Primary neuroendocrine tumors of the ear, nose and throat: A report of three cases and a review of the literature.

The aim of the present study was to review all cases of neuroendocrine tumors of the ear, nose and throat in a tertiary care center, as well as the data published in the literature. The study presents all the cases of neuroendocrine tumors (NETs) in the Hotel Dieu De France Hospital (Beirut, Lebanon) between January 2004 and January 2014. The data reported in the English and French literature is also reviewed with regard to the typical clinical presentation and management of these tumors. Three cases of NETs presented to the Department of Otolaryngology-Head and Neck Surgery during the study period. One case was of an atypical carcinoid (AC) tumor of the larynx, one case was of a typical carcinoid tumor in the middle ear and the third case was, to the best of our knowledge, the first reported case of an AC tumor of the nasopharynx. Overall, NETs are rare in the head and neck. The clinical presentation can mimic any other tumor in the same localization in the absence of a carcinoid syndrome. Management of these tumors remains controversial, but a complete excision of the tumor is crucial, followed by possible adjuvant treatment.

Survival of T4aN0 and T3N+ laryngeal cancer patients: a retrospective institutional study and systematic review.

OBJECTIVE: We aim to assess the correlation of tumor and nodal staging to survival in pT3N+ and T4aN0 laryngeal cancer with subgroup analysis within stage IVa (pT4N0 and pT3N2). STUDY DESIGN: Retrospective cohort study with systematic review of the literature. SETTING: Hotel Dieu de France University Hospital (tertiary referral center). SUBJECTS AND METHODS: Laryngeal cancer patients' registries were reviewed from 1998 to 2012 selecting pT3N+ and pT4aN0 patients treated by primary total layngectomy. Overall survivals were compared using Log rank and Kaplan-Meier analysis. A systematic review was performed by 2 reviewers including all the articles reporting the outcome of these categories of patients. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. RESULTS: Thirteen T3N+ patients and 19 T4aN0 patients treated by primary total laryngectomy were included. Five-year overall survival for T3N+, T3N2 and T4aN0 was respectively 33%, 32.1% and 73.7%. Due to the small sample, the difference was not significant. The systematic review revealed three articles reporting overall survival outcome for the T4N0 group and 6 articles for the T3N+. At 5years, the survival ranged from 62.5% to 73% in T4N0 and from 32.2% to 77% in T3N+. CONCLUSION: In advanced stage laryngeal cancer, T4aN0 tends toward a better survival than T3N+ especially when compared to T3N2 although they are grouped in the same TNM stage IVa.

PAROTID TUMORS: IS SURGERY ALWAYS THE ONLY WAY?

AIM OF THE STUDY: To analyze the characteristics and management of parotid tumors in a tertiary care center. STUDY DESIGN: Retrospective cohort study. METHODS: All cases of parotid tumors (or masses) in our department between Jan 1, 1999 and December 31st, 2012 were studied. Demographic data, clinical characteristics, histopathology and management were analyzed. We also evaluated the diagnostic value of fine needle aspiration cytology (FNAC) in our center. RESULTS: Of the 216 parotid tumors, 164 underwent parotidectomy and 52 were not managed surgically; 73.1% had a benign tumor (36.6% had Warthin's tumor) and 16.7% had a malignant one. In our center, FNAC was found to have a sensitivity for reporting malignancy of 71.4% and a specificity to rule in malignancy of 100%. CONCLUSION: In our series, Warthin's tumor was the most frequent mass probably related to the high tobacco use. The prevalence of malignant tumors was relatively high in our series. Primary malignant tumors and pleomorphic adenomas should always be treated surgically, however, lymphomas, metastatic and benign inflammatory masses and cases of Warthin's tumors could be managed nonsurgically.

Morbidity and mortality of thyroidectomy for substernal goiter.

BACKGROUND: Our objective was to evaluate morbidity and mortality of thyroidectomy in substernal goiters and identify patients at risk for these events. METHODS: The medical records of 127 patients with substernal goiters were retrospectively reviewed. RESULTS: The most common preoperative symptom was shortness of breath (48%). 13% of the 127 patients were asymptomatic. Preoperative imaging identified tracheal deviation in 69% and tracheal compression in 41% of the cases. Substernal goiters were resected via a cervical approach in 100% of the cases. Six patients (5%) had postoperative hoarseness, 1 had permanent vocal cord paralysis, and 19 (15%) had transient postoperative hypocalcemia. The mortality and permanent hypoparathyroidism were null. Patients with postoperative complications had larger goiters and were more likely to have tracheal compression. CONCLUSIONS: Thyroid resection via a cervical approach for substernal goiters is associated with low rate of morbidity and no mortality. Patients with large tumors and tracheal compression are more likely to develop postoperative complications.

Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery.

OBJECTIVE: To assess the incidence and clinical relevance of inadvertent parathyroidectomy during thyroidectomy, and the possibility of reducing its occurrence. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Consecutive patients who underwent thyroidectomy from 1999 to 2005, divided into 2 groups (group 1, those with inadvertent parathyroidectomy; and group 2, those without inadvertent parathyroidectomy). Patients who underwent surgical procedures for recurrent thyroid disease, intentional parathyroidectomy, and resection of central compartment viscera were excluded. INTERVENTIONS: All pathology reports were reviewed for the presence of any parathyroid tissue in the resected specimen. Age, sex, preoperative diagnosis, thyroid hormonal status, substernal thyroid extension, number of parathyroid glands identified and spared at the time of surgery, autotransplantation of parathyroid gland, and final histologic findings were recorded. MAIN OUTCOME MEASURES: Identification of parathyroid tissue in resected specimens and postoperative symptomatic hypocalcemia. RESULTS: A total of 307 patients were included. Surgical procedures included bilateral or unilateral thyroidectomy (95% and 5% of procedures, respectively). Central neck lymph node dissection was performed in 5% of cases. Pathologic findings showed inadvertent parathyroidectomy in 12% of cases. Of these, 32% were recognized intraoperatively. The parathyroid tissue was found in extracapsular locations in 37% of cases, intracapsular locations in 39%, and intrathyroidal locations in 24%. There was no statistical difference between the 2 groups in terms of sex, preoperative diagnosis, substernal extension, extent of surgery, pathologic diagnosis, and occurrence of postoperative hypocalcemia, except for the presence of thyroiditis. CONCLUSION: Careful examination of the surgical specimen intraoperatively decreases the incidence of inadvertent parathyroidectomy during thyroidectomy.