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Importance: A validated biomaterial would have several medical advantages in septorhinoplasties requiring a large-volume graft such as avoiding donor site morbidity, making ambulatory surgery possible, and reducing surgical costs. Objective: To assess the safety and efficacy of a ceramic to treat saddle and crooked noses. The main endpoint was the biocompatibility of the implant. The secondary endpoint was its functional and aesthetic efficacy. Design, Setting, and Participants: The nasal septum (NASEPT) study is a pilot multicenter noncomparative prospective phase IIa clinical trial. The biomaterial tested was a biphasic calcium phosphate implant composed of 75% hydroxyapatite and 25% beta tri calcium phosphate. This versatile material can be used to replace septal skeleton when it is absent or nonusable. We included 25 patients with a multifractured osseous and cartilaginous framework after several traumas or surgeries. The implant placement technique was identical to an extracorporeal septoplasty through the external approach. Main Outcomes and Measures: The primary endpoint was the occurrence of expected adverse and severe adverse events. The secondary endpoints were clinical functional and aesthetic results and histological microscopic modifications. Results: Any extrusion, infection, pain, and epistaxis were observed. All implants were placed in a sagittal, straight, and solid position without extralobular depression. Comparisons between pre- and postoperative symptoms showed that nasal comfort (p < 10-4) and quality of life (p < 10-4) were dramatically improved in all patients. The nasolabial angle (p = 0.047) and the columellar projection (p = 0.024) were improved after surgery. Histological data showed little submucosal inflammation at 6 months with well-differentiated epithelium. The mean follow-up was 23 months: three patients underwent revision surgery for functional or aesthetic details and four implants were removed (16%) owing to a foreign body reaction between 17 and 74 months. Conclusion and Relevance: The NASEPT implant meets functional and aesthetic requirements in complex septorhinoplasties but its long-term biocompatibility needs to be improved. It could potentially avoid donor site morbidity.
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Materiales Biocompatibles/farmacología , Hidroxiapatitas/farmacología , Prótesis e Implantes , Rinoplastia/instrumentación , Adulto , Anciano , Estética , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal/cirugía , Dimensión del Dolor , Proyectos Piloto , Complicaciones Posoperatorias , Estudios Prospectivos , Cicatrización de HeridasRESUMEN
INTRODUCTION: The aim of this study was to correlate the cytological and histological results and evaluate the diagnostic performance of fine-needle aspiration cytology (FNAC) in the management of parotid gland tumors. METHODS: This retrospective study included 160 patients with a parotid gland tumor who underwent fine-needle aspiration and parotidectomy surgery between January 2005 and August 2016 at the Limoges university hospital center. RESULTS: On 160 fine-needle aspirations performed, fine-needle aspiration diagnoses were: 77 benign lesions, 35 malignant lesions and 48 non-diagnostic cases. Final histological diagnosis revealed there were 113 benign lesions and 47 malignant lesions. A hundred and one cytological diagnoses were accurate over 112 contributive fine-needle aspirations: seven false-negative cases and 4 false-positive cases were observed. The sensitivity, specificity, and accuracy were 82, 95 and 90% respectively for fine-needle aspiration, and 83, 95 and 92% respectively for association of fine-needle aspiration and magnetic resonance imaging. Diagnostic concordance between fine-needle aspiration and final histology for malignant lesions was 78%. A greater number of contributive fine-needle aspirations was observed among experimented operators. DISCUSSION: Fine-needle aspiration is a reliable, safe and effective diagnostic tool that allows good differentiation between malignant and benign diagnosis in the preoperative management of parotid gland tumors. The association of fine-needle aspiration and magnetic resonance imaging (MRI) can improve diagnostic performance.
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Glándula Parótida/patología , Glándula Parótida/cirugía , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Fina/estadística & datos numéricos , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Enfermedades de las Parótidas/diagnóstico por imagen , Enfermedades de las Parótidas/patología , Glándula Parótida/diagnóstico por imagen , Neoplasias de la Parótida/diagnóstico por imagen , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility.
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Acromegalia/diagnóstico , Adenoma/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Disnea/etiología , Edema/diagnóstico , Adenoma Hipofisario Secretor de Hormona del Crecimiento/diagnóstico , Laringoestenosis/diagnóstico , Parálisis de los Pliegues Vocales/diagnóstico , Acromegalia/complicaciones , Adenoma/complicaciones , Obstrucción de las Vías Aéreas/cirugía , Cartílago Aritenoides/diagnóstico por imagen , Edema/complicaciones , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Humanos , Laringoscopía , Laringoestenosis/complicaciones , Laringoestenosis/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Traqueostomía , Parálisis de los Pliegues Vocales/complicaciones , Parálisis de los Pliegues Vocales/cirugíaAsunto(s)
Quistes/patología , Lipoma/patología , Neoplasias Faríngeas/patología , Adipocitos/ultraestructura , Adulto , Antígenos CD34/análisis , Biomarcadores de Tumor/análisis , Quistes/química , Quistes/diagnóstico , Células Gigantes/ultraestructura , Humanos , Lipoma/química , Lipoma/diagnóstico , Masculino , Proteínas de Neoplasias/análisis , Neoplasias Faríngeas/química , Neoplasias Faríngeas/diagnósticoRESUMEN
BACKGROUND: Sinonasal intestinal-type adenocarcinomas (ITACs) have a poor prognosis, and are defined on the basis of their morphological similarities to colorectal adenocarcinomas. MET signaling pathway is involved in oncogenesis in various cancers. Nothing is currently known about the role of MET in ITACs. METHODS: In a series of 72 ITACs, we investigated MET protein levels by immunohistochemistry (IHC) and gene copy number by in situ hybridization. These findings were analyzed as a function of clinical data, histological typing, and patient outcome. RESULTS: MET protein was overproduced in 64% of cases and chromosome 7 polysomy was observed in 52% of cases. No tumor displayed MET amplification. The presence of mucinous or solid histological components, T3/T4 tumors, and incomplete resection were associated with a poor outcome. CONCLUSION: MET is overproduced in about two third of ITACs, suggesting a role for the MET signaling pathway in the oncogenesis of these tumors.
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Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Biomarcadores de Tumor/metabolismo , Neoplasias Intestinales/mortalidad , Neoplasias Intestinales/patología , Proteínas Proto-Oncogénicas c-met/genética , Adenocarcinoma/genética , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Dosificación de Gen , Regulación Neoplásica de la Expresión Génica , Humanos , Hibridación in Situ , Neoplasias Intestinales/genética , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Proteínas Proto-Oncogénicas c-met/metabolismo , Estudios Retrospectivos , Transducción de Señal , Estadísticas no Paramétricas , Análisis de SupervivenciaRESUMEN
Sinonasal intestinal-type adenocarcinomas (ITACs) are uncommon tumors of poor prognosis defined by their similarities to colorectal adenocarcinomas. The involvement of the epidermal growth factor receptor (EGFR) pathway in colorectal adenocarcinoma oncogenesis is well established, and the same is expected to apply to ITACs. In a series of 39 ITACs, we investigated EGFR amplification and chromosome 7 polysomy by fluorescence in situ hybridization; EGFR, KRAS, and BRAF mutational status by polymerase chain reaction sequencing; EGFR variant messenger RNA expression by quantitative reverse transcriptase polymerase chain reaction; and EGFR protein expression by immunohistochemistry with antibodies targeting the extracellular domain, the intracellular domain, and the phosphorylated isoform. The findings were analyzed with respect to clinical data, histologic typing, and patient outcome. EGFR amplification was observed in 3 cases with a focal distribution. EGFR proteins were overexpressed in all these foci with both extracellular domain and intracellular domain antibodies, suggesting involvement of the whole receptor. Chromosome 7 polysomy was observed in 15 cases and was not associated with EGFR protein expression. EGFR, KRAS, or BRAF mutations were observed in 5 different cases. The EGFRvIII mutant was not detected. In all cases, EGFR variants were expressed. There was no association between these molecular features and patient survival. In conclusion, (1) our study revealed various EGFR expression patterns in ITACs, indicating tumor heterogeneity; (2) EGFR amplification should be distinguished from chromosome 7 polysomy; (3) fluorescence in situ hybridization analysis could be guided by immunohistochemistry; and (4) ITACs share common alterations of the EGFR pathway with colorectal adenocarcinomas, except for a lower frequency of KRAS and BRAF mutations.
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Adenocarcinoma/genética , Receptores ErbB/genética , Regulación Neoplásica de la Expresión Génica , Mutación , Neoplasias de los Senos Paranasales/genética , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas/genética , Proteínas ras/genética , Adenocarcinoma/metabolismo , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Aneuploidia , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Terapia Combinada , Femenino , Francia/epidemiología , Humanos , Hibridación Fluorescente in Situ , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias de los Senos Paranasales/metabolismo , Neoplasias de los Senos Paranasales/mortalidad , Neoplasias de los Senos Paranasales/patología , Pronóstico , Proteínas Proto-Oncogénicas/metabolismo , Proteínas Proto-Oncogénicas B-raf/metabolismo , Proteínas Proto-Oncogénicas p21(ras) , Estudios Retrospectivos , Tasa de Supervivencia , Proteínas ras/metabolismoRESUMEN
Carotid pseudoaneurysms of petrous localization are rare. They are mostly due to trauma, tumoral or infectious diseases, or a result of iatrogenic complications after skull base surgery. Symptoms such as facial paralysis are exceptional and have rarely been described in the literature until now. We report the case of a 64-year-old woman, who developed left peripheral facial paralysis induced by two carotid pseudoaneurysms in their intrapetrous section. The treatment is endovascular, despite the high morbidity rate. She was first put on antiplatelet medications, before the left carotid aneurysm was bypassed thanks to a self-expanding pipeline-type stent with flow diversion. The left peripheral facial paralysis was due to the compression exerted by the left carotid aneurysm, probably a congenital malformation. The progressive palsy recovery was fist due to the aneurysmal thrombosis, then to the secondary fibrosis.
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Cerebral abscesses are rare but often lethal complications of invasive Aspergillus sinusitis. Treatment is difficult and usually depends on a combination of neurosurgical drainage and intravenous antifungal therapy. We report a case of intracerebral frontal abscess in continuity with the anterior skull base in a 53-year-old immunocompromised female with invasive rhino-orbital aspergillosis. An aperture was created by drilling the anterior skull base during endonasal sinus surgery, and the abscess was drained through its lower pole. The aperture was left open after surgery to ensure complete abscess drainage. Follow-up at 8 months revealed no cerebrospinal fluid leak or meningitis, and no abscess recurrence. This case validates the feasibility of endonasal trans-ethmoidal drainage of intracranial abscesses.
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PURPOSE: The aim of this study was to demonstrate the ability to use human clinical positron emission tomography/computed tomography (PET/CT) to detect and investigate head and neck cancers chemically induced by 4-nitroquinoline-1-oxide (4-NQO) in a rat model. STUDY DESIGN: The study design was prospective animal research. PROCEDURES: A head and neck squamous cell carcinoma was established in 20 immunocompetent rats, who drank a 4-NQO solution during 16 weeks. 2-Deoxy-2-[F-18]fluoro-D: -glucose (FDG)-PET/CT was performed for five of them, 34 weeks after the start of the experiment to characterize the tumors. A day following the FDG-PET/CT, rats were euthanized and pathological features were evaluated by hematoxylin-eosin staining. RESULTS: All rats had head and neck tumor at various locations at 34 weeks. Among the five rats selected for having FDG-PET/CT, the clinical examination detected exophytic tumors grown in the oral cavity for three of them (one on the inferior lip, one on the hard palate, and one on the internal side of the cheek). FDG-PET/CT confirmed the presence of those tumors and detected ones located on the base of tongue for three of them. Tumor extensions were characterized and tumor metabolic volumes were measured. The smallest lesion detected measured 3 x 3 x 4 mm. Pathologic examination using hematoxylin-eosin staining confirmed squamous cell carcinoma. CONCLUSIONS: This study demonstrated that FDG-PET/CT is a feasible examination to detect occult primary tumors in rat models. It is useful to follow tumor progression and evaluate therapeutics efficacy.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , 4-Nitroquinolina-1-Óxido/administración & dosificación , Animales , Carcinoma de Células Escamosas/inducido químicamente , Neoplasias de Cabeza y Cuello/inducido químicamente , Masculino , Neoplasias de la Boca/inducido químicamente , Neoplasias de la Boca/diagnóstico por imagen , Tomografía de Emisión de Positrones , Ratas , Ratas Sprague-Dawley , Tomografía Computarizada por Rayos XRESUMEN
AIM: To develop and characterize by imaging and pathological examination a new immunocompetent rat model of head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN: Prospective animal research. MATERIALS AND METHODS: Frozen specimens of HNSCC induced chemically by 4-nitroquinoline 1 oxide (4-NQO) in Sprague Dawley rats were used for the first graft. Serial allografts were then performed with fresh specimens of tumor in twenty-five Sprague Dawley rats. A specimen of tumor (100 mm3) was picked up by head and neck dissection during an autopsy. The graft was performed in a subcutaneous manner, in the ventral part of the neck, using an incision of 4 mm, through the masseter muscle. Tumors were clinically measured once a week and volumes were calculated. 2-[18F]Fluoro-2-deoxy-D-glucose positron emission tomography coupled with computed tomography (FDG-PET/CT) was performed on days 14 and 30 after the graft. Rats were euthanized and pathological features were assessed using hematoxylin-eosin (HE) staining and immunohistochemistry markers to characterize the tumor. RESULTS: An 80% take rate was achieved using fresh tumor specimens. Tumors grew rapidly; the mean tumoral volume was 1.013 cm3 on day 14 and 7.994 cm3 on day 30. FDG-PET/CT imaging targeted regions of metabolically active tumor. It showed a uniform uptake of 18F-FDG on day 14 and a large area of central necrosis on day 30. Pathological examinations showed a typical squamous cell carcinoma, with similar immunohistochemical analyses to the human squamous cell carcinoma. CONCLUSION: We propose a new allograft HNSCC rat model which is easily reproducible and rapidly obtained in comparison to that induced chemically with 4-NQO. This model was developed in immunocompetent rats, with similar conditions to human carcinogenesis and could be used for testing new therapeutics.
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Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , 4-Nitroquinolina-1-Óxido , Animales , Carcinógenos , Carcinoma de Células Escamosas/inducido químicamente , Modelos Animales de Enfermedad , Fluorodesoxiglucosa F18/farmacología , Neoplasias de Cabeza y Cuello/inducido químicamente , Masculino , Trasplante de Neoplasias , Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacología , Ratas , Ratas Sprague-Dawley , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodosRESUMEN
Squamous cell carcinoma of the nasal columella (SCCNC) is a rare disease. We aimed to define a strategy for the diagnosis and management of nasal columella squamous cell carcinoma. Medical records of 66 patients presenting with columella squamous cell carcinoma in nine French hospitals, from 1980 to 2003, were evaluated to determine the clinical characteristics and current treatment of the disease. Mean age was 69 years. The sex ratio was one female for three males. Majority of the lesions were T1 N0 according to the classification international union against cancer. Patients underwent one of the three treatments: surgery alone for the T1 lesions, radiotherapy for tumors of T2-T3 and combined (surgery and radiotherapy) for T4 lesions. The 5-year Kaplan-Meier survival test was 39% and no difference was found between the therapeutic groups. Thirty-five (53%) tumor recurrences were observed with a median time of 43 months. As regards TNM classification and treatment, no significant difference between the two groups disease free/recurrence was found. Prognosis of early lesions was considered better than the advanced lesions. SCCNC is difficult to manage and has a poor prognosis. No therapeutic solution has yet been confirmed in the treatment of this pathology.
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Carcinoma de Células Escamosas , Tabique Nasal , Neoplasias Nasales , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/patología , Neoplasias Nasales/terapiaRESUMEN
Laryngeal mucous cysts are rare congenital malformations of the upper aero-digestive tract. We report one case of a ductal cyst developed in the supraglottic area. The diagnosis of an antenatal malformation was suspected on the basis of a hydramnios development during pregnancy. Ultrasound scan showed a cervical anechogen mass. This led to a fetal MRI which showed the cyst extension. A management of delivery had to be prepared due to the risk of air obstruction at the birth. The treatment consisted of a marsupialization of the cyst under laryngo-endoscopic surgery. Six months follow-up showed no recurrence.
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Quistes/patología , Quistes/cirugía , Enfermedades Fetales/diagnóstico , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/cirugía , Diagnóstico Prenatal , Adulto , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Periodo Posparto , EmbarazoRESUMEN
A multidisciplinary working group of experts met in 2006 in order to establish a list of recommendations concerning the aesthetic and functional rhinoplasties. These experts tried to answer various practical problems while relying, on one hand, on a critical analysis of the literature, and on the other hand, on a consensus within the group. Six topics were approached. The management of the preoperative consultation, the surgical environment, the contra-indications, the materials used, the management of the post operative period, some particular pathological situations. This collective reflexion thus did not relate to the surgical techniques but to the methodology of treatment of patients who are candidates for rhinoplasty. It comes out clearly from this collective work that surgical indication can only be addressed after having clarified all the technical and psychological aspects. The use of computer graphics is recommended. Cartilage autograft are recommended as a priority.