A rare case of follicular thyroid carcinoma metastasis to the sacral region: A case report with literature review.

INTRODUCTION: Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer subtype after papillary thyroid cancer (PTC), and it accounts for approximately 10% of all thyroid cancers, the incidence of distant metastasis in FTC has been reported to be 6-20%, bones and lungs are the most frequent sites of distant metastases. Most occult thyroid carcinomas are papillary carcinoma. CASE PRESENTATION: We describe an extremely rare case of a 74-year-old woman who had a history of right thyroid lobectomy 20 years ago, was referred to our hospital for metastatic thyroid follicular carcinoma to the sacral region confirmed by the biopsy of the sacral mass. The patient was treated by analgesic radiotherapy, surgical totalisation of thyroidectomy, and Radioactive Iodine, with thyroid replacement by levothyroxine. In the follow up we noticed a significant symptom reduction leading to a much better quality of life. CONCLUSION: Increasing importance should be given to rare metastases in DTP patients. Early detection will help in the early diagnosis and treatment of the disease, thereby improving the patient's survival rate and quality of life.

An unusual combined glomus vagale and jugular tumor: A case report.

INTRODUCTION: and importance: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. We report an unusual combined glomus vagal and jugular tumor that was rarely described in the literature to the best of our knowledge. CASE PRESENTATION: A 51 years old female with no pathological history was presented to our ENT department with 6 months' history of a right latero cervical swelling gradually increasing in size associated with a swallowing difficulties and hoarseness. Preoperatively clinical examination had found vagal and hypoglossal nerve paralysis. Cervical CT scan and MRI had shown glomus jugular tumor. The patient underwent a surgical excision with severe swallowing difficulties and facial palsy in the immediate postoperative period with a mild recovery afterwards. CLINICAL DISCUSSION: Paragangliomas of the mesotympanum and jugular foramen most commonly present as a vascular middle ear mass. The most common presenting symptom is pulsatile tinnitus occurring in 80% followed by hearing loss (60%). Dysfunction of cranial nerves traversing the jugular foramen may be commonly encountered with resultant abnormalities of speech, swallowing and airway function. Vagal paragangliomas are the least common of the three primary craniocervical paragangliomas. The most common presenting sign is the presence of a painless neck mass accompanied occasionally by dysphagia and hoarseness. The association of both glomus vagal and jugular tumor is rarely described in the literature to the best of our knowledge. CONCLUSION: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. Vagal paragangliomas are the least common of the three primary craniocervical paragangliomas. The association of both glomus vagal and jugular tumor is rarely described in the literature to the best of our knowledge. The choice of treatment depends on the location, size, and also biologic activity of the tumor as well as the physical condition of the patient.

Intermittent dysphagia revealing a lateropharyngeal neurofibroma in a child: Case report: A case report.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is an disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. CASE PRESENTATION: We present the case of a 12-year-old patient referred by his pediatrician for intermittent dysphagia and a sensation of food attachment, in whom several café-au-lait spots on the body had been found, and a case of type 1 neurofibromatosis in the patient's siblings. The decision was to closely follow-up the patient, the progression of his symptoms and the size of the cervical neurofibroma. The patient's current follow-up has been two years, with a minimal increase in the frequency of episodes of dysphagia, and with Ct-scan performed every year. No major growth of the cervical mass was noted. DISCUSSION: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. CONCLUSION: The treatment is not codified and abstention therapeutic may be a wise decision.

Primary Non-Hodgkin Lymphoma of the temporal bone: A rare case report.

INTRODUCTION: Primary lymphoma of the temporal bone is extremely rare, difficult to diagnose and to manage. It is essential that the clinician keeps in mind the possibility of this pathology as a differential diagnosis with the infections resistant to the usual treatment. CASE REPORT: We report a rare case of a diffuse large B-cell lymphoma in a 70-year-old- woman, with history of diabetes. The pathological study was in favor of a Non-Hodgkin Lymphoma of the Temporal Bone. DISCUSSION: Lymphomas defined as malignant monoclonal proliferation of lymphoid cells, are not uncommon in the head and neck region. Literature presents with few cases. CONCLUSION: The aim of this article is to report a rare case of a diffuse large B-cell lymphoma with primary mastoid and external auditory canal infiltration without systemic involvement initially presented as a benign ear infection.

A rare cause of cervical swelling: Solitary plexiform neurofibroma.

INTRODUCTION: Plexiform cervical neurofibromas are benign neoplasm, extremely rare, difficult to diagnose and to manage. Only some cases have been reported in the literature. CASE PRESENTATION: We report the case of a 60-year-old man admitted for a lateral neck mass, for which the surgical indication was the increase in volume of this mass, as well as the aesthetical impairment, the surgical exploration found the tumor attached to the cervical plexus. The excision of the mass was performed without damaging nerve. The pathological study was in favor of a plexiform neurofibroma. DISCUSSION: Even though Plexiform cervical neurofibroma are extremely rare, and their diagnosis are not often primary evoked in front of any growing mass of this region, the surgeon must keep in mind the existence of these neoplasms as a differential diagnosis of a neck tumor. CONCLUSION: Surgery remains the gold standard in the treatment of these locally invasive tumors. It is essential that the surgeon keep in mind the possibility of these tumors as a differential diagnosis of a neck tumor.

Efficiency of Melatonin as a Sedative for Auditory Brainstem Response in Children.

Introduction-Although auditory brainstem response (ABR) testing is among the most frequently used investigations in pediatric audiology and it often requires sedation or general anesthesia. In recent years, melatonin has been successfully used as an alternative way of inducing sleep, particularly in children undergoing magnetic resonance imaging (MRI) or electroencephalography (EEG). Purpose-To assess the effectiveness of orally administered melatonin as an alternative to sedation or general anesthesia during ABR testing. Method-In total, 33 children with suspected hearing loss underwent ABR tests in melatonin-induced sleep. Each patient received an initial dose of 5 mg, which was re-administered in case of failure to obtain sleep. Click-induced ABR tests were performed on both ears. Results-ABR tests were successfully performed in 72.7% of the patients. The average total length of time needed to obtain sleep and complete the ABR testing was 45 min. There was no significant difference between the patients who completed the examination and those who did not in terms of age or psychomotor development. There was a statistically significant association between receiving a maintenance dose and successful completion of the test (p < 0.001). There was also a significant connection between the degree of hearing loss and the success rate of the ABR tests (p < 0.001). Conclusions-Melatonin-induced sleep is a good and safer alternative to anesthesia to perform ABR testing in young children. It is easily administered, tolerated by the patients, and accepted by parents.