Primary tuberculosis of the larynx.

INTRODUCTION: Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis, usually affecting the lung, but very rare cases of isolated laryngeal tuberculosis have been reported. PURPOSE: To demonstrate the importance of considering the diagnosis of this disease, which presents with very variable and sometimes misleading clinical and endoscopic features, but for which medical treatment is very effective. MATERIAL AND METHODS: This retrospective study was based on ten cases of laryngeal tuberculosis managed between January 2004 and December 2009. The objective of this study was to describe the epidemiology, clinical and complementary investigation findings and treatment of primary tuberculosis of the larynx in a context of endemic tuberculosis based on a review of the literature. RESULT: In this series, primary tuberculosis of the larynx essentially affected male smokers and drinkers. Clinical and endoscopic signs were totally non-specific and similar to those of laryngeal cancer. Only bacteriological and histological examinations were able to establish the diagnosis. Once the diagnosis was confirmed, antituberculosis chemotherapy was administered for a minimum duration of 6 months with excellent short-term and long-term results. CONCLUSION: Globally, the characteristics of this series are closely correlated with those reported in the literature. Due to the non-specific laryngeal signs observed on clinical examination, clinicians must consider the possibility of laryngeal tuberculosis and must not hesitate to confirm this diagnosis by bacteriological and histological examination

[Florid cemento-osseous dysplasia of the jaws]. / Dysplasie cémento-osseuse floride des maxillaires.

INTRODUCTION: Florid cemento-osseous dysplasia is a benign and rare tumor of the jaws. It is more commonly seen in middle-aged black women. Most cases are asymptomatic and are found during routine radiographic examination. OBSERVATIONS: We report two complicated cases of florid cemento-osseous dysplasia, one with facial deformity and the other with chronic osteitis. DISCUSSION: The diagnosis of florid cemento-osseous dysplasia is based on clinical and radiological features. The lesions are commonly bilateral and symmetrical.

[Primary extranodal ENT tuberculosis]. / La tuberculose primitive ORL extraganglionnaire.

OBJECTIVES: The aim of this sinusonasal study was to study several locations of ENT extranodal tuberculosis. MATERIAL AND METHODS: Our study focused on eight cases of tuberculosis in the cervicofacial region gathered in the ENT department of the Rabat Specialization Hospital (Morocco) between August 2004 and August 2006. They comprise two cases of rhinopharyngeal tuberculosis, two cases of tuberculosis, two cases of endobuccal tuberculosis (mandibular and lingual locations), and two cases of glandular tuberculosis (thyroid and parotid locations). RESULTS: These locations are rarely affected by tuberculosis. The clinical signs as well as radiology and endoscopy are not specific. The final diagnosis is based on histology. Bacillus cultures are necessary when caseum tuberculosis is not found, causing problems of differential diagnosis with granulomatous and malignant lesions. PCR provides quick bacterial antigen detection when cultures are negative. The treatment provides a quick and complete recovery while recurrences are infrequent. CONCLUSION: ENT tuberculosis is rare if excluding the nodal locations. It should be mentioned as a differential diagnosis, especially in endemic areas. Most often, this is a surprise diagnosis.

[Sinonasal adenocarcinomas reviewed. Prognostic value of WHO 2005 histological classification]. / Les adénocarcinomes nasosinusiens revisités. Intérêt pronostique de la classification histologique OMS 2005.

OBJECTIVES: The WHO 2005 histological classification separates sinonasal adenocarcinoma (ADC) into three classes: intestinal-type adenocarcinoma (ITAC), low-grade sinonasal ADC and high-grade sinonasal ADC. The goal of this study was to check the relevance of this classification on the prognosis of patients treated for ADC. PATIENTS AND METHODS: All the files of patients treated consecutively in the ENT department of the Montpellier University Hospital for ADC between 1980 and 2003 were retrospectively re-examined. Each case was reviewed for anatomical and pathological data based on the immunohistochemistry results according to the WHO 2005 classification, with a study of a panel of markers: cytokeratin 7 (CK7), cytokeratin 20 (CK20), Villin, CDX2 and EGFR. The epidemiologic data, the methods of treatment and the follow-up were studied. The survival probabilities were calculated using the Kaplan-Meier method and the survival graphs were compared using a log-rank test. RESULTS: Sixty-two files were reviewed. Twelve patients were reclassified into the adenoid cystic carcinoma category and excluded from the study. In the 50 remaining cases, there were 36 ITAC cases, four low-grade ADC cases and 10 high-grade dedifferentiated carcinomas. For all of the ADC cases, the total survival at 5 years and without recurrence was 64 and 52%, respectively. The analysis of the three subgroups showed a total survival of 72.2% for ITAC, 100% for low-grade and 20% for high-grade ADC with a significant difference (p=0.044). This immunohistochemical distinction was mainly based on the expression of CK20 found in 98% of the ITAC cases and absent in low- and high-grade ADC patients. CONCLUSION: The WHO 2005 classification for sinonasal ADC provides a valuable prognosis by showing a difference in the progression profile between ITAC, low-grade ADC and high-grade ADC. Moreover, broader studies should be conducted to investigate the different subtypes of ITAC.

[Primary tuberculosis of the parotid gland]. / Tuberculose primaire de la glande parotide.

OBJECTIVES: To report on a case of primary tuberculosis of the parotid gland in a 13-year-old child, and to stress the corresponding diagnostic pitfalls. CASE REPORT: A 13-year-old child presented with an isolated mass of the right parotid area. Radiological findings were in favour of a cystic lesion. Skin tuberculin test was positive. Bacteriological and histopathological examinations were realized after spontaneous fistulization of the mass, and allowed the diagnosis of tuberculosis of the parotid gland. Evolution was favourable under antituberculous chemotherapy. DISCUSSION: Localization of tuberculosis in salivary glands is rare. Diagnosis is difficult because there are no specific clinical, radiological or biological signs of the disease. Only bacteriological and histopathological findings can confirm the diagnosis. Fine needle aspiration cytology is very helpful, and permits to avoid abusive surgery. Treatment is based on antituberculous drugs and allows usually a favourable evolution.