[Infratemporal metastasis from a renal cell carcinoma]

INTRODUCTION

Kidney cancer, particularly clear cell carcinoma, has an unpredictable clinical course with a variable metastatic potential in time. Some metastatic sites are atypical, such as head and neck (6% of cases). We report an extremely rare case of clear cell renal carcinoma with a metastasis in the infratemporal fossa.

OBSERVATION

A 67 year old male patient, operated in 2007 for a Fuhrman grade I clear cell carcinoma of the left kidney (radical nephrectomy), consulted for swelling of the left temporo-zygomatic region. A local biopsy allowed diagnosing clear cell renal carcinoma metastases. The patient was inoperable and was treated by antiangiogenic drugs.

DISCUSSION

The recommended treatment is surgical exeresis when the metastasis is single and can be resected. Antiangiogenic therapy is an alternative in other cases.

[Invasive aspergillosis of the maxillary sinus in an immunocompetent patient]

INTRODUCTION

Invasive aspergillosis of the maxillary sinus is a severe infection most commonly observed in immunocompromised patients. We report a pseudo-tumoral presentation of invasive aspergillosis of the maxillary sinus, in immunocompetent adult.

CASE REPORT

A 70-year-old female patient consulted for chronic rhino-sinusitis resistant to medical treatment. Computed tomography scan revealed a hyperdense mass filling the left maxillary antrum, with erosion of sinus walls. The ethmoidal and right frontal sinuses were involved. The histological and mycological examination of the surgical resection confirmed the diagnosis of invasive aspergillosis. The patient was given voriconazole as first line treatment. The outcome was good at 18 months.

DISCUSSION

Invasive aspergillosis of the maxillary sinus is a rare disease, usually observed in immunodepressed patients. It is very rarely observed in immunocompetent patients.

[Plantar forefoot lipoma: an uncommon case report]

The plantar tumors of soft tissues are rare and are characterized by their slow and asymptomatic evolution, which delays their diagnosis. The authors report an exceptional case of plantar foot lipoma. The diagnosis was suspected by magnetic resonance imagery, which represents the technique of choice for the investigation of soft tissue tumors of the foot. The surgical treatment made the histological diagnosis and restored a normal and painless plantar support. The lipoma, in spite of its exceptional localization at the plantar level, will have to be evoked like differential diagnosis of the benign tumors of the foot.

Metallic foreign body in the sphenoid sinus after ballistic injury: a case report

Paranasal sinus injuries by foreign bodies have a lower incidence compared with facial injuries. Among them, penetrating maxillofacial injuries to the sphenoid sinus and skull base remain rare. We report the case of a 41-year-old man who presented with, after a missile-related maxillofacial injury, a metallic foreign body enclosed within the sphenoid sinus with carotid-canal fracture. Angiographic evaluation showed a mass in the right internal carotid artery. The foreign object was successfully extracted through a transmaxillary sublabial approach with a good outcome. We discuss the extensive preoperative evaluation and interdisciplinary management of this unusual injury.

Métastase maxillaire révélatrice d'un cancer de prostate

CASE

A 57 year-old-man presented with a maxillary tumor which proved to be an adenocarcinoma. The prostate was hard and PSA were high. Biopsy confirmed the diagnosis of metastatic prostatic adenocarcinoma. Evolution was fatal despite a medico-surgical treatment.

DISCUSSION

Facial bone metastases are rare comparatively to the high metastatic incidence in the rest of the skeleton.

[Ganglioneuroma of the zygoma]

INTRODUCTION

Ganglioneuroma is an uncommon benign tumor that arises from the sympathetic nervous system accounting for less than 1% of all soft-tissue neoplasms.

CASE REPORT

We report the case of a 22 year-old man who presented a ganglioneuroma localized in the zygoma.

DISCUSSION

Ganglioneuroma generally develop in the abdomen or thorax soft tissue. The occurrence of ganglioneuroma in the bone is exceptional. To date less than ten cases have been reported, six of which involved the mandible. We discuss the possible causes of tumor development at this site.

[Natal teeth: apropos of five cases]

INTRODUCTION

The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth.

MATERIAL AND METHODS

Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth.

RESULTS

We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue.

DISCUSSION

According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.

[Orbito-temporal plexiform neurofibroma: 6 cases]

INTRODUCTION

Orbito-temporal plexiform neurofibroma is characteristic of Von Recklinghausen neurofibromatosis. We report 6 cases of orbito-temporal plexiform neurofibromas and review different aspects of diagnosis, course and treatment.

PATIENTS AND METHODS

Six patients, 4 males and 2 females, with orbito-temporal plexiform neurofibromas were treated between 1986 and 2003. Patient age varied between 10 and 29 years (age average=19). Computed tomography and magnetic resonance imaging were performed in all 6 patients. Surgical resection of the neurofibroma was performed in all patients.

RESULTS

The tumor was located on the left in 5 cases and on the right in one. Spheno-orbital dysplasia was found in all patients and was associated with fronto-temporal meningoencephalocele and pulsate exophthalmia. Surgical resection enabled reduction of the neurofibroma. Exenteration was performed in all patients because of a nonfunctional eye. Two patients underwent cure of fronto-temporal meningoencephalocelus with reconstruction of the large wing of the sphenoid using an iliac bone graft and a titanium plate.

DISCUSSION

Surgery is essential for orbito-temporal plexiform neurofibroma but is usually difficult, particularly when the tumor has developed increasing the risk of hemorrhage. Bony reconstruction is difficult considering the risk of progressive osseous dysplasia. The cosmetic results achieved in this patient were considered good.

Orbitotomie latérale par voie palpébrale supérieure

Lateral orbital approach by eyelid crease incision constitutes a good way to the lateral sectors of the orbit allowing a good exposure, an invisible scar and light postoperative course. It constitutes a good alternative to the supero-lateral approach which certainly, offers a good view but the heaviness of the postoperative course gives to the lateral orbitotomy all its interest. By a review of the literature, we try to report the advantages and the indications of this approach.