Combined medico-surgical strategy for invasive sino-orbito-cerebral breakthrough fungal infection with Hormographiella aspergillata in an acute leukaemia patient.

Hormographiella aspergillata is a rare causative agent of invasive filamentous breakthrough infection, mostly arising after echinocandin exposure. We report a neutropenic patient who developed a severe sino-orbito-cerebral H. aspergillata infection while receiving empirical caspofungin, successfully controlled by an aggressive strategy associating surgical debridement and combined high-dose regimen of antifungal drugs.

Efficacy and safety of photodynamic therapy with temoporfin in curative treatment of recurrent carcinoma of the oral cavity and oropharynx.

Therapeutic options for recurrent carcinoma of the upper aérodigestive tract (UADT) are limited. The prognosis of these tumours remains poor with significant rate of recurrence and a lower median survival time. Photodynamic therapy (PDT) is a relatively new therapeutic alternative which combines the use of a photosensitising agent and light to induce a cytotoxic effect on the tissues. This is a retrospective single-centre study carried out in patients with a recurrence of an oral cavity or oropharyngeal carcinoma or a second appearance of tumour in a previously irradiated area. There were no metastases in lymph nodes or other organs. Laser treatment was carried out 96 h after temoporfin (Foscan(®)) injection. In our series we had 14 cases with a complete response, 1 partial response. Overall survival at 1 year was 72 % and 36 % at 5 years. Disease-specific survival at 1 year was 82 % and 45 % at 5 years. Recurrence-free survival at 1 year was 52 % and 34 % at 5 years. Side effects mainly described are pain in the area of illumination, well controlled. PDT with Foscan(®) gives useful results in terms of survival and improvement in quality of life with few adverse events or severe complications. The fact that it has low toxicity and that treatment sessions can be repeated mean it should be considered in the therapeutic armamentarium for recurrent carcinoma of the UADT.

Maxillary sinus fungal infection by Acremonium.

OBJECTIVE: To illustrate by this case report that Acremonium must now be considered as a differential diagnosis in cases of maxillary fungus balls. CASE REPORT: Seventy-seven-year-old woman consulted for persistent pain of the right maxillary sinus, with rhinorrhea and nocturnal coughing. Computed tomography (CT) of the sinuses showed a heterogeneous opacification of the right maxillary sinus with well-defined hyperdense foci suggesting aspergillosis. She underwent a middle meatus antrectomy by an endonasal approach. Six months after the surgery, her symptoms were gone and had not recurred. Mycological examination found Acremonium. DISCUSSION/CONCLUSION: Acremonium is a genus of saprobic fungi that rarely cause disease in humans. Infection with Acremonium has recently been described in immunocompromised patients. We describe the first case of fungal maxillary sinusitis caused by Acremonium in an immunocompetent person. Clinically and radiologically, the initial diagnosis was aspergillosis. Acremonium must be considered together with aspergillosis in all situations of fungus ball chronic sinusitis.

[T1-T2 NO hypopharyngeal cancers treated with surgery alone. A GETTEC study (French Neck Study Group)]. / Cancers de l'hypopharynx T1-T2 "N0" traités par chirurgie exclusive. Etude GETTEC.

OBJECTIVE: Consider whether surgery alone in the treatment of early cancers of the hypopharynx can give identical or better results in terms of survival and local control than radiotherapy. METHODS: Forty-five patients were operated on during the years 1991-2004. Surgical treatment consisted in a resection by the transoral approach in four patients and 41 patients had a partial pharyngolaryngectomy. An elective neck dissection was performed on 43 patients. RESULTS: The 1-, 3-, and 5-year overall survival rates were 100, 95, and 75%. The 1-, 3-, and 5-year locoregional control rates were 93, 88, and 82% and were influenced by the presence of dysplasia on surgical margins (p=0.027). The oncological occurrences observed were five local recurrences, two nodal recurrences, ten second primary cancers, and two metastases. Five locoregional failures out of seven were controlled after a second treatment. CONCLUSION: Surgery alone gives completely satisfactory results in terms of survival and locoregional control. In case of recurrence, this makes it possible to operate on patients in nonirradiated areas with lower morbidity and mortality and better results. These results must be confirmed by a randomized trial.

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses.

INTRODUCTION: Small cell neuroendocrine carcinoma (SNEC) of the sinonasal tract is a rare disease. OBJECTIVE: Report a descriptive study of a relatively large cohort of SNEC of the nasal cavity and paranasal sinuses. METHOD: The medical records of 21 patients presenting with nasal and paranasal SNEC to various French hospitals, from 1989 to 2003, were analysed to determine the clinical features and current treatment of the disease. RESULTS: Patient data were obtained from eight French hospitals. Twelve of the patients were male and nine were female, with a mean age at presentation of 55 years (range: 27 to 79 years). Patients' staging for nasal cavity malignancy was: T1, four; T2, three; T3, one; T4, 13; N0, 18; N2, three; M0, 20; and M1, one. None of the patients suffered from SNEC of the sinonasal tract with ectopic hormone production. Immunohistochemistry proved useful for diagnosis in 20 cases. Twelve cases were positive for cytokeratin, 14 for chromogranin, eight for neuron-specific enolase and 11 for neuron-specific synaptophysin. One patient had an adenocarcinoma and an inverted papilloma associated with neuroendocrine carcinoma. Patients underwent surgery (11 cases), radiotherapy (14 cases) and chemotherapy (12 cases). Recurrence occurred in 10 cases. Five patients had visceral metastases or cervical lymph node involvement. Nine of the patients died within four years of onset of the disease. CONCLUSION: Small cell neuroendocrine carcinoma of the sinonasal tract is an uncommon neoplasm with aggressive clinical behaviour. Recurrence is frequent and the prognosis is poor. However, the current treatment of these neuroendocrine neoplasms varies widely.

[Endobronchial lipomas and their treatment: one case report]. / Lipomes endobronchiques et leur traitement: a propos d'un cas.

PURPOSE: Starting from a clinical observation of an endobronchial lipoma and in the light of worldwide literature, the aim of this case report is to specify the epidemiology, the key points of the diagnosis and the advantage of endoscopy both in the diagnosis and the treatment of these rare benign bronchopulmonary tumours. CLINICAL CASE: Recent pneumopathy in the right superior lobe bronchial area in a 73 year old female, symptomatic with cought. Biopsy exeresis gave the histological diagnosis. DISCUSSION AND CONCLUSION: The clinical symptoms due to bronchial obstruction associated with the conventional radiological and computed tomography signs orientate the diagnosis definitively obtained through the anatomopathological study. This histological study is carried out from biopsies performed either during a bronchial fibroscopy or during a tracheobronchoscopy. By confronting the benign macroscopic aspect and the data from the extemporaneous anatomopathological study of the lesion, endoscopy provides an early-stage diagnosis and makes it possible to perform a concomitant and conservative treatment before the stage of irreversible broncho-pulmonary complications. It also avoids the risks and sequelae of classical surgery by thoracotomy.