Fungal necrotizing external otitis: diagnosis, management and outcomes of 15 cases.

Fungal necrotizing external otitis (NEO) is a rare disease. It is an aggressive and potentially fatal infection. The most commonly reported pathogen is Candida. We aim through this study to share our experience in the management of fungal necrotizing external otitis and discuss its diagnosis tools, anti-fungal treatment choice, and outcomes. We included fifteen patients with diagnosis criteria of fungal NEO; clinical features of NEO with positive culture swabs and/or positive serologic test to a fungal pathogen. The mean age was of 70 years with a prevalence of males. The main symptoms were otalgia (n=15) and otorrhea (n=7). Facial palsy was observed in four cases. Fungal pathogens were Candida(n=10) and Aspergillus (n=5). Complications were observed in eight cases: extension to the temporo-mandibular (n=4), abscess in the retropharyngeal space (n=2), abscess in the parapharyngeal space (n=1) and thrombophlebitis of the internal jugular vein (n=1). Six patients were treated with fluconazole, eight with voriconazole, and one patient with itraconazole. After a mean duration of 52 days of antifungal therapy, fourteen patients have been cured with normalization of the ear symptoms, biological, and imaging features. One patient died of septic shock. No recurrence of the disease was observed after a follow-up of 12 months in all cases.

[Therapeutic outcomes of nasopharyngeal carcinomas: a single-center study conducted at the Fattouma Bourguiba University Hospital in Monastir, Tunisia]. / Résultats thérapeutiques des carcinomes nasopharyngés: étude monocentrique à l´hôpital universitaire Fattouma Bourguiba de Monastir en Tunisie.

INTRODUCTION: nasopharyngeal carcinomas (NPCs) are relatively common in the Mediterranean basin. Survival has been greatly improved by new radiation techniques and new molecular-targeted chemotherapy. The purpose of our study was to analyze the therapeutic outcomes and to describe the prognostic factors of NPCs. METHODS: we conducted a retrospective study of patients with nasopharyngeal carcinoma on treatment and follow-up in our department between January 1995 and December 2014. Data were collected using a standardized sheet. Statistical analysis was performed using SPSS software. Kaplan-Meier method was used to determine patient´s overall survival. RESULTS: seventy-three cases of NPC were reported. The average age of patients was 48 years. A male predominance was noted. The majority of cancers (56%) were locally advanced tumors (T3-T4). After an average follow-up of 45.5 months, the rate of locoregional recurrences was 19.4%. Three patients (4%) had bone metastases. Five-year overall survival was 65%. Factors positively influencing overall survival were early-stage tumor (TNM classification) and 1.8 Gy single fraction radiotherapy. Local and lymph node recurrence rates were 13.8% and 5.5% respectively, mainly for T4 N2 tumors. Therapeutic sequelae were dominated by seromucous otitis (42.7%), trismus (38.7%), and xerostomia (32%). CONCLUSION: overall survival in patients with NPC has improved, in particular with the advent of concomitant radiotherapy and chemotherapy; however, disabling late toxicity is significant. Good prognostic factors reported in this study include early tumor stage as well as radiotherapy fractionation.

Parapharyngeal metastasis from papillary thyroid microcarcinoma.

Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type and its pattern of metastasis are usually lymphatic. Lymphatic metastasis to parapharyngeal space is rare and have been reported, so we report the case of a 50-year-old male patient who had an occult papillary carcinoma of the thyroid presented as right lateral node of the neck and a nodal involvement of the right parapharyngeal space.

Castelman's disease of the neck: a case report and literature review.

Castleman's disease is a rare pathology, poorly understood. It is considered as a lymphoproliferative disorder, described for the first time in 1954, which may be confused with other causes of lymphadenopathy. We report in this paper the case of a young women presenting with left latero-cervical lymphadenopathy. All the investigations were negative except a large high-vascularized level II cervical lymphadenopathy. We performed a cervicotomy. The extemporaneous histological exam was non-contributive. We decided to perform a complete level II and III left cervical lymphadenectomy. The diagnosis of unicentric Castleman's disease was confirmed based on the final histological study of the specimen, and the absence of other cervical and extra-cervical lymphadenopathy. The patient is free of recurrence at the time of reporting this article.

Pediatric naso-sinusal inverted papilloma: report of a case and literature review.

Inverted papilloma is a rare nasosinusal tumor that mainly occurs in adults during the 5th decade. The occurrence in children is exceptional and only few cases have been reported in the litterature. Clinical and radiological findings mimic other benign nasosinusal pathologies; therefore, diagnosis is based on histopathology either via biopsy or following surgical excision. Here we present a rare case of pediatric inverted papilloma in a 11-year-old child and we discuss clinical, radiological, therapeutic and evolutionary features through a literature review.

Primary papillary carcinoma of the thyroglossal duct in a 14-year-old female: case report and review of the literature.

Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.

A rare location of thyroglossal duct cyst in a newborn.

Thyroglossal duct cyst of the tongue is a rare entity. Occurrence in the anterior part of the tongue is exceptional. We report in this paper a rare case of thyroglossal cyst of the anterior part of the tongue, discovered in a five-days-old newborn at delivery. Images have shown a cystic mass with homogenous liquid content. A transoral complete resection of the lesion was performed, with no postoperative complication. The histological analysis confirm the diagnosis of lingual thyroglossal duct cyst. There were no recurrence with a follow-up of eight months.