RESUMO
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.
Assuntos
Tumor Carcinoide/diagnóstico , Neoplasias Laríngeas/diagnóstico , Laringectomia , Recidiva Local de Neoplasia/diagnóstico , Biópsia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Feminino , Rouquidão/etiologia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologiaRESUMO
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.
Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/terapia , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/terapia , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/terapia , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
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.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Criptococose/diagnóstico , Doenças da Laringe/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Idoso , Feminino , Humanos , Doenças da Laringe/diagnósticoRESUMO
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.
Assuntos
Brônquios , Broncoscopia , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/etiologia , Sons Respiratórios/etiologia , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Corpos Estranhos/cirurgia , Humanos , Lactente , Masculino , Anamnese , Exame Físico , Pneumonia Aspirativa/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Resultado do TratamentoRESUMO
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).
Assuntos
Angiofibroma/tratamento farmacológico , Angiofibroma/radioterapia , Neoplasias Encefálicas/radioterapia , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/radioterapia , Adulto , Angiofibroma/patologia , Neoplasias Encefálicas/patologia , Feminino , Humanos , Neoplasias Nasofaríngeas/patologia , Invasividade NeoplásicaRESUMO
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.
Assuntos
Linfoma de Células T , Cavidade Nasal , Neoplasias Nasais , Adulto , Idoso , Feminino , Humanos , Linfoma de Células T/diagnóstico , Linfoma de Células T/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/terapia , Neoplasias dos Seios Paranasais/diagnóstico , Neoplasias dos Seios Paranasais/terapia , Estudos RetrospectivosRESUMO
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.
Assuntos
Carcinoma Mucoepidermoide/patologia , Cistos/patologia , Neoplasias Parotídeas/patologia , Adulto , Carcinoma Mucoepidermoide/diagnóstico por imagem , Carcinoma Mucoepidermoide/cirurgia , Feminino , Humanos , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/cirurgia , UltrassonografiaRESUMO
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.
Assuntos
Aspergilose , Aspergillus fumigatus , Mastoidite/microbiologia , Abscesso/microbiologia , Idoso , Aspergilose/tratamento farmacológico , Aspergilose/epidemiologia , Doenças Cerebelares/microbiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Doenças do Nervo Facial/microbiologia , Evolução Fatal , Feminino , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Mastoidite/tratamento farmacológico , Mastoidite/epidemiologia , Osso Temporal/microbiologiaRESUMO
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.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/isolamento & purificação , Células Matadoras Naturais , Linfoma de Células T , Neoplasias Nasofaríngeas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Biópsia , Terapia Combinada , Ciclofosfamida , Doxorrubicina , Infecções por Vírus Epstein-Barr/diagnóstico , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Hibridização In Situ , Células Matadoras Naturais/imunologia , Linfoma de Células T/diagnóstico , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/etiologia , Linfoma de Células T/patologia , Linfoma de Células T/radioterapia , Linfoma de Células T/virologia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/etiologia , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/virologia , Nasofaringe/patologia , Recidiva Local de Neoplasia , Prednisolona , Prognóstico , Dosagem Radioterapêutica , Fatores de Tempo , Resultado do Tratamento , VincristinaRESUMO
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.
Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose dos Linfonodos/microbiologia , Tuberculose dos Linfonodos/cirurgia , Adolescente , Adulto , Idoso , Antibióticos Antituberculose/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose dos Linfonodos/tratamento farmacológicoRESUMO
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.
Assuntos
Hamartoma/complicações , Neoplasias Nasofaríngeas/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Feminino , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Recém-Nascido , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/cirurgia , Nasofaringe/patologia , Síndrome do Desconforto Respiratório do Recém-Nascido/patologiaRESUMO
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.
Assuntos
Otopatias/diagnóstico , Miíase/diagnóstico , Adulto , Criança , Otopatias/epidemiologia , Otopatias/parasitologia , Otopatias/terapia , Humanos , Técnicas In Vitro , Masculino , Miíase/epidemiologia , Miíase/parasitologia , Miíase/terapia , Dor/parasitologia , Irrigação TerapêuticaRESUMO
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.
Assuntos
Litíase/patologia , Doenças da Glândula Submandibular/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Litíase/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Glândula Submandibular/cirurgia , UltrassonografiaAssuntos
Encefalopatias , Mucormicose , Doenças dos Seios Paranasais , Adulto , Encefalopatias/diagnóstico , Encefalopatias/mortalidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucormicose/diagnóstico , Mucormicose/mortalidade , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/mortalidadeRESUMO
Introduction : L'inhalation du corps etranger (Ce) est un accident domestique grave survenant surtout chez le petit enfant et peut occasionner une detresse respiratoire aigue necessitant une prise en charge therapeutique urgente. Le but de notre travail est d'analyser les aspects cliniques et therapeutique des Ce tracheo-bronchiques vus en urgence. Patients et methode ; etude retrospective regroupant 107 enfants ages de moins de 15 ans; presentant une symptomatologie respiratoire aigue (= 3 jours); admis au service d'OrL; CHU Farhat Hached Sousse; pour bronchoscopie rigide devant la suspicion d'inhalation d'un Ce; entre janvier 2000 et Decembre 2011. Resultats : nous avons retrouve en moyenne 9 cas de Ce par an. L'age moyen de nos patients etait de 30 mois avec des extremes allant de 6 mois a 15 ans. Parmi ces enfants; 70 avaient un age compris entre 1 et 3 ans. Le syndrome de penetration a ete retrouve dans 77;6 des cas. Le symptome le plus frequent etait une toux dans 74;8 des cas. Deux patients ont presente un etat d'asphyxie aigue. La diminution du murmure vesiculaire a ete retrouvee dans 39;2 des cas. L'examen clinique et la radiographie pulmonaire etaient normaux dans 24;3 des cas. Un Ce radio-opaque a ete retrouve dans 5 cas. L'emphyseme obstructif unilateral a ete retrouve dans 39;2 des cas. Les grains de tournesol etaient les plus frequents; notes dans 26;2 des cas; suivis par les cacahuetes dans 15 des cas. Le Ce etait bronchique dans la majorite des cas avec une predominance du cote droit; 62;6 contre 33;7 du cote gauche. La bronchoscopie rigide a ete pratiquee pour l'extraction des Ce chez tous nos patients. Il n'y avait pas de deces dans notre serie. Conclusion : L'inhalation d'un Ce chez l'enfant est une pathologie grave qui engage le pronostic vital. Il faut l'evoquer devant meme des anomalies non specifiques et une endoscopie bronchique doit etre faite au moindre doute
Assuntos
Brônquios , Broncoscopia , Criança , Emergências , Corpos Estranhos , TraqueiaRESUMO
Objectif : Rappeler les principales caracteristiques etiopathogeniques des stenoses tracheales post-intubation; preciser le bilan preoperatoire et discuter les differentes modalites therapeutiques. Materiel et methodes : Notre travail porte sur une etude retrospective de vingt huit stenoses tracheales cicatricielles traitees de 1987 a 2003 au service d'ORL et de chirurgie cervico-faciale du CHU Farhat Hached de Sousse. Resultats : Elles sont toutes acquises; secondaires a une intubation et/ou a une tracheotomie. Les resultats de notre travail montrent le role primordial du traitement medical et endoscopique. Cependant; le meilleur traitement des stenoses tracheales reste le traitement chirurgical base sur la resection anastomose tracheale dont on a precise les indications et evalue les resultats; juges bons avec 89de cas favorables. Conclusion : Nos resultats montrent que le traitement endoscopique des STPI peut etre considere comme un traitement de premiere ligne. Les stenoses complexes et resistantes au traitement endoscopique relevent d'un traitement chirurgical
Assuntos
Intubação Intratraqueal , Estenose Traqueal , TraqueotomiaRESUMO
Introduction : Les tumeurs parotidiennes de l'enfant sont rares. Plusieurs types histologiques peuvent etre rencontres et rappellent souvent ceux de l'adulte. But : Analyser les particularites epidemiologiques; cliniques et therapeutiques des tumeurs parotidiennes chez l'enfant. Materiel et methodes : Il s'agit d'une etude retrospective; portant sur 13 observations de tumeurs parotidiennes de l'enfant colligees sur une periode de 23 ans de Janvier 1985 a Decembre 2007. Resultats : Nos malades se repartissaient en 8 filles et 5 garcons. L'age moyen etait de 11 ans. Notre serie avait comporte 12 cas (92;3) de tumeurs benignes et un cas (7;7) de tumeur maligne. Tous nos malades ont eu un traitement chirurgical. L'examen histologique definitif a conclu a un adenome pleomorphe dans 5 cas; un oncocytome dans un cas. Deux malades etaient porteurs d'une tumeur vasculaire; un malade d'une tumeur nerveuse; deux de kystes lymphoepitheliaux; un malade d'un kyste hydatique et un patient d'un carcinome mucoepidermoide. L'evolution a ete marquee par l'absence de recidive tumorale avec un recul variant entre 8 mois et 6 ans pour tous nos malades. Conclusion : Bien que les tumefactions parotidiennes soient rares chez l'enfant; elles representent une grande variete de diagnostics histologiques y compris des tumeurs malignes
Assuntos
Neoplasias Parotídeas , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/epidemiologiaRESUMO
L'otite externe necrosante est une pathologie grave qui pose de plus en plus de difficultes dans la prise en charge therapeutique. Nous rapportons dans ce travail une observation d'otite externe necrosante compliquee d'une paralysie faciale qui avait resiste au traitement medical et chirurgical bien conduits. L'adjonction de l'oxygenotherapie hyperbare comme traitement complementaire a permis une regression des signes cliniques et une guerison de l'infection. Il s'agissait du premier cas d'otite externe necrosante ayant beneficie en mars 1996 de l'oxygenotherapie hyperbare en Tunisie. A travers cette observation; nous discutons l'indication de l'oxygenotherapie hyperbare dans le traitement de l'otite externe necrosante
Assuntos
Otite Externa , OxigenoterapiaRESUMO
Objectifs: Rappeler les caracteristiques cliniques; paracliniques; et les modalites therapeutiques adaptees devant des paragangliomes bilateraux. Methodes: Nous rapportons deux observations de paragangliomes bilateraux; l'un tympano-jugulaire bilateral et l'autre cervical (carotidien et vagal); colligees durant une periode de 22 ans (1985-2007). Nos deux patients avaient eu un examen clinique complet un bilan radiologique et biologique. Resultats: Notre premier malade a eu une radiotherapie exclusive; le deuxieme a eu une exerese chirurgicale complete de la tumeur vagale et on a opte pour une surveillance de la tumeur controlaterale. Pour nos deux patients l'evolution etait favorable marquee par une stabilisation tumorale. Conclusion: Les paragangliomes cervico-cephaliques bilateraux sont des formes cliniques rarement observees. Le diagnostic positif repose sur l'imagerie. L'attitude therapeutique n'est pas univoque et doit etre adaptee en fonction du siege de la tumeur et du bilan d'extension locoregional
Assuntos
Relatos de Casos , Paraganglioma/radioterapia , Paraganglioma/cirurgiaRESUMO
La mastoïdite masquée (MM) se définit comme un état inflammatoire latent de la muqueuse et de l'os mastoïdien avecun tympan normal. Elle est révélée par une complication généralement endocrânienne. Le traitement est une mastoïdectomie associée à une antibiothérapie intraveineuse.Nous rapportons deux observations de mastoïdites masquées dont le diagnostic a été évoqué par l'examen tomodensitométrique qui a rattaché les complications endocrâniennes à leur origine mastoïdienne. Le but de notre travail est de discuter les circonstances diagnostiques, les investigations paracliniques et le traitementdes mastoïdites masquées