A case report of synchronous bilateral multifocal nodular oncocytic hyperplasia in parotid gland.

INTRODUCTION AND IMPORTANCE: Multifocal nodular oncocytic hyperplasia (MNOH), alternatively known as Benign Nodular Oncocytosis, was first identified by Schwartz and Feldman in Cancer in 1969. It manifests as numerous nodular growths of oncocytic cells scattered within the salivary gland tissue; Bilateral and multifocal lesions in the parotid gland are rare occurrences. Among these, bilateral multifocal oncocytic lesions are even less common. CASE PRESENTATION: We report a case of 59-year-old woman with no prior medical or surgical history who presented to our ENT department due to a gradual, painless enlargement of both parotid glands that had been ongoing for four months. She underwent bilateral parotidectomy. Histologic exam confirmed the diagnosis of bilateral multifocal nodular oncocytic hyperplasia with a histological variant of clear cells. The postoperative course was unremarkable. CLINICAL DISCUSSION: Diagnosis presents challenges due to the rarity of this condition. Precise diagnosis relies on imaging techniques such CT scans and MRI features. There is no consensus on the therapeutic management. CONCLUSIONS: Our case report adds to the scarce literature concerning this condition, emphasizing the importance of careful clinical evaluation, precise diagnosis, and proper management.

Clinical manifestations, diagnosis, and management of first branchial cleft fistula: Case series and review of the literature.

INTRODUCTION AND IMPORTANCE: The first branchial cleft (FBC) is an extremely rare occurrence, manifesting as cysts, sinuses or fistula. Among all branchial anomalies, FBC represents 8-10 % of branchial clefts. It accounts for about 17 % of all cervical masses in childhood. FBC can be caused by inadequate removal or closure of the ectoderm. The location of the fistula can be adequately determined by magnetic resonance imaging (MRI). CASE SERIES PRESENTATION: We report three cases from the first branchial cleft fistula (FBCF) in our ENT Department with a good response to surgical treatment. Patients had an average of 24 months of follow-up. The aim of our study is to study the clinical manifestations, the diagnosis and the surgical management of the FBCF. DISCUSSION: An in-depth knowledge of the embryology of the neck and face will ensure early diagnosis and complete surgical resection of FBCFs, which will minimize the risk of severe complications including facial paralysis. CONCLUSION: FBC is rare and may present as a cyst or fistula. It is managed by surgical excision, leaving the tract cyst of the fistula intact with preservation of the facial nerve.

Malignant degeneration of thyroglossal duct cysts: Clinical aspects, imaging findings and management: Case series.

INTRODUCTION AND IMPORTANCE: Thyroglossal duct cysts (TDCs) are congenital anomalies that can rarely undergo malignant transformation, with approximately 1 % of operated TDCs demonstrating malignant degeneration. Therapeutic management and follow-up methods are still controversial subjects. CASE SERIES PRESENTATION: We report 3 cases of a papillary carcinoma of thyroid occurring in a thyroglossal duct cyst. The diagnosis was suspected preoperatively in 2 patients, hence the indication of frozen section examination. All patients underwent Sistrunk procedure associated with total thyroidectomy and central neck dissection. Concomitant papillary thyroid carcinoma was found in 2 patients. A complementary treatment by radioactive iodine 131 with frenetic hormone therapy was undertaken in all the cases. The follow-up showed no recurrence. CLINICAL DISCUSSION: The clinical presentation of thyroglossal duct cyst carcinoma is often nonspecific, posing challenges in early diagnosis. The chosen treatment strategy, involving the Sistrunk procedure, total thyroidectomy, and central neck dissection, along with adjuvant therapy using radioactive iodine 131 and frenetic hormone therapy, was effective in preventing recurrence. CONCLUSION: The management of degenerated TDC is based on a multidisciplinary approach. Papillary carcinomas of TDC generally have a good prognosis.

Huge second branchial cleft cyst: A case report.

INTRODUCTION AND IMPORTANCE: Second branchial cysts are benign dysembryological cystic tumors that develop in the antero-lateral part of the neck. They represent 2 % of laterocervical tumors of the neck and are usually diagnosed before adulthood. The cysts can increase in size and cause multiple complications. Ultrasound and MRI (Magnetic Resonance Imaging) confirm their cystic nature. Treatment consists of surgical excision. CASE PRESENTATION: We report the case of a 31-year-old woman who presented with a left laterocervical swelling measuring 8 cm, which had been present for 18 months without any other associated symptoms. An exploratory cervicotomy was performed, and the histological diagnosis was a second branchial cleft cyst without signs of malignancy. CLINICAL DISCUSSION: The definitive diagnosis of a second branchial cleft cyst is confirmed by anatomopathological examination. Therapeutic management is always surgical and should be performed as early as possible to limit the risk of complications. CONCLUSION: Second branchial cleft cysts are relatively uncommon malformations. Diagnosis is suspected based on physical examination, guided by imaging data, and confirmed by anatomopathological examination. Treatment is surgical, with complete removal of the cyst being necessary to prevent recurrence.

A rare case of submandibular mucocele extending into the oral cavity: A case report.

INTRODUCTION AND IMPORTANCE: Salivary mucoceles, originating from major and minor salivary glands, rarely affect the submandibular gland, accounting for just 0.6 % of its tumors and cysts. With only 18 case reports in the literature to date, their occurrence in this location is infrequent. CASE PRESENTATION: The patient is a 9-year-old male with no relevant medical history who developed progressive submandibular swelling extending into the oral cavity. CT scan confirmed a submandibular gland mucocele. Surgical treatment involved excision of the mucocele along with the submandibular and sublingual glands. The postoperative course was unremarkable. CLINICAL DISCUSSION: Diagnosis presents challenges due to potential similarities with congenital and acquired lesions. Precise diagnosis relies on imaging techniques such as ultrasound, CT scans, and MRI. Distinguishing between submandibular mucoceles and plunging ranulas remains intricate based solely on imaging findings. CONCLUSIONS: This case report contributes to the limited literature available on this condition, highlighting the necessity for vigilant clinical assessment, accurate diagnosis, and appropriate management within the pediatric population.

Acute presentation of giant parathyroid adenoma extending to the mediastinum: A case report.

INTRODUCTION AND IMPORTANCE: Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients. Giant parathyroid adenomas are rare and can present diagnostic and therapeutic challenges. The clinical presentation is often insidious, and acute presentation is uncommon. CASE PRESENTATION: Herein we report a case of primary hyperthyroidism secondary to giant parathyroid adenoma in a 54-year-old woman presenting with acute and severe hypercalcemia. Preoperative laboratory exams indicated elevated values of parathormone and serum calcium. CT scan and parathyroid scintigraphy showed a giant right inferior parathyroid adenoma measuring 6 cm in its largest diameter extending to the mediastinum. Despite its size and extension, the gland was successfully managed through a transcervical parathyroidectomy. The patient is actually asymptomatic and normocalcemic after a follow up of 3 years. CLINICAL DISCUSSION: Giant parathyroid adenomas can cause severe hypercalcemia. Imaging studies are crucial for preoperative localization. A classic transcervical approach can be used to remove giant adenomas, even when they extend into the anterior mediastinum. Despite their size, giant parathyroid adenomas have a good prognosis if they are removed surgically. CONCLUSIONS: Hypercalcemia associated with a giant, functional parathyroid adenoma can be life-threatening. It is management is urgent. It is both medical and surgitforward, and various morphologiccal including correction of hypercalcemia and parathyroidectomy.

An unusual presentation of papillary thyroid carcinoma: a case report.

INTRODUCTION: Parathyroid carcinoma (PC) is exceptional cause of primary hyperparathyroidism (PHPT). It has an estimated prevalence of 0.3 to 5.6% and is rarely associated with non-medullary thyroid cancer. OBSERVATION: We report a case of parathyroid carcinoma resulting in a hyperparathyroidism and revealing a papillary thyroid carcinoma and emphasize on the management particularities of this entity. A 37-year-old woman, with prolactin secreting pituitary microadenoma, presented with asthenia and bone pain. Laboratory findings were consistent with PHPT. Neck ultrasonography showed a 3 cm nodule adjacent to the right thyroid lobe with no abnormalities in the thyroid gland. Parathyroid scintigraphy showed a right inferior parathyroid adenoma. Because of the patient age and the decreased renal function, surgical treatment was required. During the intra-operative neck exploration, a juxta-thyroid tumoral right mass was strongly adherent to the right infra-hyoid muscle and the recurrent laryngeal nerve. The frozen examination of the mass demonstrated malignancy features suggesting a poorly differentiated thyroid carcinoma. Thus, a total thyroidectomy with bilateral central neck dissection was carried out. Final histopathological examination showed a 3.5 cm PC infiltrating the thyroid gland with a papillary thyroid microcarcinoma of the left thyroid lobe. External radiotherapy of the neck, indicated for PC, was performed 1 month after surgery. A radioactive iodine therapy was used 6 months postoperatively. CONCLUSION: Despite its rarity, PC is to bear in mind in case of PHPT. The association between PC and differentiated thyroid carcinoma is not to be ignored.

A rare case of primary sinonasal meningioma: A case report.

INTRODUCTION AND IMPORTANCE: Extra cranial primary meningioma of sinonasal tract is a rare entity. It is often misdiagnosed as nasal polyp. CASE PRESENTATION: Here we report a case of a primary ethmoid sinus meningioma with extension into the nasal cavity in a 41-year-old man. The tumor was completely excised via endoscopic endonasalapproach and the histologic diagnosis of meningioma was established. The patient was regularly follow up for 12 months without recurrence of the tumor. CLINICAL DISCUSSION: The final diagnosis of primary sinonasal meningioma is based on histopathology and immunohistochemistry analyses results. The importance of complete surgical resection is undoubted and also is a goodindicator prognosis. CONCLUSION: The otolaryngologists should be aware of the diagnosis of primary meningioma; despite of its rarity it is considered as a possible cause of nasal obstruction.

Management of Isolated sphenoidal aspergillosis: Case report and review of literature.

INTRODUCTION AND IMPORTANCE: Sphenoidal aspergillosis is an uncommon serious condition that could lead to a fatal outcome. There is dilemma in its management. Published data concerning this pathology are limited so we find interesting in adding our experience to the literature mass. In fact, this work focused on the description of the clinical features of this entity as well as its management by presenting a case report and reviewing literature. CASE PRESENTATION: We report a case of 53 years old male who presented to the outpatient department of our university teaching Hospital with isolated chronic headache complaint that evolving through two years. His physical examination revealed no abnormalities. CT scan of facial bone and MRI showed an aspect in favor of sphenoidal aspergillosis. He underwent an endoscopic sphenoidotomy. Microscopic examination was consistent with the diagnosis of sphenoidal aspergillosis. There were no needs to associate an antifungal treatment since we estimate the surgery excision was complete. The patient remained free of disease after surgery for a follow-up of 4 years. CLINICAL DISCUSSION: Aspergillosis is ubiquitous in nature, currently causing severe disease in both immunocompetent and immunocompromised patients. Its frequency has increased over the past few years due to the widespread use of antibiotics, corticosteroids, and improved diagnostic methods. Surgery is the primary form of treatment, however if signs of invasion are present, it should be supplemented with an anti-fungal treatment. CONCLUSION: Sphenoidal aspergillosis is a rare condition whose diagnosis is not always obvious. The clinician should always bear this diagnosis in mind in patients with chronic sinusitis avoiding invasive and fulminant forms which could be life-threatening.

Solitary Fibrous tumor of Nasal cavity: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Solitary fibrous tumors (SFTs) involving the nasal cavity are extremely rare with few cases reported in the literature. CASE PRESENTATION: We present a case of SFT in a 90 year-old male complaining of a slow-growing mass prolapsing through left nostril. Nasal endoscopy and imaging exams revealed a mass occupying the entire left nasal cavity, pushing the nasal septum to the opposite side and extending up to the nasopharynx. Biopsy specimen examination reported sarcoma. The patient underwent complete surgical resection of the mass through left para-latero-nasal approach. Immuno-histochemical analyses confirmed the diagnosis of SFT. The patient has remained free of tumor 2 years after surgery. CLINICAL DISCUSSION: Clinical and imaging features of SFTs of nasal cavity are not specific. A broad of differential diagnosis is associated with histopathologic features of SFTs. Therefore, immuno-histochemical analyses are crucial to confirm the diagnosis. Complete resection of the mass with clear margins is mandatory to minimize local recurrence. CONCLUSION: SFTs of nasal cavity are very rare neoplasms which continue to pose challenges to practitioner. Pathological examination and mainly immunohistochemical studies are important to establish the diagnosis. Complete resection of the tumor is the key for good outcome.

Acute idiopathic velopharyngeal insufficiency.

Idiopathic velopharyngeal insufficiency is a rare clinical entity. Typical clinical features are rhinolalia and nasopharyngeal regurgitation. It is usually observed in children. We report a case of a 28-year-old female with this rare disorder. The symptoms were rhinolalia and regurgitation of liquids into the nose. The magnetic resonance imaging of the brain and upper cervical region was normal. The infectious serologies were negative.

Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.

A huge retropharyngeal lipoma: a rare cause of dysphagia: a case report and literature review.

Dysphagia is commonly seen after a cerebral vascular accident. It is rarely caused by lipomas of the retropharyngeal region which are rare benign mesenchymal neoplasms. We report a case of a 53-year-old man who presented with a history of ptyalism and dysphagia occurring after a brain stroke. Flexible nasal endoscopy revealed a pooling of saliva in both pyriform sinuses. Cervical and neurological examinations were unremarkable. Computed tomography (CT) scan suggested the diagnosis of retropharyngeal lipoma. The mass was resected by trans-cervical approach. The histological examination confirmed the diagnosis of a retropharyngeal lipoma. The postoperative course was unremarkable. Although lipomas in the retropharyngeal space are rare, clinicians should evoke this diagnosis when treating a patient presenting with dysphagia, even if there is a medical history of cerebral vascular accident.

Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results.

Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ±â€Š6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.

Extranodal NK/T-cell lymphoma in Tunisia: clinicopathological features, immunophenotype and EBV infection.

BACKGROUND: Extranodal NK/T-cell lymphomas (ENKTL) are rare non-Hodgkin's lymphomas with aggressive clinical behavior. ENKTL are frequently associated with the Epstein-Barr virus (EBV). Data on ENKTL in Africa and Arab world are extremely limited. The study investigated the clinicopathological characteristics, EBV infection, and immunophenotype of ENKTL in Tunisia. We conducted a retrospective study of ENKTL. Main clinicopathological features were reported. The expression of CD3, CD4, CD5, CD8, CD20, CD56, CD57, and Granzyme B were analyzed by immunohistochemistry. EBV infection was detected by IHC (LMP-1) and Epstein-Barr encoding region (EBER1/2) in situ hybridization. RESULTS: A total of nine ENKTL were identified (mean age of 48 years and male-to-female ratio of 8:1). There were five nasal ENKTL, and the remaining four cases had extranasal involvement (palate, sub-mandibular gland, skin, and soft tissues of the ankle). The histopathology showed a lymphoid and pleomorphic proliferation characterized by images of angiocentrism. Strong and diffuse CD3 expression was observed in all cases. Tumor cells exhibited an expression of CD5 (two cases), CD8 (three cases), CD56 (six cases), CD57 (three cases), and Granzyme B (eight cases). All ENKTL cases were EBV-associated. Overall 5-year survival rate was 57%. Although six ENKTL were diagnosed at early clinical stages, the prognosis was unfavorable and associated with patient death in three cases. CONCLUSIONS: ENKTL are exceptional in Tunisia with unfavorable outcome. Histopathological diagnosis remains challenging in clinical practice. However, a careful histopathological examination combined with a correct interpretation of immunohistochemistry and in situ hybridization results refines the ENKTL diagnosis.

Laryngeal synovial sarcoma: Report of 2 cases.

Synovial sarcoma is a malignant mesenchymal tumor. It most commonly occurs in the lower extremities of young adults. The head and neck are rare sites, accounting for less than 10%. The larynx is an extremely rare site. We report two cases of 27 and 18 year-old men who developed a synovial sarcoma of the larynx. They presented with hoarseness of voice and hemoptysis. Endoscopy detected a mass in the supraglottic region. The biopsy concluded a synovial sarcoma. Immunohistochemistry conveyed diagnostic certainty. They had been treated with total laryngectomy and post-operative radiotherapy. The 2 patients are seen for regular follow-ups in our department and they remained recurrence-free for 10 years and 24 months, respectively. Synovial sarcoma is a very rare tumor of the larynx. A multidisciplinary therapeutic approach is essential for the management of this malignancy. Long-term follow-up is required to monitor for recurrence and improve disease-free survival.

[Metastatic nasopharynx cancer at diagnosis: clinical and prognostic (study of 51 cases)]. / Cancer du cavum d'emblee metastatique: étude clinique et pronostique (à propos de 51 cas).

This retrospective study aimed to highlight the different epidemiological, clinical, therapeutic and prognostic features of nasopharinx cancer with inaugural metastases in patients hospitalized in a Tunisian Hospital. We here report 51 cases of histologically diagnosed nasopharynx cancer (NPC) with inaugural metastases. Data were collected in the ENT departments and in the radiation therapy departments at the University Hospital Farhat Hached, Sousse, Tunisia as well as at the Centre Medical Ibn Khaldoun, Hammam Sousse, between January 1995 and December 2010. We collected data on 51 patients with metastatic nasopharynx cancer at diagnosis. The average age was 49 years. Sex ratio was 6,2. Bone metastases were the most common finding (94.1%), followed by liver metastases (34.6%). In the majority of our patients therapeutic approach was based on chemotherapy (41 patients); 31 of these patients underwent chemotherapy in combination with radiation therapy. Adriamycin+cisplatin protocol was the most frequently used (92.6%). Twenty patients underwent cervicofacial radiation therapy with curative purposes (doses ≤ 70 Gy), fourteen patients underwent radiation treatment to the nasopharynx with symptomatic purposes (doses of 30Gy in 10 sessions) associated with radiation treatment to the metastatic sites in 9 cases. Overall survival at 2 years and 5 years was 29% and 10%, respectively. Nasopharinx cancer with inaugural metastases is a serious disease, rapidly fatal despite therapeutic advances. In view of our data and of those from the literature cisplatin-based chemotherapy and cervicofacial radiation therapy with curative doses and that of metastases resulted in long-term survival and even in complete responses. Future trials should focus on new molecules for therapeutic intensification.

Second branchial cleft cyst: about 34 cases.

BACKGROUND: the amygdaloid cyst is a rare laterocervical cystic tumor arising from the second branchial cleft. It accounts for 2% of laterocervical tumors. AIM: analyze the anatomo-clinical characteristics and discuss the management and therapeutic indications of second branchial cleft cysts. METHODS: we report a 14-year retrospective study (2000-2013) concerning 34 cases of amygdaloid cysts diagnosted and treated at ENT department of Farhat Hached hospital of Sousse. RESULTS: The average age of our patients was 27 years with a sex ratio 0.8. Physical examination found a cervical mass in all the cases: jugulo-carotid in 26 cases (77%), supraclavicular in two cases (6%). The location was not specified in 6 cases (17%). Cervical ultrasound was performed in 30 patients, and showed a cystic mass in 17 cases. Complement by CT was performed in 5 patients suggesting the diagnosis of second branchial cleft cysts in two cases. One patient had an MRI for a large supraclavicular mass. A fine needle aspiration biopsy was performed in 13 patients. All patients underwent surgery with complete excision of the cyst. Histopathological examination confirmed the diagnosis of second branchial cleft cysts, with 2 cases of malignant degeneration. One case of recurrence was noted. CONCLUSIONS: Second branchial cleft cysts are relatively rare malformations. Their diagnosis is confirmed by pathological examination. The treatment is surgical.

[Gallbladder agenesis: about three cases]. / Agénésie de la vésicule biliaire: à propos de trois cas.

Gallbladder agenesis is a rare congenital anomaly. This study aimed to highlight the epidemiological aspects of this condition as well as the peculiarities of its diagnostic and therapeutic management through three case reports. Two adults were admitted to Hospital with hepatic colics and dyspepsia. Ultrasound showed multilithiasic scleroatrophic vesicle. In one of the two patients, CT scan results showed a stone at the level of scleroatrophic vesicle. These two patients were wrongly operated for vesicular lithiasis by using conventional method. The absence of gallbladder was detected during surgery. In order to confirm post-operative diagnosis, the first patient underwent biliary MRI. The other patient was lost to follow-up. The third patient was a 13-year old child hospitalized with acute pancreatitis. Vesicular agenesis was suspected based on its scannographic aspect and then confirmed using biliary MRI. This patient didn't underwent surgery.