Massive multinodular head and neck recurrence of parotid gland pleomorphic adenoma: a case report.

Introduction. The optimal initial management of parotid pleomorphic adenomas reduces the risk of recurrence and malignant transformation. Surgery of recurrence can be difficult in multinodular disseminated forms. Case Report. A 67-years-old patient was referred for management of a large multifocal recurrence of a pleomorphic adenoma operated on 23 years ago. The clinical and radiological assessment found parapharyngeal, infratemporal, and prestyloid invasion, with nodules in the sternocleidomastoid muscle. Excision by transmandibular approach was performed. The pathologist found a multinodular recurrent pleomorphic adenoma without criteria of malignancy. Postoperative radiotherapy was performed. Discussion. Multinodular forms and incomplete resections are the most important factors that are thought to predispose to recurrence. A precise analysis of the extension by preoperative MRI is essential. Adjuvant radiotherapy can be given in these recurrent multifocal forms.

Transtracheal esophageal stent removal: a case-series.

Benign esophagorespiratory fistula is a rare but often lethal affection and difficult to cure. Possible treatments are surgery or esophageal stenting but may fail and cause respiratory failure. Two patients with spontaneous esophagorespiratory fistula after chemoradiotherapy for an esophageal malignancy were both treated by esophageal exclusion but esophageal stent were left in place. The esophageal stents were transtracheally removed through the fistula. The removals were successful, patients could leave Intensive Care Unit and returned home. Transtracheal esophageal stent removal is technically possible but very risky. Such situations must be avoided: esophageal stents must absolutely be removed before esophageal exclusion.

Inverted papilloma with associated carcinoma of the nasal cavity and paranasal sinuses: treatment outcomes.

CONCLUSIONS: Degenerated inverted papilloma is a rare, aggressive, and lethal disease. To avoid missing the target, it is absolutely necessary to consider the microscopic extension even in cases of complete exeresis and to irradiate the whole of the adjacent sinuses. A dose increase may lead to better locoregional control. OBJECTIVE: To evaluate overall survival and progression-free survival of external radiotherapy in the management of nasal cavity and paranasal sinus inverted papilloma with associated carcinoma. METHODS: Clinical data from 11 patients treated by surgery followed by external radiotherapy (three-dimensional conformational radiotherapy until 2007 then intensity-modulated radiation therapy) for degenerated inverted papilloma in the Léon Bérard Cancer Centre between 1985 and 2009 were retrospectively analyzed. RESULTS: Five patients (45%) had a local recurrence and died from their recurrence. Three had a premature recurrence, just before or during radiotherapy. We could not determine the prognostic factors for overall survival and progression-free survival.

Pre- and posttherapeutic staging of laryngeal carcinoma involving anterior commissure: review of 127 cases.

Background. The objective of this study is to assess the accuracy of pre- and posttherapeutic staging of endolaryngeal cancer involving anterior commissure. Materials and Methods. 127 patients were included in this retrospective study, and laryngectomy (partial or radical) was achieved in all of them. Initial radioclinical evaluation (cT) was performed (endoscopy-CT scan) and compared with postoperative histopathological findings. Results. 24,6% of cT2 and 33,3% of cT3 laryngeal tumors were reclassified pT4 after the histopathological examination. Conclusion. pre-therapeutic staging (combining endoscopy-CT scan) of endolaryngeal cancer involving anterior commissure is inadequate and sometimes underestimates thyroid cartilaginous invasion. Nethertheless, a precise diagnostic assessment by surgery with postoperative histological findings is possible. Cartilage and/or paraglottic structures are involved, or not, on the laryngectomy specimen exam. So surgery should always be discussed in first line in transdisciplinary meeting for endolaryngeal cancer management.

Alimentation impact of treatments of 254 oropharyngeal cancers (1998-2003).

Objective. To analyze the functional impact of the various possible treatments of oropharyngeal squamous cell carcinomas to find the main prognostic factors of dysphagia induced by these treatments. Patients. Clinical data from 254 patients treated for squamous cell carcinoma of the oropharynx between 1998 and 2003 were retrospectively analyzed. A multivariate model enabled us to evaluate the role of each potentially harmful factor on swallowing. Main Outcome Measures. The significant factors influencing the consumption of liquid, pasty, and normal food were the same: the initial T stage and the type of treatment. Conclusion. Whatever the possible and selected treatment was, the impact on the functional capacities, and thus, the quality of life of the patients was considerable. Even though we could not significantly demonstrate exclusive radiotherapy caused more long-term undesirable effects than surgery followed by radiotherapy, our daily practice has shown that we should favour the latter.

Determination of predictive factors of tracheobronchial prosthesis removal: stent brands are crucial.

OBJECTIVES: We sought to describe in a retrospective study our experience in the endoscopic management of tracheobronchial stenoses over 20 years and to determine prognostic factors of stent removal. METHODS: We analyzed the medical records of 166 patients (111 male and 55 female) who underwent the placement of a prosthesis for all causes of tracheobronchial stenosis between 1990 and 2009. RESULTS: Overall, 34% of the patients had their stents removed. The incidence of complications for the first stent was 0.08 per patient-month. One hundred five patients (63%) had no complications. In univariate analysis, stent removal was significantly linked with the stent brand. In multivariate analysis, taking into account the causes of stenosis, the stent brand appeared to be the only factor that significantly influenced stent removal. Finally, stenosis with more than 1 stent replacement was most prone to repeat endoscopies. CONCLUSIONS: Even though endoscopic stent placement is a relatively safe and effective treatment for tracheobronchial stenoses, particularly in cases with malignancy, complications led to stent removal in about one third of cases. The type of stent chosen is crucial.

Cartilaginous tumors of the larynx: endoscopic laser management using YAG/KTP.

BACKGROUND: The objective of this study was to analyze results of endoscopic YAG laser management as a treatment of chondroma and/or low-grade laryngeal chondrosarcoma. METHODS: Between 1996 and 2006, 13 patients were included, 11 men and 2 women with a median age of 69.7 years at diagnosis. Primary treatment included endoscopic laser resection in all cases. All tumors were diagnosed as cricoid cartilaginous tumor by histopathologic examination: 6 chondromas and 7 chondrosarcomas grade 1. RESULTS: The global actuarial survival rate was 95% for 5 years. The 5-year Kaplan-Meier disease-free survival and overall recurrence rate estimates were 72% and 54%, respectively. With a median follow-up time of 5 years, 12 of 13 patients were without recurrence. Nine were alive and 4 died during follow-up, and only 1 patient died from disease. Three patients required definitive tracheotomy. None had required it for endoscopic laser complications. CONCLUSION: Laser endoscopic surgery is 1 of the conservative surgical ways to manage laryngeal chondroma especially in cases of elderly patients with poor health status. It permits adequate removal of the tumor and still maintains structural and functional integrity and preserves possibilities of subtotal or total salvage surgery.

Management of tracheobronchial stenoses with endoprostheses: experience with 103 patients and 11 models.

OBJECTIVE: To describe in a retrospective study our experience in endoscopic management of tracheobronchial stenosis with 145 stents (11 different models). METHODS: We analyzed the medical records of 103 patients (67 males and 36 females) who underwent the placement of prosthesis for any causes of tracheobronchial stenoses between 1990 and 2005. RESULTS: A total of 145 prostheses were placed. Of these, 96.1% of the patients had a relief of dyspnea, and 73.8% had only one prosthesis. Stent removal and replacement were significantly linked with etiologies (more frequently in patients with an inflammatory component), but not with the type of stent. CONCLUSION: Endostenting is a safe and effective treatment for tracheobronchial stenoses. Removal and replacements were due to etiologies of the strictures, but not to the type of stent. Stenoses with an inflammatory component were prone to iterative stenting. Only benign diseases that are a contra-indication to open surgery should be treated by endoscopic stenting.