Peripharyngeal space tumors: Can magnetic resonance and multidetector-row computed tomography help predict location, malignancy and tumor type?

PURPOSE: The goal of this study was to assess the performances of magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) in determining tumor location, suggesting the specific diagnosis of tumors involving the peripharyngeal space and identifying findings suggestive for malignancy using histopathological findings as standard of reference. MATERIAL AND METHODS: The MDCT and MRI examinations of 99 patients with a total of 102 tumors located in the retropharyngeal, carotid and parapharyngeal spaces were retrospectively reviewed. MDCT and MRI examinations were independently analyzed for tumor location and specific histological type of tumor. Finally, benign or malignant criteria were evaluated. Agreement between imaging features and final histopathological diagnosis that served as the standard of reference was assessed with the Kappa statistic. RESULTS: Regarding tumor location almost perfect agreement was obtained between imaging findings and histopathological findings (kappa=0.86 and 0.92 for MDCT and MRI, respectively). Agreement between the results of imaging and histopathological findings regarding malignancy was substantial for MDCT (Kappa=0.73), MRI (Kappa=0.65). A definite histopathological diagnosis was suggested on the basis of imaging findings for 84 tumors and in agreement with the final histopathological diagnosis in 77/84 tumors (92%). CONCLUSION: MDCT and MRI provide accurate information to localize and characterize peripharyngeal tumors. These two examinations provide complementary data to identify imaging criteria that suggest malignancy.

Isolated lateral semicircular canal aplasia: Functional consequences.

INTRODUCTION: Lateral semicircular canal aplasia is a malformation of the inner ear, usually associated with vestibular and cochlear malformations in the context of congenital malformation syndromes. We report a rare case of a young patient with isolated lateral semicircular canal aplasia and no associated vestibular symptoms. CLINICAL CASE SUMMARY: A 20-year-old man with no personal or family history presented with persistent unilateral tinnitus for three years with no associated vestibular symptoms. Moderate unilateral right sensorineural hearing loss was detected. Magnetic resonance imaging demonstrated isolated aplasia of the right lateral semicircular canal. Videonystagmography revealed right hyporeflexia. Vestibular evoked myogenic potentials were absent after stimulation on the right side and normal on the left side. DISCUSSION: Although the morphological abnormalities appeared to be isolated on imaging, the patient presented functional signs of global cochlear, semicircular canal and otolithic lesions, probably related to a developmental disorder of the membranous labyrinth. Functional investigations must be performed in the presence of isolated semicircular canal aplasia, even when it is an incidental finding, to exclude more extensive labyrinthine lesions.

[Parotid involvement in Churg-Strauss syndrome]. / Atteinte parotidienne et syndrome de Churg-Strauss.

INTRODUCTION: Churg-Strauss syndrome is a rare systemic vascularitis. This disease causes eosinophilic tissue infiltration. The most frequent manifestations are cortico-dependent asthma, mono- or polyneuropathy, paranasal sinus polyposis, and digestive and renal dysfunction. Salivary glands are very rarely involved. OBSERVATION: We describe a case of CSS in a patient presenting with bilateral parotid swelling. The morphological study of salivary glands revealed an unusual thickening of the salivary duct walls. DISCUSSION: Salivary gland involvement in Churg and Strauss syndrome can be difficult to demonstrate histologically; it does not usually present in the clinical foreground of the disease, and can be a source of misdiagnosis. The biopsy should be performed in the symptomatic gland, away from any previous corticoid treatment.

Prognostic factors for secondary recurrence of pleomorphic adenoma: a 20-year, retrospective study.

PURPOSE: To evaluate the results of treatment of parotid pleomorphic adenoma, and the risk factors for secondary recurrence. MATERIALS AND METHODS: Single-centre, retrospective study of 32 patients with pleomorphic adenoma recurrence managed between 1988 and 2008. RESULTS: The mean age at diagnosis of primary pleomorphic adenoma recurrence was 43.4 years. Twenty-eight per cent of patients had secondary recurrence; 32 per cent had undergone two or more surgical resections and external adjuvant radiotherapy. An age of less than 25 years was significantly associated with an earlier primary recurrence (p = 0.008). The most significant histopathological risk factor for secondary recurrence was the presence of a multifocal tumour (p = 0.019). Other histopathological criteria (i.e. cellularity and capsule rupture) were not significant. Radiotherapy was not associated with a decrease in recurrence. Nine per cent of patients progressed to malignancy. The main surgical complication was definitive facial palsy (14 per cent). CONCLUSION: Pleomorphic adenoma recurrence requires surgery, with greatly increased risk to the facial nerve. Resection with clear surgical margins is required, especially in young patients with multifocal tumours. Radiotherapy may delay second recurrence in cases of multifocal tumour.

Adenoid cystic carcinoma of the paranasal sinuses: retrospective series and review of the literature.

OBJECTIVES: Adenoid cystic carcinomas (ACC) are rare malignant tumours arising in the major and minor salivary glands. Involvement of the nasal cavity and paranasal sinuses is rare and poorly described. The purpose of this study was to define the clinical and prognostic criteria of ACC of the paranasal sinuses based on the review of a series of 25 cases. MATERIAL AND METHODS: Single-centre retrospective study of 25 cases of ACC of the paranasal sinuses managed between 1998 and 2011, evaluating epidemiological, clinical, diagnostic and prognostic criteria. Factors influencing survival (Kaplan-Meier/Log Rank test) and the patient's quality of life (EORTC QLQ-C30 questionnaire) were also analysed. RESULTS: Most patients (72%) had a locally-advanced tumour (stage T3 or T4) at diagnosis. Tumour sites, in decreasing order of frequency, were the maxillary sinus, nasal cavities and ethmoid sinus. The most common presenting complaints were maxillary pain or heaviness, unilateral blocked nose, and repeated epistaxis. When the tumour was resectable, treatment comprised a combination of surgery and adjuvant radiotherapy. The 5-year overall survival rate was 63% and the 5-year disease-free survival rate was 43%. The TNM stage at diagnosis (P=0.03), the histological subtype (P=0.023), the possibility of combined surgery and radiotherapy (P=0.03), and local control (P=0.05) were significant factors of improved 5-year overall survival. Positive surgical margins were associated with a trend towards poorer 5-year disease-free survival (ns). CONCLUSIONS: ACC are rare malignant tumours associated with a poor prognosis, characterized by a high recurrence rate. Recommended treatment is a combination of surgery and adjuvant radiotherapy whenever possible. Five-year survival varies as a function of TNM stage, histological subtype, treatment options and local control.

[Parapharyngeal tumors: management and postoperative results]. / Tumeurs de l'espace parapharyngé: prise en charge et résultats postopératoires.

OBJECTIVES: Parapharyngeal space tumours are rare and mostly benign, and their access is difficult. The aim of the study was to define the optimal treatment of these tumours. MATERIAL AND METHODS: Clinical retrospective study, with histological, treatment, prognosis analysis of the parapharyngeal space tumours occurred between 1994 and 2012 and the surgical approach considerations. RESULTS: 35 patients were included with a male sex ratio predominance (51.43%, p = ns). The mean age of diagnosis was 49 years. The majority of tumours were benign (75.76%, p < 0.001). 54.5% originated from salivary gland with a majority of pleomorphic adenomas (42.42%). The second most frequent aetiology found was schwannoma (21.21%). 2 patients refused the treatment. Accidentally discovered were frequent (28.57%). In the symptomatic forms, dysphagia dominated (25.71%). Oropharyngeal (20%) and/or cervical (17.14%) mass were rare. A CT scan and a MR imaging were performed in 82.86% and 71.43% of the cases. A fine needle aspiration cytology was achieved in 10 cases with a positive predictive value of 60%. The cervical submandibular trans digastric approach was the most accomplished (40%). Other approaches were also used: Trans oral (25.71%), parotidectomy (14.71%), combined trans oral and cervical or parotidectomy (14.71%) and the cervical approached associated to a mandibulotomy (5.71%). A complementary treatment was proposed in 85.7% of the cases of malignant tumours. Post-operative complications were dominated by Horner's syndrome (n = 3), a temporary facial palsy (n = 5), definitive (n = 1), a velar insufficiency (n = 1), persistent pain (n = 6). CONCLUSIONS: The presence of 25% of malignant tumours and 40% of pleomorphic adenomas require removal of parapharyngeal tumours, even if non symptomatic.

[Ethmoidal metastasis revealing lung adenocarcinoma]. / Métastase ethmoïdale révélant un adénocarcinome pulmonaire.

OBJECTIVES: Ethmoidal cancers are rare and are mostly primitive adenocarcinomas. Sinuso-nasal metastases from adenocarcinoma occurring in other localisations are exceptional. We report a case of a patient presenting with an ethmoidal metastasis revealing a pulmonary adenocarcinoma. CASE REPORT: A 57 years-old patient consulted for a right fronto-orbital pain which had appeared 3 weeks prior, associated with a central scotoma of the right eye and a third and fifth cranial nerve palsy. MR-imaging revealed a right ethmoidal tumour invading the orbit. Pathology results were in favour of a metastasis from a secondary adenocarcinoma. The CT-scan disclosed a pulmonary tumour of the right apex with liver and spleen metastasis. CONCLUSION: Ethmoidal metastases are rare and often diagnosed in patients presenting with a previously known tumour. We report the first case of a pulmonary adenocarcinoma revealed by an ethmoidal metastasis. We emphasize the point that in ethmoidal tumours, pathological investigations are important for diagnosis.