To What Extent Can Orbital Cellulitis Emergency Aspect Influence the Diagnosis of Maxillary Sinus Lymphoma?

We present a case of a 46-year-old woman admitted to the emergency department for acute swelling and erythema of the right eyelid for 3 days. Ophthalmological examination was notable for 10/10, P2 best visual acuity, and inflammatory periorbital edema, without exophthalmia nor extraocular motility disturbance. Intraocular pressure was 14 mmHg and fundoscopic examination was not notable for any abnormality. Preseptal cellulitis diagnosis was made, and oral antibiotherapy was immediately started; after 72 hours, the patient did not improve and started complaining of pain on ocular movements. Brain and orbit MRI scan revealed right retroseptal cellulitis associated with homolateral pansinusitis. Intravenous antibiotherapy with oral corticosteroid was started simultaneously leading to full remission but with steroid dependency; 5 days after finishing prednisone, orbital cellulitis symptoms reappeared. The same treatment protocol was given but with corticosteroid tapering over weeks. Nevertheless, steroid dependency persisted. Except for the inflammatory syndrome, complete biological examinations did not disclose any abnormalities. The patient underwent maxillary sinus and fat orbital biopsy; however, histopathological examination was not contributory. Persistence of steroid dependency, chronic atypical rhinosinusitis, normal paraclinical investigations, and age of patient let us suspect lymphoma origin hidden by chronic corticosteroid. We carried out for the second time a maxillary sinus biopsy after stopping steroids, which disclosed primitive non-Hodgkin lymphoma of the maxillary sinus. The aim of this observation is firstly to evoke though it is exceptional the diagnosis of maxillary lymphoma in case of atypical orbital cellulitis and secondly to incite clinicians to be more vigilant in prescribing corticosteroid even if there is an emergency character of orbital cellulitis.

[The inferior laryngeal nerve: anatomical and surgical considerations about 60 thyroidectomy]. / Le nerf laryngé inférieur: considérations anatomiques et chirurgicales à propos de 60 thyroïdectomies.

Thyroid surgery requires a thorough knowledge of cervical anatomy and anatomical variations, in particular of the lower laryngeal nerve, in order to avoid iatrogenic lesions. The objective of our study was to analyze the relationships of the lower laryngeal nerve, the existence of branches of nerve division and a subjective appreciation of the size of the nerve. This is a prospective study of 1 year including 60 patients who underwent thyroidectomy. Sixty patients underwent surgery on the thyroid gland between February 2014 and January 2015 by the same principal operator (10 men and 50 women). The average age of our patients was 51 years. For men were performed 6 total thyroidectomies, 2 left lobo-isthmectomies and 2 right lobo-isthmectomies. For women were performed 33 total thyroidectomies, 8 left lobo-isthmectomies and 9 right lobo-isthmectomies. On the right, the nerve was superficial relative to the artery in 71.6% of cases; it was divided in 33.3% of cases and was abnormally thin in 16.6% of cases. On the left, the nerve was deep in relation to the artery in 83.3% of cases; it was divided in 15% of cases and was abnormally thin in 11.6% of cases. Knowledge of the anatomical variations of the lower laryngeal nerve is essential in thyroid surgery, the risk is particularly important on the right side given the sometimes very small caliber and the existence of branches of division more frequent than on the left side.

Medial migration of the tympanostomy tube: what is the optimal management option?

The tympanostomy tube insertion is the gold standard of treatment for secretory otitis media. Complications are associated with this surgery in 17% of cases. One of the rare but real complications is the medial migration of the tympanostomy tube. To our knowledge, this is the 14th case reported in childhood. Considering this rarity, there is no consensus for the management of this phenomenon. Some authors propose a surgical removal, while others prefer to observe whether the patient is asymptomatic. We reported a case of migration of the tympanostomy tube and described the detailed clinical features and management options. This case report and mini-review will broaden readers the knowledge of medial migration of the tympanostomy tube and may guide the relative treatment of this complication in the future.

[Giant parathyroid carcinoma: diagnostic difficulties and therapeutic strategies]. / Carcinome parathyroïdien géant: difficultés diagnostiques et stratégies thérapeutiques.

Parathyroid carcinoma is a very rare malignancy responsible for 0.4 to 5.2% of hyperparathyroidism. Clinical diagnosis is difficult and treatment should be codified. Surgery is the only curative treatment. We report the case of a female patient treated for malignancy-associated hypercalcemia revealing parathyroid carcinoma. The patient underwent surgery; after three months she developed lymphatic recurrence. Given the absence of other secondary involvement, bilateral lymph node dissection followed by chemotherapy was performed. Parathyroid carcinoma is often suspected on the basis of biological, radiological and especially intraoperative macroscopic criteria, but definitive diagnosis is made histopathologically. Surgery is currently the only curative treatment and the role of adjuvant therapy is to establish.

Primary Burkitt lymphoma of the thyroid gland: case report of an exceptional type of thyroid neoplasm and review of the literature.

BACKGROUND: Primary thyroid lymphoma is an uncommon pathological entity that accounts for only 1 to 5 % of all thyroid malignancies. Primary Burkitt lymphoma of the thyroid gland is very rare. This article presents the first Moroccan case of a primary BL of the thyroid to be reported in the literature to date. CASE PRESENTATION: We describe here a case of a 70-year-old male who developed a rapidly enlarging thyroid gland with progressive symptoms of compression. Core biopsy confirmed the diagnosis of Burkitt lymphoma. The patient died of septic shock, 2 weeks after the first cycle of appropriate therapeutic chemotherapy. CONCLUSIONS: This presentation emphasizes the importance of considering lymphoma when dealing with a thyroid mass, as its management is different from that of other thyroid pathologies, and affords an opportunity to review a very rare type of primary thyroid lymphoma.