Primary nasosinus meningioma, an etiology masks another: Case report.

INTRODUCTION AND IMPORTANCE: Extracranial meningiomas of the sinonasal tract are rare tumors. The diagnosis is not generally evident. We report, through an observation, the clinical particularities, the diagnostic difficulties and the therapeutic approach of primary sinonasal meningiomas. CASE PRESENTATION: We report the case of a 54-year-old woman who presented with complaints of right nasal obstruction with the notion of recurrent epistaxis evolving for one year. At the examination, nasal endoscopy found a voluminous purplish-gray mass filling both the middle meatus and the olfactory cleft. The CT examination showed an ethmoïdonasal tumoral process extending to orbital cavity and infratemporal fossa without endocranial extension. A transnasal approach was performed, histopathological examination demonstrates a méningothélial meningioma rank1. The clinical, endoscopic and CT controls did not show tumor residue or a local recurrence. CLINICAL DISCUSSION: Meningioma is a common non-glial intracranial neoplasm. Primary or secondary extracranial meningioma (depending on whether they are isolated or associated with an intracranial tumor) location is uncommon, clinical presentation is nonspecific. Diagnostic confirmation is anatomopathological with immunohistochemically study. Imaging confirms the primary nature of these tumors. The prognosis is favorable after complete surgical excision without further adjuvant treatment. CONCLUSION: Primary nasosinus meningiomas are rare, with non-specific symtomatology and common with other local pathologies. Imaging confirms the primary character of these tumors, anatomopathological examination completed by immunohistochemical study confirms the diagnosis. Surgery with complete exeresis remains the best option with a good prognosis.

Hypothyroidism and multinodular goiter due to tubercular thyroiditis: A rare coexistence.

Introduction and importance: the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific clinical, biological and radiological presentation. Case presentation: A 38-year-old woman presented with swelling in the anterior part of the neck for 7 years. Clinical and radiological examination found multinodular goiter and fine needle aspiration cytology showed colloidal cells with follicular cells. A total thyroidectomy was performed and histological examination of showed epithelioid and giganto-cellular granulomatous with caseous necrosis, confirming the diagnosis of tuberculous thyroiditis. Clinical discussion: Tuberculosis of the thyroid gland is a very rare disease, the diagnosis is often made by fine needle aspiration cytology (FNAC), the treatment is mainly medical with antituberculosis drugs, but surgery remains a therapeutic means for some cases. Conclusion: The diagnosis of thyroid TB should be suspected in the presence of a thyroid swelling or nodule, especially in countries with a high prevalence of TB, to allow for early and appropriate management.

Diagnostic and therapeutic determinants in parathyroid surgery: A retrospective cohort study.

Introduction: The systematic realization of biochemical and radiological examinations of the parathyroid has increased the incidence of primary hyperparathyroidism; which explains the increasing incidence of parathyroid surgery. Our study aims to predict the factors determining the diagnosis and management of parathyroid adenomas. Methods: We included 87 patients who presented with hyperparathyroidism and underwent parathyroid surgery. Ultrasound, computed tomography (CT), and more rarely sestamibi, were performed to localize the lesion preoperatively. Body mass index (BMI), blood and urine calcium and PTH concentrations before and after surgery, and preoperative vitamin D concentrations were evaluated. Results: In 90.8% of the cases, the location of the adenomas was retained thanks to cervical ultrasound, and in 86% of the cases, the ultrasound results were concordant with the intraoperative results, whereas the MIBI scanner was used in only 6 patients with a specificity and sensitivity of 100%, but these results cannot be taken into account because the sample is too small. No significant association was found between weight and preoperative vitamin D concentration, whereas we find a positive correlation between preoperative vitamin D concentration and adenoma weight (p = 0.001). Postoperative follow-up showed a positive relationship between the onset of hypocalcemia and vitamin D deficiency, and an inverse correlation between PTH concentration and postoperative hypocalcemia. All patients with an unknown vitamin profile (n:4) who developed postoperative hypocalcemia had a BMI greater than 25 kg/m2. The higher the PTH concentration in the preoperative period, the more profound the hypocalcemia. Conclusion: Further studies are needed to explore the role of vitamin D in the localization of parathyroid adenomas on the one hand, and to properly document the association between BMI and preoperative PTH concentration on the other.

Otalgia revealing McCune-Albright syndrome: A case report.

Introduction and importance: McCune-Albright syndrome (MAS) is typically described by the asociation of cutaneous (coffee-at-milk spots), endocrine (endocrine hyperfunction most often precocious puberty), and fibrous dysplasia (FD). In 90% of cases, AD manifests itself as a disorder of the craniofacial skeleton, affecting the maxilla, mandible, and even the temporal bone. Case presentation: We report the case of a 14-year-old girl who presented with complaints of left otalgia with the notion of recurrent otitis evolving for one year, she presents as antecedent an early puberty. At the examination, we found café-au-lait macules, and a slight left exophthalmos without visual acuity decrease. Otoscopic examination showed a narrowing of the external auditory canal (EAC). An audiogram showed conductive hearing loss in the left ear; the air-bone gap was 35 dB. A computed tomography (CT) scan was performed, showing a large "ground glass" appearance of the left temporal region. Given the presence of the cafe-au-lait spot, fibrous dysplasia of the temporal bone, and a history of early puberty, the diagnosis of McCune-Albright syndrome was made. clinical Discussion: Management of SMA is based on the needs of the individual patient and should be performed by a multidisciplinary team. Management of endocrinopathies is usually medical, with precocious puberty in girls most often treated with aromatase inhibitors. The objectives of the management of craniofacial DF are to correct the functional and aesthetic damage. Conclusion: McCune-Albright syndrome (MAS) is a rare disease. The involvement of the craniofacial region by FD during SAM is a complicated entity, in its effects and in its management.

Concomitant abducens and facial nerve palsies following bone temporal fracture: Case report.

Introduction: Lesions of the nervus abducens, the 6th cranial nerve tend to be rare, usually occur suddenly following head injuries. The existence of the association of several lesions of the cranial pairs in spite of their rarity must lead the clinician to establish a complete lesion assessment before any cranial trauma. Case report: We describe an illustrative case of sixth nerve palsy associated to facial nerve palsy following a motor vehicle accident. A 36-year-old man had temporal bone fracture after a motor vehicle accident and developed horizontal diplopia and left-sided facial droop, Cranial tomography demonstrated left translabyrinthique bone temporal fracture and fracture of the petrous apex. Discussion: The petrous apex is an anatomical area rich in vascular and nervous elements. Any damage to this area, whether inflammatory, tumoral or traumatic, as described in this manuscript, can have an irreversible effect if a rapid diagnosis and management is not established. Conclusion: we report our experience with head trauma with exceptional manifestations, for a better knowledge of these affections, studies with a large number of patients are necessary.