Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers(SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire.Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the first cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10.CONCLUSION: The VHI is a reliable self assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers (SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire. Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the rst cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10. CONCLUSION: The VHI is a reliable self-assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Usefulness of IGF-1 serum levels as diagnostic marker of nasopharyngeal carcinoma.

BACKGROUND: The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters. MATERIALS AND METHODS: IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controls RESULTS: Our results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p<0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p<0.01). The IGF-1 levels are, also, higher among women compared to men (p<0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p<0.01). CONCLUSION: IGF-I could be a good nasopharyngeal cancer diagnostic marker.

The CC-genotype of the cyclooxygenase-2 gene associates with decreased risk of nasopharyngeal carcinoma in a Tunisian population.

BACKGROUND: The cyclooxygenase-2 (cox-2) pathway is now recognized to be important in human cancer development and progression. The gene for cox-2 carries a common single nucleotide polymorphism, T8473C, located within a potential functional region in the 3'-UTR of cox-2 gene was identified. We have investigated the frequencies of cox-2 genotypes in Tunisian population to determine whether that polymorphism was associated with the risk of nasopharyngeal carcinoma (NPC) in Tunisian population. MATERIAL AND METHODS: One hundred and eighty-nine NPC patients were compared to 237 healthy controls. RESULTS: The cox-2 T8473C polymorphism was significantly associated with NPC (P=0.031). The CC-genotype and C allele were more frequent in control compared to patients group [CC: OR=0.37; P=0.013; 95% CI: 0.17-0.81; C: OR=0.72; P=0.032; 95% CI: 0.53-0.97]. Multivariate logistic regression analyses revealed that the CC-genotype was associated with a significantly decreased risk of NPC (P=0.013). Tumor sizes, histologic grade, presence of primary lymph node metastases, age or sex were not associated with cox-2 genotypes. CONCLUSION: We conclude that the CC-genotype and C allele of cox-2 T8473C gene polymorphism are associated with decreased risk of nasopharyngeal carcinoma in a Tunisian population.

Adenopathies cervicales metastatiques d'un carcinome non retrouve

Introduction : Les adenopathies cervicales metastatiques d'un carcinome non retrouve representaient 3 a 5 des cancers de la tete et du cou. Cette entite pose un probleme de prise en charge. But : Soulever les difficultes diagnostiques et therapeutiques et degager les principaux facteurs pronostiques regissant le controle local de la pathologie et surtout la survie. Materiels et methodes: Cette etude retrospective a ete portee sur une serie de 80 cas d'adenopathies cervicales metastatiques primitives colliges entre 1980 et 2007. Resultats : Tous les malades ont eu un examen clinique complet; une panendoscopie des VADS avec des biopsies systematiques. Une cytoponction a l'aiguille fine a ete realisee chez 65 de nos malades. Tous les patients ont eu une cervicotomie avec examen histologique. Le carcinome epidermoide etait retrouve dans 70 des cas; alors que 11 des malades avaient un adenocarcinome et 1;5 avaient un melanome. La chirurgie a ete indiquee pour 25 malades. Une radiotherapie post operatoire aete appliquee pour 21 malades. Le protocole associant a la radiotherapie; une chimiotherapie neo adjuvante etait indique chez 27 malades. La survie globale moyenne etait de 2;5 ans. Conclusion : Le pronostic etait significativement aggrave par : l'age superieur a 65 ans; le stade N3 et l'envahissement ganglionnaire avec rupture capsulaire

Carcinome epidermoide du larynx chez la femme

Le cancer du larynx est assez rare chez la femme. Cependant; il risque d'etre en recrudescence a cause de l'augmentation du tabagisme feminin. Peu de travaux se sont consacres a rechercher les specificites du cancer du larynx chez la femme. But: Analyser le profil epidemiologique et clinique des femmes porteuses d'un carcinome epidermoide du larynx et degager les caracteristiques therapeutiques; evolutives et les facteurs pronostiques chez cette population. Methodes: etude retrospective portant sur 50 femmes prises en charge pour un carcinome epidermoide du larynx sur une periode de treize ans (1994-2006). Resultats : L'age moyen de nos patientes etait de 63;5 ans. L'intoxication tabagique etait retrouvee chez 32;6 des patientes. Chez 30 de nos patientes aucun facteur de risque n'a ete retrouve. Les signes cliniques etaient domines par la dysphonie suivie de la dyspnee et la dysphagie. Les tumeurs prenaient naissanceau depend de l'etage glottique dans 55;8 des cas. Nous avons releve que 60;4 des tumeurs etaient vus a un stade evolue T3-T4 et que 95;3des tumeurs etaient initialement classees N0. La chirurgie a ete pratiquee chez 47;5 des patientes tandis que 16;2 ont recu une radio-chimiotherapie. La survie globale cumulee etait de 78;8 a 3 ans et de 73;5 a 5 ans. Conclusion : L'absence des facteurs de risque classiques chez un grand nombre de nos patientes laisse supposer le role d'autres facteurs etiopathogeniques dans la genese du cancer du larynx chez la femme. Toute dysphonie chez la femme doit etre exploree meme en l'absence de facteurs de risque. La prise en charge et le pronostic semblent superposables a celui de l'homme

Prise en charge des cancers primitifs des glandes submandibulaires

Introduction :Les tumeurs malignes de la glande submandibulaire se caracterisent par une grande diversite histologique. de ce travail est de rapporter notre experience dans la prise en charge de ces tumeurs et de suggerer une attitude therapeutique apres revue de la litterature. Patients et methode : Il s'agit d'une etude retrospective a propos de 20 patients colliges sur 17 ans. La decision therapeutique etait prise au sein d'un comite multidisciplinaire. Les moyens therapeutiques etaient la chirurgie tumorale et ganglionnaire; la radiotherapie et la chimiotherapie. Les pieces operatoires ont ete adressees pour examen anatomopathologique extemporane et definitif. Une surveillance clinique et radiologique a ete realisee. Le recul moyen etait de 35 mois. Resultats: L'age moyen etait de 60;75 ans. Le delai moyen de consultation etait de 6;15 mois. La tumefaction submandibulaire etait le motif de consultation chez tous les patients. Des adenopathies cervicales etaient notees chez 8 patients (40). Seize patients avaient beneficie d'une tomodensitometrie cervicale et du massif facial et un autre d'une Irm. La radiographie du thorax montrait un aspect de lacher de ballon chez un patient et une opacite mediastinale chez un autre. L'abstention chirurgicale avait ete decidee pour 2 patients. Les patients metastatiques ont ete operes uniquement dans un but diagnostique. Dix-huit patients (85) ont eu une submandibulectomie; dont une elargie a la mandibule. Pour le geste ganglionnaire; 11 patients ont eu un curage selectif triangulaire et 3 un curage fonctionnel complet. Une radiotherapie postoperatoire a ete realisee chez 14 patients (70). Une radiotherapie palliative isolee a ete realisee chez 2 patients. Une chimiotherapie palliative a ete indiquee chez les 2 patients presentant des metastases a distance lors du diagnostic; mais n'a ete administree que dans un cas. La remission complete etait notee dans 11 cas (55). Un seul patient avait presente une poursuite evolutive. Une recidive loco-regionale avait ete decelee chez 2 patients. Deux patients avaient developpe secondairement des metastases a distance. Le taux de mortalite dans notre serie etait de 25. Conclusion: Les cancers de la glande submandibulaire representent une pathologie peu frequente. Le diagnostic a grandement beneficie de l'apport de l'imagerie. La strategie therapeutique depend du stade tumoral au moment du diagnostic et de l'etat general du patient. Le pronostic de ces tumeurs reste toujours reserve; surtout pour les tumeurs de haut grade diagnostiquees a un stade avance

Place du prelevement ganglionnaire dans le traitement des cancers differencies de la thyroide n0 clinique

Objectif : Demontrer l'interet du prelevement ganglionnaire sus-claviculaire et jugulaire inferieur dans la prise en charge des cancers differenties de la thyroide (CDT) N0 clinique. Materiel et methodes : Nous rapportons une etude retrospective a propos de 170 patients colliges sur 12 ans 2005). Tous les patients ont eu une thyroidectomie totale en 1 ou 2 temps. Le curage mediastino-recurrentiel a ete pratique soit systematiquement soit en cas de decouverte d'adenopathies en peroperatoire. Le curage lateral a ete realise soit de principe soit apres un prelevement ganglionnaire sus-claviculaire et jugulaire inferieur positif a l'examen extemporane. Des doses ablatives d'iode radioactif ont ete administrees en cas d'elevation du taux de la thyroglobuline ou d'une fixation d'iode lors du balayage cervico-thoracique. Resultats : L'examen anatomopathologique trouvait un carcinome papillaire (74;1); vesiculaire (16;5) ou papillaire a composante vesiculaire (9;4). Trente patients ont eu un curage fonctionnel systematique uni ou bilateral; une metastase ganglionnaire a ete notee chez 9 d'entre eux. Cent quarante patients ont eu un prelevement ganglionnaire uni ou bilateral; un curage fonctionnel a ete pratique chez 6 d'entre eux devant un examen extemporane positif. Les taux de remission; de recidive et de metastases etaient respectivement de 83;3; 6;7et 10dans le premier groupe; et de 89;3; 4;3et 6;4dans le deuxieme groupe. Par ailleurs; un deces a ete observe chez deux patients du deuxieme groupe (1;4) . Aucune difference statistiquement significative n'a ete retrouvee entre les differents taux. Conclusion : Les resultats de notre serie mettent en evidence l'interet du prelevement sus-claviculaire et jugulaire inferieur permettant d'eviter le curage fonctionnel systematique

Carcinome a petites cellules du sinus piriforme : a propos d'une observation

Les auteurs rapportent un cas de localisation au sinus piriforme d'un carcinome a petites cellules. Ce type histologique a ete souvent decrit dans la pathologie tumorale pulmonaire. Sa localisation au sinus piriforme etant exceptionnelle. Nous presentons dans ce document les aspects endoscopiques; radiologiques; anatomopathologiques et therapeutiques de cette tumeur qui a ete diagnostiquee chez un patient de 56 ans

Les cancers de l'orbite et l'etude retrospective : a propos de 31 cas

Introduction : Les cancers de l'orbite sont rares. Ils sont caracterises par leur diversite histologique et leur agressivite locoregionale rendant le traitement difficile et mutilant. Dans ce travail; nous rapportons notre experience dans la prise en charge diagnostique et therapeutique de ces tumeurs. Materiels et methodes : Notre etude retrospective a concerne 31 cas de cancers de l'orbite colliges sur 13 ans (1993- 2005). Tous les patients ont beneficie d'un examen clinique complet; d'une imagerie du massif facial (TDM et/ou IRM) et d'une biopsie de la tumeur. Le traitement a ete base sur la chirurgie; la radiotherapie et/ou la chimiotherapie. Resultats : La symptomatologie clinique etait dominee par les signes ophtalmologiques et les algies faciales. L'imagerie a montre dans tous les cas un processus expansif tissulaire a point de depart orbitaire; avec lyse osseuse orbitaire chez 16 patients (51;6); une extension au massif facial chez 7 patients (22;6); endocraniennes chez 6 patients (19;4) et des formes bilaterales atteignant les deux orbites dans 3 cas (9;7) L'anatomopathologie montrait une predominance des lymphomes malins non hodgkiniens (32;3) et des carcinomes epidermoides (32;3); suivis des rhabdomyosarcomes embryonnaires (19;4). Douze patients ont ete traites par chirurgie et radiotherapie postoperatoire; dix patients par une association radio-chimiotherapie; et neuf autres par une chimiotherapie neo-adjuvante. La survie globale etait de 67;8 a 3 ans; 48;4 a 5 ans et 22;6a 10 ans

[Thyroid carcinoma and Hashimoto thyroiditis]. / Carcinome de la thyroïde et thyroïdite de Hashimoto.

OBJECTIVES: To study of the association between thyroid carcinoma and Hashimoto's thyroiditis (HT). MATERIAL AND METHODS: [corrected] Retrospective study of 78 patients undergoing surgery between 2001 and 2002, with a pathological diagnosis of Hashimoto's thyroiditis. The clinical data and complementary tests performed before surgery are reported. RESULTS: The mean age was 44.6 years, with 77 females and only one male. There were 12 cases of thyroid cancer associated with HT, mostly with the nodular form, with 11 papillary carcinoma (14.1%) and one non-hodgkin B lymphoma of the thyroid. Tumor size varied from 4 to 60 mm with a mean of 26 mm. There was one microcancer (size<10 mm). CONCLUSIONS: We did not find an increased incidence of thyroid cancer associated with this highly selected population of HT patients.

[Epidemiology of nasal and paranasal sinus cancer in Tunisia]. / Epidémiologie des cancers du massif facial en Tunisie.

OBJECTIVE: To report the epidemiological and clinical features of nasal and paranasal sinus cancers collected during a period of 35 years at the Salah Azaiez Institute of Tunis. MATERIAL AND METHODS: This retrospective study concerned patients with histologically confirmed nasal and paranasal sinus cancers treated at our institute from 1969 to 2004. We collected the following data: age, sex, residence (rural or urban), site, occupation and professional exposure, histological type and tumor extension. RESULTS: We identified 265 cases (163 M; 102 F; Sex-ratio=1.65) with a mean age of 60 years (3 months - 91 years). Epidermoid carcinoma (47%) and adenocarcinoma (16%) predominated followed by sarcoma (14%) and melanoma (6%). We observed only 2 cases (0.7%) of ethmoidal adenocarcinoma. CONCLUSION: Nasal and paranasal cancers in Tunisia are linked more to chronic rhino-sinusal inflammation than professional exposition (wood).

[Regional failure of hypopharyngeal squamous cell carcinoma]. / Echecs ganglionnaires du carcinome épidermoïde de l'hypopharynx.

PURPOSE: Lymph nodes and distant metastases contribute to the poor prognosis of hypopharyngeal squamous cell carcinoma. The purpose of this study is to estimate the frequency, mode and prognosis factors related to regional and distant metastasis. PATIENTS AND METHOD: The authors' report is based on a retrospective study concerning 271 hypopharyngeal squamous cell carcinoma, compiled in the service of Surgery of Head and Neck Cancers of the Salah-Azaïz Institute (1977-2002). Frequency and histoclinical characters of cervical and distant metastases have been assessed, as well as their prognosis factors among 155 patients treated in a curative purpose. RESULTS: 39.1% of the tumours were classified N0, 24.4% N1, 10.7% N2 and 25.8% N3 (UICC 2002). The cervical nodal invasion was significantly more frequent for the classified tumors T3T4 than for the T1T2 (for pyriform sinus, postcricoid esophagus, posterior wall, and total hypopharynx, respectively : P =0.001, P =0.007, P =0.047 and P =0.0005). A cervical lymphatic evidement was preferred in thirty two patients. Among N0, 46.9% were N+; The frequencies of the capsular effraction were not significantly different for the N0N1 from for the N2N3 (P =0.11). The two and five years survival rates were respectively 32.5 and 20.5% for N0, and 10.9% and zero for N3. The survival differences after two and five years between the N0N1 and the N2N3 were significant (P =0.04). A regional failure was noticed for 18.5% of the patients. The tumoral site did not influence significantly the rate of nodal failure (P =0.98), neither the clinical status N (P =0.34). Capsular effraction was a significant factor for the regional failure (P =0.007). Distant metastasis significantly occurred more frequently among the patients initially classified N2N3 than those classified N0N1 (P =0.03), and in case of capsular effraction (P =0.0009). CONCLUSION: Hypopharyngeal squamous cell carcinoma has a high rate of lymph nodes metastasis, correlated to the local extension, and a high rate of occult nodal metastasis. Lymph node clinical status does not seem to have influenced the patients survival; however, capsular effraction constitutes a major prognosis factor of regional failure and distant metastasis. Distant metastases are frequent, particularly in case of wide local and regional tumoral extension.

[Hypopharyngeal squamous cell carcinoma: retrospective study of 149 patients]. / Carcinome épidermoïde de l'hypopharynx: étude rétrospective de 149 traitements à visée curative.

PURPOSE: Hypopharyngeal squamous cell carcinoma is associated to one of the most unfavorable prognosis among the cancers of the head and neck. The purpose of this study is to analyze its therapeutic modalities in the Salah-Azaïz Institute (Tunis) and to compare their results. PATIENTS AND METHOD: This retrospective study concerns 271 hypopharyngeal squamous cell carcinomas, compiled in the Carcinologic Surgery Department of Head and Neck of the Salah-Azaïz Institute over a period of 25 years (from 1977 to 2002). The average age of the patients was of 56 years; sex-ratio was on average of 1.2 (man/woman). The indication of a curative treatment was initially retained for 149 (55%) patients, who were the only ones retained for the analysis of results. RESULTS: We retained the indication of a protocol including surgery and postoperating radiotherapy for 26.2% of the patients. Postoperation mortality rate was 5.1%; the operating rate of morbidity was 46.2%. For 13.5% of the patients, postoperating radiotherapy was permanently interrupted because of a gradual deterioration of the patients' health in the course of treatment. We retained the indication of exclusive radiotherapy for 59.7% of the patients. The average age was of 56 years and the sex-ratio of 1.2. The external radiotherapy was conventional. Radiotherapy had to be permanently interrupted in progress in 32.6% of cases on account of an deterioration of the patients' health; the rate of morbidity of the radiotherapy was 33.3%. We indicated a protocol of conservation of organ with induction chemotherapy for 21 patients (14.1%). The average age was of 53 years (28-65 years) and sex-ratio (man/woman) of 0.5. The global survival was 25.5% at one year, 18.1% at two years, 11.4% at three years and 7.4% at five years. All the patients selected for chemotherapy died in the course of treatment. The rates of survival in two and five years according to protocols surgery-radiotherapy and exclusive radiotherapy were respectively: 21.5 and 12%, and 18.3 and 10%. The difference between the rates of survival of this two protocols is not significant (P =0.08). CONCLUSION: Although the induction chemotherapy entails a particularly high death rate in our series, the association surgery-radiotherapy and the exclusive radiotherapy seem to be similarly efficient for the treatment of the hypopharyngeal carcinoma.

[Metachronous cancers after treatment for undifferentiated nasopharyngeal carcinoma]. / Cancers métachrones après traitement des carcinomes indifférenciés du cavum.

OBJECTIVE: To collect second cancers occurring in the head and neck area after treatment by chemotherapy and/or radiotherapy for undifferentiated nasopharyngeal carcinoma in Tunisia. PATIENTS AND METHODS: This is a retrospective study of patients developing second cancers after treatment for nasopharyngeal UCNT by radiotherapy and/or chemotherapy. To be retained in this study, second tumour had to be histologically different from the initial UCNT, localised in the irradiated area and occurring after a minimal delay of 3 years. RESULTS: We collect 11 cases of second cancers occurring among 2346 patients treated from 1984 to 2001 in Tunisia (0.46%). Patients have been treated for nasopharyngeal UCNT mainly advanced T3-T4 (72%) or N2-N3 (63%). Median age was 20 years (11 to 48) with a sex-ratio of 0.3 (3 M/8 F). Treatment protocol included primary chemotherapy in 4 cases (adriamycin-cisplatin) or adjuvant (in 4) associated to the loco-regional irradiation at a mean dose of 72 Gy (70 to 75). Median delay of second cancer occurrence was 9 years (3 to 17). Tumors were epidermoid carcinomas in 4 cases, fibrosarcomas (2), osteosarcomas (2), glioblastoma (1) and basocellular carcinomas in 2. Second tumors have been treated by surgery alone in 4 cases and chemotherapy alone in 7 patients. No patient have been reirradiated. Median survival was 17 months, 4 patients died and 7 are still alive including 4 in complete remission (24+, 36, 36 and 48+ months) and 3 with progressing disease (8, 16 and 18 months). CONCLUSION: Even very rare, second cancers after treatment for UCNT need to be detected and have a poor prognosis.

[Thyroid papillary microcarcinoma. Salah Azaiz Institute experience]. / Microcarcinomes papillaires de la thyroïde. Expérience de l'Institut Salah Azaiz.

The incidence of thyroid papillary microcarcinoma appears to be increasing and therapeutic modalities remain controversial. This retrospective study concerns 25 cases, from 1978 to 1999. The circumstances of diagnosis were: a cervicotomy for thyroid nodule (88% of cases), cervical node metastases (8%), and osseous metastases (4%). The sensitivity of ultrasounds was 22.2%, that of scintigraphy was 9.1% and that of extemporaneous histological examination was 18.2%. Multifocality was found in 16% of cases and bilaterality in 16.6%. Treatment modalities were guided by histological examination. Adjunctive radioiodine ablation was used for 20% of the patients. The treatment of the osseous metastases was completed with external irradiation. The average follow up was 4.8 years (4 months to 19 years), with a rate of survival without disease of 100%.

[Cervical lymph node involvement in carcinomas of the mobile tongue in Tunisia. Retrospective study of 135 cases]. / Envahissement ganglionnaire dans les carcinomes épidermoïdes de la langue mobile (CELM) en Tunisie.

OBJECTIVE: To report the profile of histologic cervical nodes involvement associated with mobile tongue squamous cell carcinoma. PATIENTS AND METHODS: Our retrospective study concerned patients treated from 1978 to 1998 by cervical neck dissection for mobile tongue carcinoma. RESULTS: A population of 135 patients (90 M/45 F, sex-ratio 2) with a 53.5 mean age (19 to 75) is analyzed. Clinical palpable nodes were present in 68 cases (50%) mainly submental-submaxillar (54). Histologic examination showed a node involvement in 54 cases without (32 cases) or with capsular rupture (22 cases) mainly in the jugulo-carotidian chain (46/54). Among the 67 clinically N0 patients collected after 1990, 22 patients (33%) exhibited an histological involvement vs 32/68 (47%) for the group presenting palpable cervical nodes for the whole period. Histologic node involvement seemed to be linked to the clinical status, node size and TNM stage. CONCLUSION: Cervical lymph node treatment needs to be systematic in mobile tongue carcinoma. The probability of histologic involvement is linked to the loco-regional extent of disease and influences the prognosis. In N0 patients, neck dissection is required because of the frequency of histological involvement, particularly when loss to follow-up may be expected.

[Thyroid oncocytomas]. / Les oncocytomes thyroidiens.

OBJECTIVE: Thyroid oncocytomas are rare tumors. They put problems of differential diagnosis enter malignant and benign forms. The modalities of the surgical treatment are controversial, in form as benign as malignant. Their prognosis is also debated. MATERIAL AND METHOD: Our retrospective study concerns 111 thyroid oncocytomas, so 6.5% of thyroid operated in our centre between 1981 and 2001. The sex-ratio of the patients was 0.16 with an average age of 41 years (15 to 72 years). RESULTS: All the fixed nodules, those associated to a recurrential paralysis, to tangible nodes or/and to microcalcifications on the radiography of the neck was malignant. Histological extemporaneous exam was not decisive in 16% of cases, among which 33% showed themselves malignant in the definitive exam, which put in evidence 9 carcinomas (8%). We treated benign oncocytomas by a loboisthmectomy for the isolated nodules, and the subtotal or total thyroidectomy for multinodular glands. For oncocytic carcinomas, we realized a total thyroidectomy with ganglionic taking and histological extemporaneous exam, followed by evidment in case of invasion (2 patients). For the 5 patients having presented a residual fixation, we obtained a white cartography after radioactive iodine administration. For the benign oncocytoma, we did ot notice any recurrences with an average drop of 28 months (2 months to 7 years). For carcinoma, 8 patients on 9 presented an actuarial survival without disease with an average drop of 44 months (18 months to 8 years). CONCLUSION: The diagnosis of malignancy of thyroid oncocytomas can be strongly evoked on however fickle clinical and radiological criteria; it can be eliminated only after definitive anatomo-pathological exam.