Unknown primary cancer of the head and neck: a multidisciplinary approach

The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors (AU)

[Fibroglandular hamartoma of the nasal cavity: case description and review]. / Hamartoma fibroglandular de fosa nasal: descripción de un caso y revisión.

A fibroglandular hamartoma of the nasal cavity was found in a patient with nasal polyposis. The only symptom had been bilateral nasal obstruction for years. The tumor was removed by lateral rhinotomy. Our initial differential diagnosis included nasal glioma and inverted papilloma, but this rare tumor was not suspected. Four years after surgery, the patient is well and the risk of recurrence is deemed to be very low. Surgeons and pathologists must be aware of these and other uncommon tumors of the nose because some may require special diagnostic and therapeutic procedures.

Hamartoma fibroglandular de fosa nasal: descripción de un caso y revisión / Fibroglandular hamartoma of the nasal cavity: case description and review

Presentamos un tumor poco frecuente en lafosa nasal encontrado inesperadamente en el contexto de una poliposis nasal. El paciente se quejaba de obstrucción nasal bilateral de varios años de evolución como único síntoma. El tumor se resecó por rinotomía lateral. Nuestro diagnóstico diferencial incluía glioma nasal y papiloma invertido, pero todas las hipótesis preoperatorias fueron incorrectas al no sospechar esta variedad de tumor tan rara. Cuatro años después de la cirugía, el paciente se encontraba libre de enfermedad. El riesgo de recidiva de este tumor es bajo, según los casos descritos en la bibliografía. Tanto cirujanos como anatomopatólogos debemos tener en cuenta la existencia de éste y otros tumores poco frecuentes en la fosa nasal, ya que algunos requieren un diagnóstico especial y/o procesos terapéuticos específicos (AU)

A fibroglandular hamartoma of the nasal cavity was found in a patient with nasal polyposis. The only symptom had been bilateral nasal obstruction for years. The tumor was removed by lateral rhinotomy. Our initial differential diagnosis included nasal glioma and inverted papilloma, but this rare tumor was not suspected. Four years after surgery, the patient is well and the risk of recurrence is deemed to be very low. Surgeons and pathologists must be aware of these and other uncommon tumors of the nose because some may require special diagnostic and therapeutic procedures (AU)

Craniofacial necrotizing fasciitis secondary to sinusitis.

Necrotizing fasciitis is a rare condition which usually affects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures. Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisive factors for the outcome of the patient.

Haemangioma of the maxillary sinus.

Haemangiomas of the maxillary sinus are very rare. In this paper we present one case with an inaccurate preoperative diagnosis which was treated by entire excision of the tumour. One year after surgery there is no evidence of recurrence. The literature on the topic is reviewed.

[Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms]. / Tuberculosis del área otorrinolaringológica: formas laríngeas y extralaríngeas.

BACKGROUND: The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis. METHODS: All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included. RESULTS: Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital. CONCLUSIONS: Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.