[Nasal involvement in Crohn's disease: report of a case and diagnostic difficulties of systemic diseases affecting the nose]

The authors describe the case of a 32 years old man with Crohn's disease who has developped sinonasal and tracheal localizations. The review of the literature, quite poor, allows to find some cases of nasal involvement in Crohn's disease and few associations between this illness and others systemic diseases as Wegener's disease or relapsing polychondritis. Among these diseases, we can find atypical conditions mixing different features of the most classical systemic diseases, which are called "overlap syndromes". The case we report illustrate these questions relative to the diagnosis. To conclude, it may be important to point at the difficulties of the anatomopathological diagnosis and the interest of the iterative biopsies. Regular follow-up can help us to identify systemic disease with the research of new extra-sinonasal symptoms.

[Our experience with papillary microcarcinoma of the thyroid]

INTRODUCTION

Papillary microcarcinoma (PMC) of the thyroid gland is high incidence pathology. Most of cases are related to a good prognosis. Conversely, numerous cases are reported with an aggressive course. Prognosis factors are age, size of tumour, multifocality, capsular invasion and cervical lymphadenopathy.

MATERIAL AND METHOD

We have conduced a retrospective study about 4,208 consecutive thyroidectomies over a period of 16 years. 251 cases of papillary cancers were analysed including 64 PMC (25.5%).

RESULTS

90% of PMC were incidentally found and 59% were diagnosed during surgical procedure. Multifocality improved the sensibility of histological diagnosis (P = 0.04). In 78%, total thyroidectomy was performed associated with a selective neck dissection in 47%. In case of extemporaneous diagnosis all partial thyroidectomy was convert into total thyroidectomy. In case of delayed diagnosis and in the absence of unfavourable prognosis factor, no other surgical procedure was carried out. A 7 years mean follow-up revealed only one case of recurrence successfully treated with Iodine 131 ablation. There was no case of death due to PMC.

CONCLUSION

This study confirms the good prognosis of PMC treated according to usual criterions.