RESUMEN
The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess.
RESUMEN
BACKGROUND: Intraparotid facial nerve neurofibromas are benign neoplasms, extremely rare, difficult to diagnose and to manage. Only three pediatric cases have been reported in the literature. CASE PRESENTATION: We report the 4th case of a 7-year-old child admitted for a parotid mass without facial palsy, for whom 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 lower branch of the division of the facial nerve. The excision of the mass was performed with the sacrifice of the inferior branch of the facial nerve, the trunk and the upper branch of the facial nerve was preserved, the pathological study was in favor of a plexiform neurofibroma.The patient has presented postoperatively a grade 5 facial palsy in the inferior territory of the facial nerve with a slight recovery 1 year after surgery. CONCLUSION: Even though plexiform neurofibromas in the parotid gland 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 parotid tumor.
RESUMEN
INTRODUCTION: Primary neuroendocrine carcinomas are uncommon head and neck malignancies. Their classification is still debated. We report four cases of unusual primary locations of neuroendocrine carcinomas of head and neck region emphasizing two entities and rare sites that were never described in the literature to the best of our knowledge. PRESENTATION OF CASES: We reported four different cases of neuroendocrine carcinomas (nasal cavity, larynx, lymph nodes and tonsil) treated in our institution. The diagnosis was made by biopsy and confirmed by Immunohistochemical study. We underscored 2 atypical and rare entities in their location and anatomo histopathological type. Chemotherapy and radiotherapy were proposed for patients with nasal's and laryngeal locations. This latter had also undergone surgery. For lymph node location, the patient received decompressive radiotherapy alone. The patient diagnosed with neuroendocrine carcinoma of the tonsil didn't get any treatment except initial tonsillectomy for diagnosis purposes. Regarding the evolution in our case series, 2 patients had a relapse with local and regional metastasis. Among the 4 patients, 50 % passed away, one is still alive with deterioration of his general status and one is lost to follow-up and refused undergoing further investigations. DISCUSSION: There is confusion in the literature regarding the classification of neuroendocrine carcinomas. According to the 2005 WHO, these lesions, can be subdivided into TC, AC (including LCNEC), SmCC, combined SmCC with nonsmall cell carcinoma, and paraganglioma. Their treatment is still debated. Through an overview of the literature, we have gathered the main studies and 2 meta-analysis summarizing the mainstay treatment and disease's outcome. CONCLUSION: Neuroendocrine carcinomas of head and neck region are aggressive tumors with poor prognosis, low incidence and their diagnosis is not obvious. The treatment protocol depends on the type, the site of the lesions, and metastasis status. It's still not well codified.