechanisms of action, they also have new adverse events and guidelines concerning their safety are of critical importance. New innovative strategies using combination of targeted therapies and immunotherapies with anti-PD-1 are in accelerated development. The quality of patient-physician relationship is central to this promising but complex new paradigm of treatment.

[Larynx cancer]

Closely linked to heavy smoking, larynx cancer is more common in men but its occurrence is rising in line with the increase in the number of women smokers. France is one of the most affected countries in Europe with 3,735 new cases in 2005. In terms of treatment, new endoscopic surgical techniques or radiotherapy are suitable for treating the disease in its early stages. For advanced stages, some patients may benefit from a larynx preserving approach based on chemotherapy and radiotherapy. Otherwise, a total laryngectomy is necessary.

PROKR2 and PROK2 mutations cause isolated congenital anosmia without gonadotropic deficiency

OBJECTIVE

Isolated congenital anosmia (ICA) is a rare phenotype defined as absent recall of any olfactory sensations since birth and the absence of any disease known to cause anosmia. Although most cases of ICA are sporadic, reports of familial cases suggest a genetic cause. ICA due to olfactory bulb agenesis and associated to hypogonadotropic hypogonadism defines Kallmann syndrome (KS), in which several gene defects have been described. In KS families, the phenotype may be restricted to ICA. We therefore hypothesized that mutations in KS genes cause ICA in patients, even in the absence of family history of reproduction disorders.

DESIGN AND METHODS

In 25 patients with ICA and olfactory bulb agenesis, a detailed phenotype analysis was conducted and the coding sequences of KAL1, FGFR1, FGF8, PROKR2, and PROK2 were sequenced.

RESULTS

Three PROKR2 mutations previously described in KS and one new PROK2 mutation were found. Investigation of the families showed incomplete penetrance of these mutations.

CONCLUSIONS

This study is the first to report genetic causes of ICA and indicates that KS genes must be screened in patients with ICA. It also confirms the considerable complexity of GNRH neuron development in humans.

Inverted papilloma of the middle ear

INTRODUCTION

Inverted papilloma (IP) of the middle ear is a very rare lesion, as less than 20 cases have been reported in the literature.

CASE REPORT

The authors report the case of a 73-year-old male with IP of the middle and external ear that had already been operated many times. Treatment consisted of creating a large resection cavity. No recurrence was observed on clinical examination or MRI with a follow-up of 2 years.

DISCUSSION AND CONCLUSION

This case is analysed in the light of a review of published cases with a discussion of the pathophysiological and treatment problems raised by these lesions.

Sinus mucocele: natural history and long-term recurrence rate

OBJECTIVE

To define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele.

PATIENTS AND METHOD

Retrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded.

RESULTS

The mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years.

CONCLUSION

This study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.

Acute pulmonary embolism: a current surgical approach

Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. Thrombolysis and catheter embolectomy have recently shown various degrees of failure and adverse effect. Surgical embolectomy has now been liberalised for haemodynamic stable patients with right ventricular dysfunction. We report our surgical experience in the last ten years including massive and sub-massive pulmonary embolism. A retrospective review of charts of all patients undergoing pulmonary embolectomy at our institution over the last ten years was performed. Patients were followed up until December 2005, end point of our study. Between March 1995 and December 2005, 21 patients underwent pulmonary embolectomy. Fourteen patients had a massive pulmonary embolism and were in cardiogenic shock (group A). Seven patients had a sub-massive embolism and were haemodynamically stable with right ventricular dysfunction (group B). In group A, 43% of patients survived and were discharged from the hospital. In group B, all the patients survived and were discharged from the hospital. After a follow-up of 57+/-12 months no late death linked to pulmonary embolism was observed. Our approach by initial surgical embolectomy improved outcome in sub-massive PE. Rescue embolectomy for very compromised patients remains a current treatment for massive PE. Furthermore, surgical embolectomy in haemodynamically stable patients is an immediate and definitive treatment for PE, with excellent long-term results. Keeping in mind that thrombolysis and catheter embolectomy have varying degrees of failure and risk, we propose surgical embolectomy in (sub)massive pulmonary embolism as an alternative procedure, or even as a primary treatment.