Histology of solid lateral cervical masses biopsied in children.

INTRODUCTION: Solid cervical lateral neck masses in children may require surgical biopsy to confirm appropriate diagnostic and begin a directed therapeutic treatment. We aimed to describe the contribution of pathological results and compare them with the clinical diagnosis and the paraclinical tools. METHODS: A retrospective review of surgical biopsies for solid lateral neck masses in children over a ten year period in a pediatric tertiary center was conducted. Demographic, imaging, laboratory analysis, surgical and pathological data were collected and analyzed using descriptive statistics with SPSS 17.0. RESULTS: 44 biopsies were done between 2002 and 2012. Inflammatory masses were found in 26/44 biopsies with half of them (13/26) being nontuberculous mycobacterial (NTM) lymphadenitis. Non-inflammatory/benign masses represented 9/44 biopsies and 5/44 masses were of malignant etiology. Malignant masses imaging had a sensitivity and specificity of 33% and 75%, respectively, for ultrasound, whereas Neck CT scan had 33% and 77%, respectively. The contribution of pathological results to the clinical management was questionable in 39% (17/44) of biopsies. CONCLUSION: Inflammatory masses with NTM lymphadenitis were the most common diagnosis. Imaging was not helpful in establishing the diagnosis. Heterogeneity in the management of solid lateral neck masses between clinicians was important and indicates the need for guideline approach.

Langerhans' cell histiocytosis of the temporal bone in children.

OBJECTIVE: Langerhans' cell histiocytosis (LCH) is a rare pathology that implies an abnormal proliferation of these kinds of cells associated with a granular infiltration that affects different structures of the human body, including the temporal bone. The authors present their series of LCH of the temporal bone in children at the Sainte-Justine university hospital. The twofold objective of this study is to illustrate the clinical presentation, management and prognosis of this disease, and to compare these results with previously reported series. METHODS: A retrospective study was conducted between 1984 and 2007 with patients diagnosed and treated for a LCH of the temporal bone at the Sainte-Justine university hospital, a paediatric tertiary care center. A chart review was performed to obtain demographic, clinical, paraclinical, and therapeutic data. They were analysed and compared to other published series. Through a MEDLINE query, we found that since 1966, 50 articles dealing with a LCH of the temporal bone have been published. RESULTS: Fifty-nine cases of LCH were diagnosed and among them, 10 children had temporal bone involvement. They were four females and six males with a mean age of 3.28 years. The two most frequent clinical manifestations were the presence of a mass in the temporal region (70%) and otitis (60%). Two of our patients had a unifocal lesion of the temporal bone implicated. Eight patients had a multisystem involvement among which, two showed evidence of organ dysfunction. In 80% of cases, the diagnosis was made by immunohistochemical findings of the S-100 protein and/or the CD1 antigen. The common radiological finding on a skull CT scan is a lytic lesion in the temporal bone. Seven patients were treated by chemotherapy, two were treated by radiotherapy as a primary treatment, and one received radiotherapy for a recurrence on the pituitary gland. Finally, one patient was treated with local steroid injections. Two patients had a recurrence. All our patients were in total remission on a mean average of 1.6 years after the diagnosis. Our results concord with other studies in which the prognosis of unifocal bone disease is excellent and children with a multifocal disease have a survival rate of 65-100%. CONCLUSION: LCH is a rare disease. A high-index suspicion should be raised in the context of a temporal mass, chronic otitis, and otorrhea. A biopsy is recommended in the presence of a temporal bone lytic lesion. Chemotherapy is the preferred therapeutic modality.

Temporal bone rhabdomyosarcoma in children.

OBJECTIVE: Rhabdomyosarcoma is the most frequent soft tissue sarcoma in the pediatric age group. The authors present their series of rhabdomyosarcoma of the temporal bone in children at Saint Justine Hospital. The twofold objective of this study is to illustrate the clinical presentation, management, and prognosis of this malignant striated muscle tumor, and to compare these results with previously reported series. METHODS: A retrospective study was conducted of patients diagnosed and treated for rhabdomyosarcoma of the head and neck at Saint Justine Hospital, a tertiary pediatric center, between 1970 and 2005. Only cases of temporal bone rhabdomyosarcoma were included in the study. A thorough review of medical and surgical charts was performed to obtain demographic, clinical, paraclinical, and therapeutic data, which were subsequently analyzed and compared to published results. A MEDLINE search yielded 34 studies dealing with temporal bone rhabdomyosarcoma since the year 1966. RESULTS: Thirty-nine patients with rhabdomyosarcoma of the head and neck region were identified, among which only six children had temporal bone rhabdomyosarcoma. The mean age at the time of diagnosis was 4.15 years. Chronic otitis media was the most common clinical presentation. Five children had the embryonal subtype and one had the botryoid subtype on histology. All patients except two received combined chemotherapy and radiotherapy as treatment. Five-year survival rate was 66%. Our results match those reported in the literature 41-81%. CONCLUSION: Rhabdomyosarcoma of the temporal bone is an aggressive tumor that clinically simulates chronic otitis media. A high index of suspicion should be raised in the context of otitis media that is unresponsive to ordinary medical treatment. A biopsy is hence recommended in the presence of polyps in the external auditory canal that are resistant to medical treatment. Early diagnosis and the adoption of multimodal therapy offer the best outcome.

Effectiveness and long-term results of laparoscopic common bile duct exploration.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a cost-effective, efficient, and minimally invasive method of treating choledocholithiasis. We reviewed the long-term results and efficacy of LCBDE for the common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Medical charts were reviewed for all patients undergoing LCBDE at St. Vincent Hospital over 11 years (1990-2001). Demographic data, clinical features, laboratory data, radiologic and operative findings, and postoperative follow-up evaluation were analyzed. RESULTS: A total of 346 LCBDE were performed during the study period. The mean operative time was 127 +/- 3 min, and the length of hospital stay averaged 2.8 +/- 0.1 days. In 8 patients (2.3%), LCBDE was converted to an open procedure. Complications were noted in 33 patients (9.5%), including patients (2.7%) with retained stones. No postoperative mortalities were recorded. No long-term strictures or biliary complications were noted over a mean follow-up period of 43 months (follow-up data available for 96%). CONCLUSION: A policy of routine cholangiography and LCBDE for CBD stones was effective in clearing the bile duct and avoiding further hepatobiliary instrumentation. The findings show that LCBDE can be performed successfully with low morbidity and mortality.

Nontuberculous mycobacterial adenitis of the head and neck in children: experience from a tertiary care pediatric center.

OBJECTIVE: To describe our experience with the diagnosis, surgical treatment, and outcome of nontuberculous mycobacterial (NTM) adenitis of the head and neck in children, and to present a preliminary report about the use of NTM skin tests in our institution. STUDY DESIGN: Retrospective study. METHODS: The medical records of all children diagnosed with cervicofacial NTM adenitis were retrospectively reviewed for the period from January 1, 1995, through December 31, 2000. We also examined the use of intradermal skin tests for the diagnosis of NTM infection. RESULTS: Fifty patients were diagnosed with NTM cervicofacial adenitis. Pertinent demographic information, clinical presentation, investigation, and type of diagnostic procedures were documented. Surgical procedures, complications, and relapses were also noted. One unusual case of retropharyngeal adenitis is illustrated. All patients were treated with complete excision of their lesion at the first operation. No major complications were noted. Only one patient relapsed and required a second operation. Forty-one children were skin-tested with NTM antigens. Of these, 30 patients were dual-tested with Purified Protein Derivative (PPD) also. No adverse reactions were noted with the use of skin tests. Sensitivity of NTM antigens alone is 87%. Sensitivity of dual testing is 78%. No patient had a PPD-dominant reaction. CONCLUSION: Surgical excision is the treatment of choice of NTM adenitis because of the high cure rate with a single procedure, the excellent cosmetic result, and the low complication rate. NTM skin tests are safe and could be useful in early diagnosis of the infection but further investigation is needed.

Anterior and posterior middle ear congenital cholesteatomas in children.

Congenital cholesteatomas arise from embryonic epithelial cell rests in the middle ear cleft. We report our series of 19 cases observed in 18 children between 1985 and 1990. Clinical data and surgical observations are analyzed. In regard to the location of the lesions, our findings are consistent with most of what has been reported in the literature. Sixty-eight percent of the lesions originated from the anterosuperior part of the mesotympanum. Only 10% were posterosuperiorly located. Pathogenic mechanisms are discussed with respect to the lesion's primary site.

Endonasal dacryocystocele of the newborn.

The true incidence of endonasal dacryocystocele in the newborn is probably underestimated; the number of cases in the last few years has increased with better imaging techniques and diagnostic tools. Although infrequent, it must be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. These children typically present an endonasal mass under the inferior turbinate, most often associated with inner canthal swelling. This series of four patients represents one of the largest to be reported since the first publication on the subject by Goralowna in 1979.

The large vestibular aqueduct syndrome and sensorineural hearing loss in the pediatric population.

Sensorineural hearing loss, associated with a dilated vestibular aqueduct, is often described as progressive. Since 1982, computed tomography of the mastoids has become part of the routine investigation of deaf children at Sainte-Justine Hospital. Using clinical, audiometric and radiological material from 130 patients with sensorineural hearing loss, we identified 18 patients with enlarged vestibular aqueducts. The large vestibular aqueduct population was then compared to the normal vestibular aqueduct patients in regard to the degree and evolution of the sensorineural hearing loss. Progression of hearing loss was noted in 46% of patients in the presence of large vestibular aqueducts as compared to 35% in the absence of this anomaly. Normal radiographic findings did not exclude the possibility of further hearing loss.

Acute otomastoiditis in the leukemic child.

We report three leukemic children undergoing chemotherapy who presented severe otomastoiditis with sensorineural hearing loss. They all developed a sub-total perforation of the tympanic membrane within a few days and one child sustained necrosis of the middle ear mucosa and diffuse destruction of the mastoids. Hearing tests showed severe sensorineural hearing loss in the ears affected. The evolution of the disease is reminiscent of a preantibiotic era pathology known as "acute necrotizing otitis media". A management program is proposed for the treatment of otitis media in leukemic patients receiving chemotherapy.

Congenital dermoid cyst of the oral cavity with gastric choristoma.

A case of congenital dermoid cyst of the buccal floor occurring simultaneously with a gastric choristoma is reported. Only one other similar case could be found in our review of the literature. A tracheostomy was done to relieve airway obstruction. Complete excision was achieved through an intraoral approach. A quick review of the embryology of the floor of the mouth is presented as well as the classification and differential diagnosis of these lesions.

Pediatric tracheostomies: changing trends.

We reviewed all tracheostomies performed at Sainte-Justine Hospital between 1970 and 1975, and between 1980 and 1985. The study indicates a significant decrease in the number of tracheostomies for the last period and an increase in the decannulation time from 28 to 91 days. Acute infection of the upper respiratory tracts was the major indication in the early 1970s whereas complications of prolonged intubation and congenital malformation predominated in the early '80s. Complications and mortality rate are also compared.

Persistent buccopharyngeal membrane.

Persistent buccopharyngeal membrane is an extremely rare entity. We report a three-year-old boy who presented with an oral chord-like structure that extended from the base of the tongue up to the posterior part of the vomer. Only seven cases of persistent buccopharyngeal membrane could be found in the review of the literature. Embryology is also discussed.

Group A streptococcal supraglottitis.

We describe four children with severe supraglottic infections caused by group A beta-hemolytic streptococci. In each case the clinical presentation suggested Hemophilus influenzae epiglottitis. In only one patient was there significant involvement of the epiglottis, whereas all had striking inflammation of the aryepiglottic folds. Group A beta-hemolytic streptococcus was isolated in blood cultures in two patients and from the supraglottic area and trachea in two others. Fever persisted for 6 to 22 days, and tracheal intubation was necessary for 2 to 16 days, despite appropriate antibiotic therapy. The evolution of streptococcal supraglottitis may be protracted, and it must be managed accordingly.

Eosinophilic granuloma of the temporal bone: simultaneous bilateral involvement.

Although a rare disease, eosinophilic granuloma should be included in the otolaryngologist's differential diagnosis of destructive lesions of the temporal bone. A case of bilateral simultaneous eosinophilic granuloma of the temporal bone is reported. The etiology, incidence, and symptomatology are discussed, as well as the different modalities of treatment as reviewed in the literature.

Dermoid cyst of the Eustachian tube.

A case of congenital dermoid cyst of the Eustachian tube is reported. Only seven similar cases have been found in our review of the literature. The embryology and usual mode of presentation of these cysts are discussed. Finally, a new surgical approach using a combined retro-auricular and protympanic route is presented.

Post-myringotomy care: a prospective study.

Children with tympanostomy tubes have always been considered somewhat handicapped in regard to swimming and bathing. Their parents had to maintain constant surveillance to prevent then from getting water in their ears. A prospective study involving more than 1,000 children was conducted between June 1981 and August 1982 on two groups of randomly selected patients to determine the prevalence of suppurative otitis media and its relationship to bathing and swimming. One group had to follow strict rules to prevent water entering the ear (bathing caps, earplugs) whereas the other group was allowed to bathe and swim without any precaution upon the condition of using a polymyxin B/gramicidin ear drop combination at bedtime on the day they swam. The study shows no increase in prevalence of suppurative otitis media in the "open canal" group as compared to the "closed canal" group. Furthermore, the monthly distribution of infections shows a relatively evan distribution throughout the year. This study implies that swimming and bathing are safe for the vast majority of children with tympanostomy tubes and thus simplifies enormously the post-myringotomy care for the child, the parents, and the physician.

[Corrosive esophagitis in children (author's transl)]. / L'oesophagite corrosive chez l'enfant.

The treatment of corrosive esophagitis in children remains a controversial subject. A review of the literature and the various forms of treatment is presented with a retrospective study done a the Ste-Justine Hospital in Montreal. We studied the charts (327) of patients hospitalized for ingestion of corrosive substances for the period extending between 1970 to 1976 inclusively. The mean age of the patients involved was 2 years 4 months with a slight male predominance (60%). Javel water, sodium hydroxide, Chlorine, ammoniac and different acids were, in this order, the agents most frequently encountered. Esophageal burns proven by endoscopy was noted in 81 cases. Even in the absence of oropharyngeal burns, esophageal involvement was still present in 46% of cases. The low incidence of stenosis (9%) tends to confirm the beneficial role of steroids in the treatment of corrosive esophagitis. This is particularly true for 1st and 2nd degree burns whereas their administration in severe 3rd degree burn remains controversial.

Ectopic thyroid tissue--a review of the literature.

With only two cases in 20 years in their service and considering the low incidence of ectopic thyroid gland, the authors present a review of the literature with emphasis on clinical and pathological description and modern medical or surgical management of this entity known as ectopic thyroid gland.