Extraosseous plasmacytoma of the lacrimal duct.

OBJECTIVE: Extraosseous plasmacytoma (EOP) is a rare plasma cell proliferative disorder that commonly affects the head and neck region. We report the first case of a plasmacytoma of the lacrimal duct. METHODS: A 66-year-old man presented with an isolated plasmacytoma of the right lacrimal duct and was treated surgically. RESULTS: The tumour grew slowly for a few months. CT scan and MRI showed a right lateral nasal mass extending from the right lacrimal duct toward the floor of the right maxillary sinus. The lesion was removed completely by endoscopic nasal surgery. DISCUSSION: EOP accounts for up to 3% of all plasma cell tumours. Management of this rare lesion involves surgery and radiotherapy with or without adjuvant chemotherapy. Guided by a literature review, we discuss the diagnostic and therapeutic management of EOP.

Pneumosinus dilatans associated with nasal polyposis.

OBJECTIVE: Pneumosinus dilatans (PSD) and pneumocele involve the expansion of one or more paranasal sinuses. We present the first cases of frontal PSD and pneumocele associated with nasal polyposis. We also attempt to explain the development of these rare pathologies through this unexpected association. METHODS: Two cases are described. A 31-year-old man presented with chronic rhinosinusitis for many years and a left frontal protrusion. Physical examination found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus without bone destruction. The second patient was a 17-year-old man who presented with a left frontal protrusion and orbital encroachment associated with chronic rhinosinusitis. Physical examination also found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus with focal thinning of the bony sinus walls. DISCUSSION: Focal or generalized thinning of the bony sinus walls differentiates pneumocele from PSD; otherwise, these two entities share the same physiopathological and clinical courses. Many explanations have been proposed for their development including increases in intra-sinus pressure, weakening of bone by tumor invasion, intracranial hypotension, spontaneous drainage of a mucocele, and congenital or hormonal causes. Yet, its physiopathology remains unknown. These two cases support the pressure mechanism of development.

[Multifocal nodular oncocytosis hyperplasia of the parotid gland]. / L'hyperplasie oncocytaire nodulaire multifocale de la glande parotide.

OBJECTIVES: Oncocytic lesions rarely affect the parotid gland, accounting for less than 1% of all salivary lesions. The WHO classification described three main types: diffuse oncocytosis, focal nodular oncocytosis hyperplasia, and oncocytoma. Multifocal nodular oncocytosis hyperplasia of the parotid gland represents an extremely rare, non-tumorous pathology of the parotid gland. MATERIAL AND METHODS: We report a case of multifocal nodular oncocytosis hyperplasia of the parotid gland in a 70-year-old woman who was referred for a left preauricular mass that had gradually increased in size over the last 2 years. No lymph node of the neck was palpable. RESULTS: MRI demonstrated multiple bilateral lesions of the parotid glands. Total parotidectomy, preserving the facial nerve, was performed. CONCLUSION: We discuss the physiopathology and the treatment of multifocal nodular oncocytosis hyperplasia and provide a review of the literature.

The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region.

To analyze the medical literature devoted to work-up, epidemiology, local control, survival, complications and sequelae after conservative treatment for early-stage squamous cell carcinoma of the tonsillar region. An analysis of the PubMed (1975-2016) database was performed using the following keywords and associations: "tonsil/tonsillar region/oropharynx" AND "squamous cell carcinoma" AND "early-stage (I-II; T1-2N0M0)" AND "radiation therapy/radiotherapy" OR "conservative surgery/oropharyngectomy/transoral surgery/radical tonsillectomy". The search retrieved 10 retrospective series documenting local control and/or survival in series with more than 50 cases and a minimum 2 years' follow-up after conservative treatment; no prospective studies, meta-analyses and/or Cochrane analyses were found. Magnetic resonance imaging is the key radiological exam for local extension assessment. Human papilloma virus infection (HPV) is a risk factor that must be screened for systematically, since it induces tumoral radio-sensitivity and increases the risk of specific synchronous and metachronous second primaries. Whatever conservative treatment used, local control and survival rates higher than 85% were achieved. Implementing intensity-modulated radiation therapy reduced the incidence and severity of radiation-related complications and sequelae. Transoral surgery yielded very low morbidity/mortality rates, enabled association to ipsilateral neck dissection, and allowed radiation therapy to be reserved for the management of metachronous second primaries. Transoral surgery appeared to be the first-line option in the majority of cases. Lifetime follow-up adapted to HPV status is mandatory. The development of HPV vaccination does not mean that campaigns against smoking and alcohol abuse are of diminished importance.

[Nonotologic osteomyelitis of the middle skull base]. / Ostéomyélite de l'étage moyen de la base du crâne d'origine sinusienne.

OBJECTIVES: The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the middle skull base. MATERIAL AND METHODS: Symptoms and treatment of five patients (sex ratio: 3/1; mean age: 57,1 ans) with osteomyelitis of the middle skull base treated from 1991 to 2005 are analyzed. All patients with a biopsy-proven diagnosis of osteomyelitis of the skull base were retrospectively evaluated. RESULTS: Four patients presented with asthenia, weight loss, headache, and fever. No patient presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Three patients had an underlying immunocompromising condition (diabetes mellitus, steroid and immunosuppressor use). CT scan and MRI demonstrated central skull base abnormality, mainly at the level of the clivus. Systemic antibacterial/antifungal therapy, aggressive debridement of involved bone, and medical optimization remain important in the treatment of this group of patients. CONCLUSION: The interpretation of the results is performed after an analysis of the literature.

[Granular cell tumours (Abrikossoff's tumour) of the parotid region]. / Tumeur à cellules granuleuses (tumeur d'Abrikossoff) de la loge parotidienne.

BACKGROUND: Granular cell tumour (Abrikossoff's tumour) was first described by Abrikossoff in 1926. These tumours are rare and usually presents as a solitary lesion, located mainly in the subcutaneous tissue of the head and neck, and in the oral cavity (tongue). CASE REPORT: We report a rare case of a granular cell tumor of the parotid gland, in a 55-year old woman, who was referred with a left preauricular mass that had rapidly increased in size over 2 months. There was no cervical lymph adenopathy. RMI demonstrated a solitary lesion of the parotid gland. Surgical resection was performed. CONCLUSION: We discuss the classification, pathophysiology and the treatment of granular cell tumours through a review of the literature.

Warthin's tumor of parotid gland: Surgery or follow-up? Diagnostic value of a decisional algorithm with functional MRI.

PURPOSE: Warthin's tumor is the second most frequent benign tumor of the parotid gland, with no risk of malignant evolution. That is why surgery should be avoided if the preoperative diagnosis is certain. The aim of the study was to assess the added value of a decisional algorithm for the preoperative diagnosis of Warthin's tumor. MATERIALS AND METHODS: This retrospective IRB-approved study included 75 patients who underwent standardised MRI with conventional sequences (T1- and T2-weighted images, and T1 post-contrast sequences with fat saturation) and functional sequences: diffusion (b0, b1000) and perfusion MR. Two independent readers reviewed the images using the decisional algorithm. The conclusion of each reader was: the lesion is or is not a Warthin's tumor. The MRI conclusion was compared with histology or with cytology and follow-up. We calculated the Cohen's kappa coefficient between the two observers and the sensitivity and specificity of the algorithm-helped-reading for the diagnosis of Warthin's tumor. RESULTS: Seventy-five patients; histology (n=61) or cytology and follow-up (n=14) results revealed 20 Warthin's tumors and 55 other tumors. Using the algorithm, sensitivity and specificity were 80-96%, and 85-100%, respectively for readers 1 and 2. The Cohen's kappa coefficient between the two observers was 0.79 (P<0.05) for the diagnosis of Warthin's tumor. CONCLUSION: Our decisional algorithm helps the preoperative diagnosis of Warthin's tumor. The specificity of the technique is sufficient to avoid surgery if a parotid gland tumor presents all the MRI characteristics of a Warthin's tumor.

[Tumors of the salivary glands]. / Les tumeurs des glandes salivaires.

Tumors of salivary glands arise mainly from the parotid gland. Magnetic Resonance Imaging (MRI) is mandatory not only to localize precisely the tumor within the gland but also to differentiate between benign and malignant neoplasms, in competition with cytology in fine-needle aspiration biopsy. Tumors without risk of transformation, such as adenolymphoma, are not systematically operated on. Indications of roentgenotherapy and irradiation volumes depend on histologic type, localisation and size of the tumor.

[Non-traumatic cerebrospinal fluid rhinorrhea of sphenoid origin]. / Rhinorrhée cérébro-spinale non-traumatique d'origine sphénoïdale.

The posterior wall of the sphenoid sinus is rarely implicated as a site of spontaneous cerebrospinal fluid fistula. Presented here is a case of CSF rhinorrhea of this nature, including the diagnosis workup and endoscopic approach permitting closure of the fistula.

Multifocal central nervous system lesions in three patients with trichinosis.

Three patients with trichinosis developed central nervous system complications. Cerebral computed tomography showed multifocal hypodense lesions in two patients. The lesions were associated with contrast enhancement and cortical gyral enhancement in the first case, suggesting hypoxia and infarction. In the second patient, magnetic resonance imaging showed multiple high-signal-intensity lesions. Early cerebral computed tomography was normal in the third patient. All patients recovered after treatment with antiparasitic drugs and corticosteroids. We suggest that neurologic complications of trichinosis should be treated by corticosteroids and flubendazole.

The aryepiglottic fold as a rare location of adenoid cystic carcinoma.

We report one case of a mass in the aryepiglottic fold seen on CT, which proved to be an adenoid cystic carcinoma. There was nothing specific about the imaging characteristics that would allow it to be confidentially differentiated from squamous cell carcinoma.

Ventriculus terminalis of the conus medullaris: MR imaging in four patients with congenital dilatation.

MR findings in four patients with MR evidence of congenital cystic dilatation of the ventriculus terminalis were reviewed retrospectively. The ventriculus terminalis is a small cavity of the conus medullaris that forms during embryonic development as result of canalization and retrogressive differentiation. The dilated ventriculus terminalis appears on MR images as a small ovoid cavity with regular margination; intralesional fluid resembles cerebrospinal fluid on all MR sequences. After injection of contrast material, MR imaging shows no enhancement of the cyst or its wall, and thus differentiates congenital dilatation of the ventriculus terminalis from cystic tumors, which occur more frequently in this region.

Normal laryngeal CT findings after supracricoid partial laryngectomy.

BACKGROUND AND PURPOSE: Supracricoid horizontal partial laryngectomy (SCPL) is increasingly used to treat endolaryngeal carcinoma. However, few radiologic reports of these procedures exist. Our purpose was to evaluate the normal CT appearance of the neolarynx after surgery. METHODS: SCPL includes cricohyoidopexy (CHP), cricohyoidoepiglottopexy (CHEP), and tracheocricohyoidoepiglottopexy (TCHEP). We examined CT scans obtained from 18 patients without local superficial recurrence who underwent SCPL: 10, CHEP; seven, CHP; and one, TCHEP. Three reference sections were used to analyze the main surgical reconstruction: an upper section through the hyoid bone, a lower section through the cricoid cartilage, and a middle section in between. The distance between the hyoid bone and cricoid cartilage was measured. RESULTS: The epiglottis and valleculae were visible in the upper section in seven of 10 patients who underwent CHEP; this finding allowed distinction between CHEP and CHP. The arytenoids were depicted in 13 of 18 cases and reflected neolaryngeal shortening. The lower section showed the empty cricoid lumen lined by a thin mucosa; the anterior arch of the cricoid was amputated at TCHEP. The middle section showed the neovestibule, the lateral boundaries of which were the hypertrophic neoaryepiglottic folds; the anterior limit was the epiglottis for CHEP or the base of the tongue for CHP. The average distance between the hyoid bone and cricoid cartilage was 11 mm. CONCLUSION: Normal CT anatomy of the larynx after SCPL is defined. Three key sections may accurately distinguish the various types of SCPL. CT is a valuable tool for depicting tumor recurrence, especially when the tumor is submucosal.

Comparative trial of Hexabrix (320 mg iodine/ml), iohexol (300 mg iodine/ml) and iopamiron (300 mg iodine/ml) in cerebral and spinal angiography: a preliminary report.

A comparison has been carried out of results of cerebral and spinal-cord angiography with two non-ionic contrast media, iohexol and Iopamiron, and a low-osmolality contrast medium, Hexabrix. A comparative study of iohexol, Hexabrix, and Iopamiron was carried out in a first group of 41 patients, and Hexabrix was compared with Iopamiron in a second group of 56. Evaluation criteria included local and general safety, as well as quality of angioscopy and angiography. In the first group of patients there were no significant differences in safety between the three agents. On the other hand, quality of visualisation during angioscopy with Hexabrix was clearly better. In the second group, safety and quality of the radiographic images were identical; however, once again, quality of angioscopy was better with Hexabrix than with Iopamiron. We conclude that Hexabrix appears to be the best opacifying agent currently available for cerebral and spinal-cord angiography. While results with Iopamiron were quite similar, the latter agent is slightly more expensive.

Value and limits of arthrography in the study of pathological mediopatellar plicae of the knee; a comparison with arthroscopy.

The results from arthroscopy and arthrography were compared in a prospective study of the mediopatellar plicae in 100 knees with internal disorders. With reference to arthroscopy, the sensitivity and specificity of arthrography for the detection of mediopatellar plicae were, respectively, 83.6 and 88.8%. The arthrographic signs of pathological plicae were: a thick plica, thicker than the internal condylar cartilage (sensitivity: 72%; specificity: 84%) and an interposed plica (sensitivity: 85%; specificity: 81.8%). Statistically the arthrographic signs agreed with the arthroscopic signs. The two methods did not differ significantly in their contribution to the diagnosis of pathological plicae.

Complication of jet ventilation during microlaryngeal surgery.

Complications during jet ventilation for microlaryngoscopy, which is usually a relatively safe procedure, are rare. Those described have included hypoventilation, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, and gastric distention. We describe herein a case of a life-threatening complication during jet ventilation with a Carden's tube that ended in laparotomy.

Computerized tomography of the glottis after intracordal autologous fat injection.

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autologous fat in one patient in whom this material was used for injection laryngoplasty.

Estimating anesthetic depth by electroencephalography during anesthetic induction and intubation in patients undergoing cardiac surgery.

Intravenous (IV) anesthesia titrated to continuous computer-processed electroencephalograms (EEGs) was studied in 32 consecutive patients undergoing cardiac surgery. Anesthesia was induced with fentanyl 50 micrograms/kg with no EEG monitoring (n = 16) or 25 to 50 micrograms depending on changes in EEG (n = 16). EEG, oxygen saturation by pulse oximeter, intra-arterial blood pressure (BP), central venous pressure (CVP), and pulmonary artery pressure (PAP) (n = 18) were monitored continuously. Cardiac output (CO), CVP, PAP, spectral-edge frequency for each hemisphere, and BP were recorded before induction, immediately before intubation, and 1 and 5 minutes after intubation. With EEG monitoring, intubation was performed when spectral-edge frequency decreased to 10 Hz or less. Recall and pain were investigated 2 to 12 weeks postoperatively. With EEG, the amount of fentanyl used before intubation was significantly lower (39.7 +/- 2 micrograms/kg; p less than 0.005) than without EEG (50 micrograms/kg). The decrease in BP (% change) was less with than without EEG; mean changes in BP between preinduction and preintubation were -7.4% +/- 3.8% and -16.5% +/- 3.1% and between preinduction and 1 minute after intubation 0.3% +/- 3.4% and -12.5% +/- 3.5%, respectively. Percent changes in mean BP between intubation and 1 minute after were 9.6% +/- 4.0% with EEG and 5.2% +/- 3.0% without EEG. No patient in either group had recall. The authors conclude that using EEG monitoring to estimate depth of anesthesia during induction and laryngoscopy may increase safety in high-risk patients undergoing cardiac surgery.

MRI features of craniopharyngiomas at 1.5 Tesla. A series of 13 cases.

Thirteen patients with craniopharyngioma were explored with a 1.5 Tesla magnetic resonance imager. The results were compared with those of CT and with operative findings. The MRI signals were correlated with the biochemical composition of the cysts (proteins, lipids, iron, LDH) in 5 cases; 2 patients were studied after an intravenous injection of gadolinium DOTA. MRI proved vastly superior to CT to evaluate the spread and identify the various components of craniopharyngiomas (cysts, fleshy parts, haemorrhages), except for calcifications. Gadolinium improved the detection of fleshy parts and "active" cysts. The signals emitted by cysts were extremely variable on T1-weighted sequences. The correlation between MRI and biochemical data was complex, but it appeared that protein, lipid and iron concentrations had a major influence on cyst signals. MRI with gadolinium may be envisaged as first-line examination to improve the evaluation of spread, determine the prognosis and detect recurrences of craniopharyngiomas. CT could be reserved to difficult cases with invasion of bones and sinuses.

[The value of magnetic resonance imaging in the diagnosis of spinal cord hemangioblastoma. Apropos of 12 cases]. / Intérêt de l'imagerie par résonance magnétique dans le diagnostic des hémangioblastomes médullaires. A propos de 12 observations.

This study concerned a series of 12 patients, 4 of whom had Von Hippel-Lindau disease. Six of these patients were explored by myelography, 6 by spinal cord angiography, 8 by CT scan with contrast injection and 12 by MRI, with gadolinium injection in 8. MRI proved to be the choice examination for the diagnosis of spinal cord tumor, but gadolinium injection was necessary since it made it possible to detect the tumoral bud and its intense enhancement. The absence of gadolinium injection led us to an erroneous initial diagnosis of syringomyelia in two patients and glioma in one. Sagittal sections made it easier to evaluate the tumoral extension in patients with evidence or suspicion of Von Hippel-Lindau disease. Arteriography was indicated, as it provided a preoperative map and diagnosed punctiform lesions.