[Thyroid cancers]. / Les cancers thyroïdiens.

During the last two decades, the incidence of thyroid cancer has doubled, mainly do to the early detection of small papillary tumors. However, mortality stayed stable (0.05/100.000). Well differentiated cancers (papillary and follicular) demonstrated a excellent survival prognosis (95 % at 30 years for the majority of the patients), factors of prognosis: age, size of the initial tumor, presence (or not) of distant metastases, lymph node involvement (only in patients 45 year or older). Surgery is the main treatment and should be with curative intent, hence the importance of a thorough preoperative work-up: sonography, needle aspiration cytology and MRI of cervicomediastinum for large tumors and/or suspected lymph nodes. Total thyroidectomy is mandatory, excepted for well selected patients with small (pT1) unilateral tumors under the age of 45. Central compartment lymph node clearance is advocated (but not evidence based) with presentation of the recurrent laryngeal nerves and of the parathyroids. Ablation of residual thyroid tissue (Iode 131) should be advocated for patients at high (or intermediary) risk of recurrence, only after multidisciplinary concertation. Unlimited follow-up checking the thyroglobulin serum local after the total thyroidectomy and radioactive ablation, the availability of recombinant rhTSH avoids the withdrawal of thyroid hormones (hypothyroid period). Anaplastic carcinomas are very aggressive, no therapeutic solution, excepted in some selected case for when radical surgery is possible (flap reconstruction) followed by chemoradiation. Calcitoninenia to detect and to follow medullary thyroid cancer after total thyroidectomy and lymph node clearance.

Undifferentiated carcinoma of the nasopharynx and leukemoid reaction: report of case with literature review.

A case of undifferentiated carcinoma of the nasopharynx presenting as a cervical mass associated with a paraneoplastic neutrophilic leukemoid reaction is reported. The diagnosis of undifferentiated nasopharyngeal carcinoma of the Regaud type was established by the presence of aggregates of epithelial neoplastic cells separated by areas of reactive lymphoid cells; the epithelial nature being confirmed by the positivity for epithelial markers (AE1/AE3, EMA). Serum IL-1a, GM-CSF and TNF alpha remained undetectable suggesting that these factors were not involved in the occurrence of the paraneoplastic leukemoid syndrome.

[Preoperative autotransfusion for elective surgery]. / L'autotransfusion préopératoire pour intervention programmée.

In order to eliminate the risk of transmission of infectious diseases and of alloimmunisation, a pre-deposited autologous blood program for elective surgery has been started at the Erasmus Hospital. In 8 months, 51 patients have given 111 units of packed red cells and 111 units of fresh plasma. Two vasovagal reactions were observed. Four patients were withdrawn from the program in view of a hematocrit decreasing below 34%. Out of these 51 patients, 27 (53%) were transfused with only autologous blood. The autologous blood not distributed to these patients was given to other patients (10% of packed red cells and 24% of plasma). This pre-deposited autologous program has allowed to operate more than 50% of patients, undergoing elective surgery, only with autologous blood and to save homologous blood. The pre-deposited blood appears to be an interesting tool in transfusion safety and in the reduction of blood demand.

[Tuberculous laryngitis: not so rare?]. / La laryngite tuberculeuse: pas si rare?

It is a well-known fact that tuberculosis is a major health problem in developing countries. What about its incidence in European countries, especially in Belgium? We present a case of laryngeal tuberculosis in which the clinical appearance of laryngeal malignancy was amazing. The histopathological examination revealed tuberculosis. The laryngeal involvement is the first and single sign of the primary pulmonary form. Recent Belgian epidemiological data are illustrated.

Mucorales and deferoxamine: from saprophytic to pathogenic state.

Rhinocerebral mucormycosis can be a rapidly fatal course disease if the institution of treatment is delayed. We describe a case of a long-term dialysis patient in which the role of a siderophore such as Deferoxamine in promoting mucormycosis is discussed. The frequent lack of early diagnosis, itself subsequent to a break away from the standard diagnostic tools (apart from biopsy and culture) makes the survival prognosis particularly critical.