Nasolacrimal duct oncocytoma: an unusual cause of chronic epiphora

Epiphora has traditionally fallen under the purview of ophthalmologists. However, owing to the development of endoscopic dacryocystorhinostomy, this condition has been increasingly observed in otolaryngologic practice. We report the case of a woman with a 4-month history of right epiphora and dacryocystitis. Nasal endoscopy revealed the presence of a tumor at the inferior meatus. Histopathologic examination of a biopsy specimen identified the tumor as an oncocytoma. Surgical excision via a lateral rhinotomy approach was performed. At 3 years postoperatively, the patient was disease-free. Lacrimal sac and nasolacrimal duct tumors are rare, but they should be considered as a possible etiology in patients with acquired epiphora because most of these tumors are malignant.

[CT scan, MR imaging and anatomopathologic correlation in the glottic carcinoma T1-T2]

OBJECTIVES

Endoscopy and imaging are necessary to diagnose glottis carcinoma. Today, CT scan is the gold standard but MR imaging should be more sensitive for neoplastic invasion detection. The purpose of this study was to determine which exam to perform (CT scan or MRI) for neoplastic invasion.

MATERIAL AND METHODS

This prospective study span a 18 months period. Seven patients with glottis carcinoma (TI-T2) underwent CT and MR imaging before surgery. Findings at imaging and pathologic examination were compared.

RESULTS

Both CT and MR imaging were interesting, more specific (90%) than sensitive (74%). The anterior commissure, ventricles, subglottis, thyroid and arytenoid cartilages are the more difficult area analyzing.

CONCLUSION

CT imaging stays the gold standard. MR imaging is more effective on second intention to refine the data. Indications are being improved, with complete cure and more preserved laryngealfunctions.

Vagal paraganglioma of the neck: a case report

Vagal paragangliomas are rare in the head and neck. Complementary use of computed tomography and magnetic resonance imaging can facilitate the diagnosis and help determine the best management approach. Most paragangliomas should be treated with surgery. We report a case of vagal paraganglioma of the neck in a 50-year-old man. The patient was treated with superficial parotidectomy via a transcervical approach. No postoperative morbidity was noted, and at 3 years of follow-up, he was free of disease.

Primary cancer of the sphenoid sinus--a GETTEC study

BACKGROUND

Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable.

METHODS

A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival.

RESULTS

Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases.

CONCLUSION

Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.

Prognostic value of the expression of tumor necrosis factor-alpha (TNFa) and its receptors in head and neck cancer (HNC) patients: A pilot study

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Background: TNFa was initially described as an inductor of apoptosis in cancer cells. In vitro data showed that TNFa can also activate anti-apoptotic signaling in cancer cells. We analyzed the prognostic value of the expression of TNFa and its receptors TNFR1 and TNFR2 in HNC patients. Methods: Twenty-four patients treated for HNC were retrospectively analyzed for TNFa, TNFR1, and TNFR2 expression by real-time PCR (RT-PCR). Tissue samples were collected at the time of initial diagnosis. Total RNA was reverse-transcribed with TaqMan quantitative RT-PCR (Applied Biosystems). Results were recorded as average threshold cycle, and relative expression was determined using Normalized Expressions method. Expression of TNFa, TNFR1, and TNFR2 was related to survival after 3 years of follow-up. Results: In the 24 patients, expression of TNFa (mean value 7.8, median 2.4, range 0.02–62.3), TNFR1 (mean value 58, median 49, range 0.02–246.9) and TNFR2 (mean value 4.8, median 3.3, range 0.8–18.9) demonstrated a great variability between patients. After a 3-year follow-up, 14 patients were alive without evolution of cancer (group A) and 10 were dead because of cancer evolution (group D). In group D, median level of TNFa was 8.8 whereas it was 1.1 in group A (p = 0.02). Median level of TNFR1 was 71.8 in group D and 28.5 in group A (p = 0.01). In contrast, median level of TNFR2 was 3.3 for both groups. Patients with high level of TNFa or TNFR1 expression had a worse survival (p = 0.01 and p = 0.009, respectively). There was also a strong correlation between high expression of TNFa and of TNFR1 (p = 0.0007). Conclusions: In this small series, TNFa and TNFR1 expression seem to have significant prognostic value to predict survival of HNC patients. This result needs to be confirmed in larger series and compared with usual prognostic factor. It suggests that TNFa expression could have a dual effect in HNC and that TNFR1 expression may play a role in this process.

No significant financial relationships to disclose.

Silent sinus syndrome with spontaneous orbital floor reconstruction

PROBLEM

Silent sinus syndrome is rare and its pathophysiology is unclear. We report a case of silent sinus syndrome characterized by progressive enophtalmos with chronic maxillary atelectasis and asymptomatic chronic maxillary sinusitis.

METHODOLOGY

The patient had no history of sinusitis, facial trauma, or sinus surgery. Computed tomography revealed opacification of the right maxillary sinus and inferior bowing of the osteopenic orbital floor. Silent sinus syndrome was diagnosed and functional endoscopic maxillary antrostomy without orbital floor reconstruction was performed.

RESULTS

At one-year follow-up, computed tomography showed optimal ventilation of the maxillary sinus, restoration of the orbital floor, and withdrawal of the orbital content to its normal position.

CONCLUSION

Endoscopic maxillary antrostomy without orbital floor reconstruction is effective and associated with limited risks for complications; however, the results are observed in the long term.

Rhinoscleroma of the sinuses

INTRODUCTION

Rhinoscleroma is a rare chronic, granulomatous disease of the respiratory tract.

OBJECTIVE

The aim of this paper was to report 2 unusual cases of rhinoscleroma and to review the literature.

MATERIAL

We present two cases of sinus rhinoscleroma diagnosed and treated at the ENT Department of a French University hospital.

RESULTS AND CONCLUSION

Rhinoscleroma primarily affects the nasal cavity but the nasopharynx (18%-43%), larynx (15%-40%), trachea (12%) and bronchi (2% to 7%) can also be involved. However, the paranasal sinuses are usually free of disease. Rhinological signs are generally the first reported by patients. CT scan and MRI are useful for diagnosis. Diagnosis of rhinoscleroma was based on histological characteristics and presence of Klebsiella rhinoscleromatis on biopsy cultures. In most cases treatment involves prolonged antibiotic therapy with aesthetic surgical reconstruction when necessary. However, rhinoscleroma is difficult to eradicate and its recurrence rate is high.

Unusual presentation of oropharyngeal Kaposi's sarcoma

BACKGROUND

The aim of this article is to focus ear, nose, and throat (ENT) practitioners on a pathology rarely seen within the head and neck mucosa.

METHODS

A 62-year-old black African man was referred to our ENT department for dysphagia and hoarseness. Physical ENT examination revealed a smooth normal mucosal mass on the left lateral pharyngeal wall, which masked the inlet of the larynx, and bilateral cervical lymph nodes but no other mucosal lesions. Anti-human immunodeficiency virus antibodies were found to be negative. Hemoglobin, hematocrit, white blood cell count, and platelet count were normal. Serum protein electrophoresis was also normal. A CT scan confirmed the lesion and lymph node involvement. Treatment consisted of a transoral endoscopic resection with ligature of the pedicle, with the patient under general anesthesia. The patient's improved medical condition permitted 11 cycles of bleomycin (15 mg/3 weeks).

RESULTS

A 5-month fibroscopic follow-up control showed no recurrence, and total clinical regression was observed after 1 year. Three years later, all ENT lesions had disappeared, with no adenopathy or mucosal lesions.

CONCLUSION

Kaposi's sarcoma is a pathology that the ENT practitioner must keep in mind when patients present with a laryngopharyngeal mass. The symptomatic cases were all surgically treated; however, death subsequently occurred.

Quality of life in head and neck cancers patients: predictive factors, functional and psychosocial outcome

The principal endpoints in head and neck cancer are survival with improvement of quality of life (QoL) in cancer patients. Patients treated for head and neck cancer suffer from a number of symptom domains: physical symptoms linked to diet and feeding, communication disorders, pain and their general state of health; psychological symptoms including depression, irritability, loss of self-esteem (occasionally feelings of shame), and social symptoms including relationship difficulties with partner (sexual disorders) or with other family members, loss of work, reduction in salary, and sense of uselessness, resulting in a negative impact on their daily life. At present, most tools only partially evaluate patient QoL, concentrating on the global impact of disease and its treatment on patients' physical and psychological condition. The "sociability" of individual patients is rarely evaluated, and the development of qualitative studies in this domain will enable improved understanding of the social factors involved in each patient's adaptability to disease, its treatment and after-effects.

Les tumeurs malignes primitives des voies lacrymales

OBJECTIVES

To assess the clinical characteristics, the workup, therapeutic approach and pathological findings of primitive tumors of the lacrimal sac.

MATERIAL AND METHODS

Three cases were retrospectively reviewed from the database of our ENT department. They were analyzed and compared to cases reported in the literature.

RESULTS

One adenoid cystic carcinoma and two adenocarcinomas were observed, all were adults and the sex ratio was one man for 2 women. Clinically they presented neither significant lacrimal or rhinologic sign. A CT-scan and a MRI were performed along with a physical examination. An entire surgical resection was done with subsequent postoperative radiotherapy. Two patients died, and one is alive, free of disease.

CONCLUSION

Lacrimal tumors should be considered in the differential diagnosis of a banal chronic epiphora. The ENT practitioner must associate this factor to any clinical evaluation. The management of these lesions requires a complete surgical resection, routinely associated with postoperative radiation.

Squamous cell carcinoma of the nasal columella: a retrospective study of 66 cases from the GETTEC

Squamous cell carcinoma of the nasal columella (SCCNC) is a rare disease. We aimed to define a strategy for the diagnosis and management of nasal columella squamous cell carcinoma. Medical records of 66 patients presenting with columella squamous cell carcinoma in nine French hospitals, from 1980 to 2003, were evaluated to determine the clinical characteristics and current treatment of the disease. Mean age was 69 years. The sex ratio was one female for three males. Majority of the lesions were T1 N0 according to the classification international union against cancer. Patients underwent one of the three treatments: surgery alone for the T1 lesions, radiotherapy for tumors of T2-T3 and combined (surgery and radiotherapy) for T4 lesions. The 5-year Kaplan-Meier survival test was 39% and no difference was found between the therapeutic groups. Thirty-five (53%) tumor recurrences were observed with a median time of 43 months. As regards TNM classification and treatment, no significant difference between the two groups disease free/recurrence was found. Prognosis of early lesions was considered better than the advanced lesions. SCCNC is difficult to manage and has a poor prognosis. No therapeutic solution has yet been confirmed in the treatment of this pathology.

[Acute mesenteric ischemia and rhinopharyngeal carcinoma]

This work is a part of a pharmacovigilancy survey.

OBJECTIVES

To determine the links between radiation therapy, chemotherapy, nasopharyngeal carcinoma and mesenteric ischemia.

MATERIAL AND METHODS

A case of 69 year old man with a nasopharyngeal carcinoma, treated by radiation therapy and chemotherapy, who developed a lethal mesenteric ischemia is described. Etiology of mesenteric ischemia was unknown. A review of literature had been made on Pubmed with terms: "Mesenteric ischemia" and cisplatin, 5-FU or fluorouracil, radiation therapy, cancer or neoplasm, "head and neck cancer" or "carcinoma of the nasopharynx.

RESULTS

In our case, the origin of the mesenteric ischemia is not atheromatous. Chimiotherapy with 5-fluorouracile and cisplatine, radiation therapy and morphine were suspected. According to literature, responsibility of morphine and radiation therapy is uncertain. In opposition, the 5-FU and the cisplatine can be incriminated.

CONCLUSION

Mesenteric ischemia is an uncommon adverse effect of a treatment with cisplatin and 5-FU. It's the second case of mesenteric ischemia associated with a treatment with 5-FU and cisplatin in a patient with a nasopharyngeal carcinoma. ENT physicians must be aware of this complication.

[Adenocarcinoma of the ethmoid sinuses: results of a retrospective study in Rouen]

Ethmoid adenocarcinoma is a rare tumour of the ethmoidal sinuses. The authors report on the clinical features, treatment and follow-up results in 19 cases. Risk factors were those regularly encountered. Delay to diagnosis was long due to the nonspecific clinical features and course. Nasal endoscopy was essential for follow-up. Computed tomography and magnetic resonance imaging were also required to assess tumour spread. Our results suggest that radiotherapy following surgery should be preferred. Survival rate is generally low for this type of tumor. We had 77% survival at 5 years.

Infiltrating lipoma of the head and neck: a report of one pediatric case

Infiltrating lipomas are rare benign tumors. Several cases have previously been reported in the oral cavity but only three cases have been reported to date in children. We report a case of a 7-year-old child with an infiltrating lipoma of the neck and a posterior extension to the fourth and fifth cervical roots and the vertebral artery. The absence of any neurological signs, negative clinical and radiological examination results, as well as, the surgical risk of total removal and high rate of recurrence suggested a period of watchful waiting. After 5 years, the patient's clinical and radiological characteristics remain stable. A review of the literature regarding this pathology in the head and neck area, in both children and adults is also presented.