RESUMEN
BACKGROUND: With the advent of biotherapies, endotyping of chronic rhinosinusitis with nasal polyps (CRSwNP) is becoming more and more important to optimize therapeutic management. While the majority of CRSwNPs in the United States, Europe, and Japan exhibit type 2 eosinophil-dominant inflammation response, other parts of Asia display mixed patterns including neutrophil-dominant inflammation. Until now, no study has focused on the proportion of inflammation patterns in Morocco or anywhere on the African continent. We aim to fill this gap by studying tissue inflammatory response in our operated patients. MATERIAL AND METHODS: After searching the database of the pathology department, we retrieved from the archives the stained pathology slides of all our patients who underwent surgery for CRSwNP over 5 years from 2017 to 2021. We counted then the number of eosinophils in the lamina propria at high-power magnification to determine the predominant inflammatory pattern. RESULTS: A total of 35 reports were collected. We found that eosinophilic inflammation was predominant, accounting for 97% of the cases. CONCLUSIONS: The CRSwNP endotype in our region would mainly be type 2. However, our results must be confirmed by multicenter studies involving a large number of patients.
Asunto(s)
Pólipos Nasales , Humanos , Pólipos Nasales/complicacionesRESUMEN
OBJECTIVES: Nodules of the thyroid gland are common but rarely malignant. Their management can range from simple monitoring to surgery. The use of ultrasound and fine needle aspiration can reduce the rate of unnecessary surgeries. However, there is a risk of false positives and false negatives of malignancy that only pathology can avoid. The objective of this study is to assess the impact of ultrasound classification on the rate of surgical indications. MATERIAL AND METHODS: Between 2013 and 2017, the ultrasound classification was gradually adopted in our daily practice to become now routine. During this period, we conducted a retrospective study of all the patients who presented to our department for one or more thyroid nodules. RESULTS: A total of 577 patients were included in the study. We compared two groups, a first where the ultrasound classification was used and a second where this classification was not used. In the end, we found that this classification significantly reduced the surgical indication by 19% while increasing the malignancy detection rate in operated patients by 21%. CONCLUSIONS: The use of ultrasound classification reduces the indications for surgery while increasing the rate of malignancy in operated patients. The generalization of the use of the ultrasound classification score is strongly recommended in daily practice.
Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Humanos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/cirugía , Nódulo Tiroideo/patología , Biopsia con Aguja FinaRESUMEN
BACKGROUND: Paragangliomas of the head and neck are rare vascular tumors derived from the paraganglia tissues originating from the neural crest. They are usually benign and hypervascularized. Diagnosis is relatively easy in condition to consider it in evaluating every lateral neck mass. METHODS: We made a retrospective study of the records of 10 patients who presented with carotid body tumors at the Department of Vascular surgery of the Military Hospital Avicenne in Marrakech during the period between 2008 and 2013. Epidemiologic, etiologic, diagnostic, and therapeutic features were analyzed. RESULTS: The average age of our patients was 35.4 years (26-55 years), with a male predominance (sex ratio = 2.33). We noted 7 cases of isolated carotid locations and 3 cases of multiple locations. A slow-growing neck mass was the main clinical presentation. Other signs were pain, dysphonia, dizziness, headache, and tinnitus. Physical examination showed, in most cases, a neck nontender mass with side to side mobility. Imaging techniques included Doppler ultrasound, computed tomography (CT) scan, magnetic resonance imaging, and catheter arteriography. Urinary analysis for metanephrine was carried out in 1 case. The clinical presentation and imaging results strongly suggested the diagnosis of carotid paraganglioma in all cases. Treatment was surgical excision in all cases associated with a preoperative embolization in 1 case and a postoperative radiotherapy in 2 cases. Pathology confirmed the diagnosis, and a lymph node metastasis was suspected of malignity in 1 case. The evolution was favorable in all our patients. CONCLUSIONS: Carotid body tumor requires early diagnosis and an adequate multidisciplinary team. The diagnosis must be considered in the case of any pulsatile cervical mass. Surgery is the treatment of choice despite its risks especially in large tumors. The therapeutic indication should, ideally, be set in a multidisciplinary consultation.
Asunto(s)
Tumor del Cuerpo Carotídeo , Adulto , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Tumor del Cuerpo Carotídeo/epidemiología , Tumor del Cuerpo Carotídeo/secundario , Tumor del Cuerpo Carotídeo/terapia , Angiografía por Tomografía Computarizada , Embolización Terapéutica , Femenino , Hospitales Militares , Humanos , Metástasis Linfática , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Imagen Multimodal , Disección del Cuello , Valor Predictivo de las Pruebas , Radioterapia Adyuvante , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: Spontaneous cerebrospinal fluid leaks are rare but may lead to confusion with other diseases in patients without history of trauma. We report a rare case unusual for two reasons. First, our patient was put under antiallergic medication for months before the diagnosis of spontaneous cerebrospinal fluid leak of the sphenoid sinus. Second, our patient was managed successfully by a ventriculoperitoneal shunt. CASE PRESENTATION: Our patient was a nonobese 49-year-old Arab man without history of trauma or surgery who presented with rhinorrhea. He was given allergic rhinitis medication for 4 months without improvement. After the onset of headache leading to the suspicion of paranasal sinusitis, a computed tomography scan discovered an osteodural defect in the sphenoid sinus roof and a magnetic resonance imaging scan showed an aspect of empty sella with an arachnoidocele. An eye fundus examination found papilledema suggesting the diagnosis of idiopathic intracranial hypertension. We performed a ventriculoperitoneal shunt without repair of the osteodural defect. Because of the favorable evolution, we decided to postpone surgery. CONCLUSIONS: Spontaneous cerebrospinal fluid leak should be considered even in nonobese male patients without history of trauma. Our observation adds to other case reports suggesting the decrease of cerebrospinal fluid pressure alone as an option for the treatment of spontaneous cerebrospinal fluid leaks. Additional studies are necessary to clarify the indications.