[Bronchoscopic findings in children with prolonged respiratory symptoms]. / Indication de la bronchoscopie chez des enfants avec une symptomatologie respiratoire trainante traitement.

OBJECTIVE: This retrospective study aims to establish an algorithm indicating a bronchoscopy, based on clinical and radiological criteria predictive of the presence of a foreign body (FB), in children with prolonged respiratory symptoms and no history of foreign body aspiration (FBA); to establish a study of these criteria and to compare the clinical, radiological and broncoscopic findings in such cases. METHODS: We chose to review the records of 73 children (age < or = 15 years) with prolonged respiratory symptoms (for at least 15 days) and no history of FBA who underwent bronchoscopy at our institution between 1996 and 2005. RESULTS: The mean age was 3 years and 2 months, the majority of the patients were between 1 and 3 years of age (56%), 59% of the patients were boys and the mean of evolution of symptoms before the broncoscopy was 3 months and 3 weeks. We found a foreign body (FB) in 17 cases (23.2%). The FBs were in 88.2% of the cases of vegetable origin. A granulation tissue was associated in 47% of positive bronchoscopies. There were no complications related to bronchoscopy. The clinical and the radiological findings were no specific of FBs. CONCLUSION: Bronchoscopy must be indicated in suspected cases of FBA to prevent delayed diagnosis and pulmonary sequelae. The clinical and radiological findings may help the clinician to indicate it.

Nasal NK/T-cell lymphoma in the paediatric population. Two case reports.

Nasal natural killer (NK)/T-cell lymphoma is an uncommon disease, and only a few paediatric cases are found in the literature. We report 2 cases of NK/T-cell lymphoma occurring in children. The primary site was the the nasal cavity in the first case (5-year-old girl) and the tonsil in the second case (4-year-old boy). Histological study showed a polymorphic neoplastic infiltrate with an angioinvasive pattern and T-cell phenotype. Ebstein-barr virus infection was established by in situ hybridization. Both underwent an aggressive chemotherapy regimen. The outcome was favorable for the 4-year old boy; however, the 5-year-old girl died two months after diagnosis.

[Carcinoid tumor of the larynx]. / Tumeur carcinoïde du larynx.

OBJECTIVE: Carcinoid tumors are among the exceptional neoplasms of the larynx. The literature is reviewed and the problems with diagnosis and management of this rare tumor are discussed. METHODS: The authors report a case of a carcinoid tumor of the larynx. RESULTS: This paper describes the case of a well-differentiated carcinoid tumor of the aryepiglottic fold in a 59-year-old woman who presented with hoarseness lasting eight months. After surgical excision, the patient developed recurrence of the disease 14 years later. CONCLUSION: Carcinoid tumors require accurate diagnosis because of their varied clinical behavior and prognosis. The typical carcinoid treatment of choice is conservative surgery.

[Laryngeal cryptococcosis revealing AIDS: a case report]. / Cryptococcose laryngée révélatrice d'un SIDA: à propos d'une observation.

The cryptococcal infection of the larynx is uncommon. We present a case of a 65-year-old woman who was seen because of chronic hoarseness. Direct laryngoscopy revealed an infected lesion of the laryngeal vestibule. Histologic examination showed yeasts surrounding by capsules allowing a diagnosis of laryngeal infection by cryptococcus neoformans. The patient had also meningitis and pulmonary localisation. We have undergone a risk factors research and this results in finding out that HIV serology was positive. She received a treatment with amphotericin B followed by fluconazole during 6 months with complete recovery of her laryngeal infection. The patient died 11 months after the AIDS diagnostic.

[Extra-nodal T lymphomas of the nasal cavities and sinuses]. / Les lymphomes T des fosses nasales et des sinus.

INTRODUCTION: Extra-nodal T lymphomas of the ear, nose, and throat (ENT) are unusual in Western countries, with differential diagnosis from other destructive and necrotizing lesions of the sino-nasal tract often difficult. MATERIAL AND METHODS: Eleven cases of extra-nodal lymphomas of the upper aerodigestive tract tract managed in the ENT department of F. Hached hospital in Sousse, Tunisia, were retrieved over a 10-year period (1995-2004). The aim of our study was to report the clinical and pathological data and the outcome for each patient. RESULTS: The median age of patients was 41-years. The most frequent site of involvement was the nasal cavity. Clinically, the symptoms were not specific. Histological examination identified two cases of T/NK lymphoma and nine cases of T-lymphoma not otherwise specified. Immunohistochemistry and in situ hybridization techniques positively detected Epstein-Barr virus in tumoral cells, in seven cases. Tumor staging, in 10 patients, found distant metastasis in three. Nine patients underwent the following treatment: exclusive radiotherapy (one patient), radiochemotherapy (three patients), and exclusive polychemotherapy (five patients). The two remaining patients had no treatment because of a rapidly unfavorable progression. After a median follow-up of 11-months, clinical outcome consisted in death in seven patients and remission in three patients; one patient was lost of follow-up. CONCLUSION: Extra-nodal lymphomas of the ORL tract are rare in Tunisia. Clinical presentation is not specific, depending on the lymphoma location. Diagnosis relies on clinical presentation and immunophenotypic and molecular characteristics; morphological features are not specific. These are aggressive lymphomas, often requiring multidisciplinary management.

[Parotid retention cyst revealing a mucoepidermoid carcinoma]. / Kyste parotidien rétentionnel révélateur d'un carcinome mucoépidermoïde.

OBJECTIVES: To describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid retention cyst. PATIENT AND METHODS: A 21-year-old woman presented with a 5-cm cystic swelling in her left parotid region. Ultrasound examination and a computerized tomography scan showed a clearly outlined parotid cyst. Through a conventional parotidectomy incision, the cyst was excised with parotid gland tissue around the lesion. The patient had an uncomplicated recovery. RESULTS: Histopathological examination of the resected parotidectomy material showed a parotid retention cyst and a mucoepidermoid carcinoma measuring 5mm in diameter. CONCLUSION: Among acquired cysts of the parotid gland, retention cysts are the most frequent. They may be the presenting symptom in patients with occult cancer of the parotid. In this case report, a mucoepidermoid carcinoma played a significant role in the obstruction of a salivary gland duct and caused a parotid retention cyst. Thus, a wide excision of the parotid retention cyst is necessary, as is a careful review of the histology searching for malignant lesion.

Aspergillus mastoiditis with intact tympanic membrane in immunocompetent host.

Aspergillus mastoiditis is a very rare condition usually observed in immunocompromised patients. Masked mastoiditis is defined as a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with intact tympanic membranes. To our knowledge, our report of a masked Aspergillus mastoiditis occurring in a 71-year-old diabetic woman is only the second case of masked mastoiditis in the literature. Aggressive medical and surgical management are necessary to avoid a fatal outcome from this invasive infection.

[Nasopharyngeal angiofibroma with intracranial extension: situating the chemotherapy-radiotherapy association]. / L'angiofibrome nasopharyngien avec extension intracrânienne : place de l'association chimiothérapie-radiothérapie.

Nasopharyngeal angiofibroma is a locally aggressive, although histologically benign, vascular neoplasm. This neoplasm accounts for 0.05% of head and neck tumours and affects almost exclusively male adolescents. Surgery is considered as the primary treatment of nasopharyngeal angiofibroma. Other treatment modalities such as radiotherapy and chemotherapy are still recommended for intracranial extension involving the cavernous sinus or the internal carotid artery. We report a rare case of nasopharyngeal angiofibroma, further complicated with a Kennedy syndrome in a 34 year-old women. The treatment consisted in a chemotherapy (adriamycine, decarbazine) followed by radiotherapy. We discuss the relevance and outcome of the association chemotherapy-radiotherapy in the treatment of nasopharyngeal angiofibromas with a consistent intracranial extension (stage III B of Arch Otolaryngol Head Neck Surg 122 (2003) 122-129).

[NK/T-Cell lymphoma of nasopharynx]. / Lymphomes T/NK du nasopharynx.

OBJECTIVE: Discussion of the clinical and paraclinical features of a rare tumor in the nasopharynx, the NK/T-cell lymphoma, with an emphasis on the implications of Epstein Barr Virus (EBV) in its pathogenesis and prognosis. CASES REPORT: We report the cases of a woman and a man aged 34 and 48, respectively. Clinical presentation was non-specific and diagnosis was established with deep biopsies under general anesthesia. Immunochemistry and in situ hybridization were positive for Epstein Barr virus in tumor cells in both cases. The patients were first treated with chemotherapy (CHOP regimen), then underwent radiotherapy. The first patient achieved complete response at twenty months follow-up. The second patient presented two recurrences which were treated by chemotherapy. He died from acute renal failure during treatment of the second recurrence. CONCLUSION: Diagnosis of NK/T-cell lymphoma may be delayed in the event of non-specific symptoms. Deep biopsies outside necrotic tissue must be obtained. Search for EBV is important as its presence is a factor of poor prognosis.

[Mycobacterial cervical lymphadenitis: role of surgery]. / Adénopathies cervicales tuberculeuses: place de la chirurgie.

OBJECTIVE: To discuss the place of surgery in the management of mycobacterial cervical lymphadenitis. PATIENTS AND METHODS: It's a retrospective study (1982-2002) about 246 patients treated in the ENT department of Farhat Hached Sousse for cervical lymph node tuberculosis. Resolution was considered when neither symptoms nor lymphadenopathy in examination were noted. RESULTS: The mean age of our patients was 28 years. A light female prevalence was noted. In 5 patients diagnosis was established by lymph node punction. A medical treatment of first intention was then managed with a failure in 3 cases, after deadlines from 3 to 4 months. All other patients were operated: cellulolymphadenectomy (47%), adenectomy (47%) or drainage of a cervical abscess (4%). Recurrence and antituberculosis treatment resistance were noted respectively in 6% and 3% of cases. DISCUSSION: Two questions are still discussed in the management of mycobacterial cervical lymphadenitis: 1- Is surgery necessary for the diagnosis? 2- When is surgery indicated directly? Histological specimen established the diagnosis in all cases and excluded a mestastatic lymph node. In some situations surgery must be indicated at first: cold abscess, lymph node fistulation. CONCLUSION: Surgery still has an important place in the treatment of tuberculosis lymphadenopathy.

[Submandibular lithiasis. Report of 48 cases]. / Les sous-mandibulites lithiasiques. A propos de 48 cas.

This retrospective study concerned 48 patients treated surgically for sub mandibular lithiasis. Results of medical imaging (plain films, sialography, ultrasonography) are confronted with operative findings. The surgical indications are analysed according to lithiasis localisation.

[An unusual cause of neonatal respiratory distress: nasopharyngeal hamartoma. 2 case reports]. / Une cause rare de détresse respiratoire néonatale: l'hamartome nasopharyngé, à propos de 2 cas.

We report two cases of nasopharyngeal hamartomas revealed by neonatal respiratory distress. Hamartomas are congenital and benign pseudotumors. Treatment was carried out by excision of the tumor and pedicle under general anesthesia.

[Ear myiasis. Two case reports]. / Les myiases auriculaires. A propos de deux observations.

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.