Pilomatrix Carcinoma of the scalp. A case report and review of the literature.

INTRODUCTION: Pilomatrix Carcinoma (PC) is a rare and malignant dermo-hypodermic tumor. Only 11 cases were reported in patients younger than 18 years old and only 13 cases were reported on the scalp. CASE REPORT: We report the case of a 15-year-old woman who underwent cyst excision on the vertex. Anatomopathology shed light trichilemmal cyst. Five months later, she presented a first local recurrence. The tumor was removed with wide margin. Anatomopathology shed light PC. No adjuvant therapy was performed. The patient presented a second recurrence 3 months later with a parietal bone and superior sagittal sinus invasion and a lung metastasis. She underwent a craniotomy and radiochemotherapy. A third local recurrence was detected 4 months later. Three more lines of chemotherapy were performed without success. DISCUSSION: PC is a locally aggressive tumour, with a high rate of local recurrences and metastases. PC arises de novo or through malignant transformation of a pilomatrixoma. PC were observed frequently in the white male over 50 years old. The histological diagnosis is difficult to prove. Treatment consists of a wide surgical excision. Peritumoral margins are not codified. Because of most cases are on the face and neck, Mohs Micrographic Surgery seems to be a good modality to limit margins. Radiation therapy is an adjuvant treatment. Chemotherapy can be used in metastasis case. CONCLUSION: PC is a rare malignant tumor with high rate of disease relapse. Histological diagnosis is difficult and treatment is not standardized. Surgical procedure with wide margins is recommended to avoid the large recurrence when the staging shows no metastasis.

Influence of random answers on interpretation of the Sniffin' Stick identification test in nasal polyposis.

OBJECTIVE: The Sniffin' Stick identification subtest, a validated tool to evaluate the sense of smell, is based on the recognition of 16 different odours. The patient is required to choose an answer from among four proposed odours, which introduces the possibility of obtaining random correct answers, especially in patients with an altered sense of smell. This study was designed to evaluate the influence of these random correct answers on interpretation of the simplified version of the Sniffin' Stick test comprising threshold and identification tests in patients with nasal polyposis. MATERIALS AND METHODS: Forty-two consecutive patients with nasal polyposis operated according to the nasalization procedure were enrolled in this prospective study. Odour threshold and identification tests of the Sniffin' Stick kit were performed before and 1 month after surgery. Random correct answers on the identification (I) test (IH) were subtracted from the global number of correct answers (IG) to calculate a real identification score (IR), corresponding to the number of correct answers unrelated to chance. RESULTS: Two groups of patients were identified: one group with no random correct answers (IH0) (n=17) and another group giving 1 to 7 random correct answers (IH1-7) (n=25). In the IH1-7 group, significantly more patients had an immeasurable threshold (T=0) than a measurable threshold (21 versus 4, P=0.0001). In this subgroup of 21 patients [IH1-7, T=0], the mean IR score was significantly lower than the mean IG score (P<0.0001) and 13 patients were classified as [IR=0; T=0]. Among these 13 patients classified as severe anosmia [IR=0; T=0] preoperatively, only 3 remained severe anosmic [IR=0; T=0] postoperatively. CONCLUSION: Random answers to the I identification test were more numerous among patients unable to detect n-Butanol on the T threshold test than among patients able to detect n-butanol. Calculation of the IR identification score allows more precise interpretation of the results of the identification test in patients with severe anosmia.

Laryngeal chondrosarcoma: repeated laser and radiofrequency ablation in the palliative setting.

OBJECTIVE: The purpose of this article is to illustrate the use of radiofrequency and laser ablation in head and neck oncology and to describe the management of a case of laryngeal chondrosarcoma in a 90-year-old patient. CASE REPORT: A 90-year-old man, WHO performance status 3, with low-grade laryngeal chondrosarcoma was seen in the outpatients department at the end of 2008 for assessment of dysphonia. Total laryngectomy was considered to be too invasive and was consequently excluded. The patient was initially tracheotomized under local anaesthesia to relieve dyspnoea and was subsequently managed symptomatically by radiofrequency and laser ablation to ensure laryngeal disobstruction, allowing the patient to be extubated followed by speech therapy and oral feeding rehabilitation. DISCUSSION/CONCLUSION: This patient received symptomatic palliative treatment with a combination of radiofrequency and laser. Radiofrequency ablation can be applied in head and neck oncology as an alternative treatment to surgery allowing improvement of quality of life and survival.

Navigation in head and neck oncological surgery: an emerging concept.

Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.