Search

Schwannomas are usually benign, rare, and slow-growing nerve sheath tumor composed of Schwann cells. They develop in the head and neck area in approximately 25% to 40% of cases, of which 1% in the oral cavity, where the tongue remains the preferred site. Malignant transformation occurs in approximately 8% to 10% cases. We report a unique case of a histologically proven FDG-avid schwannoma of the left mobile portion of the tongue, showing an 18F-FDG avidity on PET/CT, which was a false-positive result for local recurrence in a patient followed for squamous cell carcinoma.

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p

Hypocalcemia linked to a diminished circulating intact parathormone (iPTH) is the most common complication after total thyroidectomy. The objective of this study was to evaluate iPTH as a predictor of post-thyroidectomy hypocalcemia. Hundred-and-eight patients who underwent total thyroidectomy were included. Blood samples (iPTH, calcium and albumin) were performed at different times: preoperatively (H0), after removal of the gland (Hdrop), 6 h (H6) and one day (D1) after the surgery. Hypocalcemia was defined by total calcium corrected by serum albumin ≤ 2.10 mmol/l. The area under the ROC curve (AUC) was used to determine the best cut-off value and predictability of iPTH for hypocalcemia in terms of absolute value (ng/L), decrease in the slope (ng/L) and decline (%) between two times. The study included 101 patients. Among them, 39 had hypocalcemia (38.6%). At H6, an iPTH absolute value less than 14.35 ng/L (Se = 0.706; Sp = 0.917) and a decline from the preoperative time of more than 59.5% (Se = 0.850; Sp = 0.820) were predictive of hypocalcemia. Other absolute values, decrease in the sloop and decline between preoperative and postoperative values were less relevant. The iPTH 6 h after total thyroidectomy is predictive of hypocalcemia. It might be used to identify patients not at risk of hypocalcemia and earlier discharge could be considered.

International audience; The aims of this multicenter study were to identify clinical and preop-erative PET/CT parameters predicting overall survival (OS) and distant metastasis???free survival (DMFS) in a cohort of head and neck squa-mous cell carcinoma patients treated with surgery, to generate a prog-nostic model of OS and DMFS, and to validate this prognostic model with an independent cohort. Methods: A total of 382 consecutive patients with head and neck squamous cell carcinoma, divided into training (n = 318) and validation (n = 64) cohorts, were retrospectively included. The following PET/CT parameters were analyzed: clinical parameters, SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis, and distance parameters for the primary tumor and lymph nodes defined by 2 segmentation methods (relative SUVmax threshold and absolute SUV threshold). Cox analyses were performed for OS and DMFS in the training cohort. The concordance index (c-index) was used to identify highly prognostic parameters. These prognostic parameters were externally tested in the validation cohort. Results: In multivariable analysis, the significant parameters for OS were T stage and nodal MTV, with a c-index of 0.64 (P < 0.001). For DMFS, the significant parameters were T stage, nodal MTV, and maxi-mal tumor???node distance, with a c-index of 0.76 (P < 0.001). These combinations of parameters were externally validated, with c-indices of 0.63 (P < 0.001) and 0.71 (P < 0.001) for OS and DMFS, respec-tively. Conclusion: The nodal MTV associated with the maximal tumor???node distance was significantly correlated with the risk of DMFS. Moreover, this parameter, in addition to clinical parameters, was associated with a higher risk of death. These prognostic factors may be used to tailor individualized treatment. Superscript/Subscript Available

A 67-year-old man was referred to our department to undergo a 68Ga-DOTATOC PET/CT during the systematic follow-up of a small intestine neuroendocrine tumor. PET revealed an incidental focal increased uptake of 68Ga-DOTATOC matching with a left intraparotid lesion on the combined contrast-enhanced CT, suggestive of a benign salivary tumor. An MRI was performed to characterize this lesion, and finally, the patient underwent surgery. Histological analysis confirmed the presence of a basal cell adenoma.

Resume Introduction Les hemangiomes de l’os temporal sont des tumeurs rares davantage encore lorsqu’il existe une extension au sein de l’oreille moyenne. Le caractere exceptionnel de ces lesions rend leur prise en charge tout aussi compliquee. Cas clinique Nous rapportons le cas d’une patiente de 16 ans presentant une lesion lytique petreuse gauche se retrouvant etre un hemangiome avec une extension a l’oreille moyenne a l’origine d’une hypoacousie de transmission. Discussion La biopsie chirurgicale est essentielle pour etablir le diagnostic d’hemangiome car l’imagerie seule ne permet que rarement d’obtenir une certitude diagnostique. La chirurgie est le traitement de reference afin d’eviter les recidives. L’arteriographie est essentielle dans le bilan preoperatoire pour limiter le risque de saignement.

Rhabdomyosarcoma of the larynx has been very rarely described in pediatric population. There are 3 histological subtypes: embryonal, pleomorphic, and alveolar. With regard to the English literature, we present the first case of alveolar rhabdomyosarcoma of the larynx ever described in a child. This tumor has been diagnosed on an endoscopic biopsy. Thus, a unilateral arytenoidectomy has been performed. This tumor has a poor prognosis. Lymph node metastases were successfully treated by chemotherapy and radiotherapy. Surgery has shifted from radical to conservative combined with adjuvant treatments.

Introduction Rhabdomyosarcoma (RMS) arises from mesenchymal cells committed to skeletal muscle. It is the most frequent soft-tissue sarcoma in children and makes up 5% of all pediatric malignant tumors. In this population, there are two main histological forms, which are the embryonal or the alveolar RMS. The retro auricular location is extremely rare. We present 2 cases of children with left retro-auricular RMS occurring at a very early stage of post natal development. Case reports Two children were included in the RMS 2005 Protocol. The first child, aged 5-days, was managed by surgical resection in two steps after a previous incomplete resection which was followed by 8 chemotherapy cycle. The second, aged 3-days, was managed by surgical resection of the tumor bed, completed by 8 chemotherapy cycle. On regular follow up for over 6 years after the diagnosis, both patients are free of recurrence. Discussion RMS is a fast-growing malignant and aggressive tumor originating from skeletal muscle. It occurs in the first decade of life and is associated with genetic conditions. With an unusual clinical presentation and anatomical location, both benign and malignant tumors can be suspected. Diagnosis can be performed with CT-scan or MRI and confirmed by biopsy. The treatment is based on chemotherapy followed by radiotherapy or surgical resection. In our two patients, the treatment program achieved complete disease control, with good prognosis especially because of anatomical location as well as early diagnosis.

BackgroundModern radiotherapy (RT) planning techniques and the use of oral supportive care have reduced the occurrence of acute radiation-induced toxicities. Oral mucositis remains a major concern in patients with head and neck cancer as it can compromise treatment compliance and outcome.ObjectiveTo report the rate of mucositis with the preventive use of surface low-level laser therapy in patients with head and neck cancer.MethodsForty patients treated with definitive (n=27) or adjuvant (n=13) RT using volumetric arc therapy between August 2014 and October 2015 for squamous cell carcinoma of the head and neck were included. All patients were treated using photobiomodulation using surface low-level laser therapy (Heltschl kind FL 3500, 350 mW), 3 times a week during the whole treatment course. The grade of mucositis was obtained from week 1 to week 7 and at 1 month.ResultsThe median RT dose was 70 Gy (64–70). Concomitant chemotherapy was administered in 29 patients. According to the Common Terminology Criteria for Adverse Events (CTCAE) v. 3, grade 0, 1, 2 and 3 mucositis was observed in 9 (22.5%), 9 (22.5%), 16 (40%) and 6 (15%) patients at week 7, and 32 (80%), 2 (5%), 3 (7.5%) and 3 (7.5%) patients at 1 month following treatment. No grade 4 occurred. Median average and maximum dose to the oral mucosa was 42 Gy (12.9–66.3) and 66.6 Gy (39–76), respectively.ConclusionDespite a substantial dose to the oral mucosa, the rate of acute radiation-induced mucositis of grade ≥3 remains low in patients receiving extraoral low-energy laser during RT.

Radiological assessment of osseointegration of mastoid grafts: biological hydroxyapatite (Bio-Oss®) (BHA) versus bioglass S53P4 (Bonalive®) (BG).Retrospective (10 ± 4 months post-surgery) monocentric high resolution computed tomography (CT) scan assessment (November 2018 and October 2020) by two independent radiologists (R1, R2), blinded to patient allocation. All patients who had undergone a total mastoid obliteration were eligible. Excluded: complications namely otological acute or chronic infections, unbalanced metabolic disease, long-term cortico-steroid therapy, auto-immune disease, history of allergy to grafting materials and post-surgery CT scan in other centers (n = 8).the ratio between two regions of interests (ROI) (graft to otic capsule).resorption of mastoid grafts and assessment of clinical tolerance.Included 21 patients (mean age: 29 ± 21 years; 5 females, 16 males). Significantly higher osseointegration for BHA vs. BG (R1 p = 0.043; R2 p = 0.004); almost perfect inter-reader agreement k = 0.922). The ROI ratios for BHA and BG to that of the otic capsule were 0.57 ± 0.11 (R1) and 0.59 ± 0.14 (R2); 0.43 ± 0.11 (R1) and 0.43 ± 0.08 (R2), respectively. Density increased significantly by 399 ± 261 Hounsfield units (HU) (p = 0.008) and decreased by 464 ± 161 HU (p 0.001) for BHA vs. BG. Resorption rates were 24.1 ± 21.0% and 66.7 ± 15.1% (p = 0.076), respectively. No significant difference in clinical tolerance was observed.Post-operative CT scan of mastoid obliteration seems reliable in assessment of biomaterial graft's mid-term feasibility and stability: BHA seems to provide a more optimal osseointegration versus BG with no significant differences in graft resorption and clinical tolerance.

To report outcome and predictive factors in patients with N3 (6 cm) non-metastatic locally advanced head and neck squamous cell carcinoma (LAHNSCC) treated with a conservative approach or with initial surgery.104 patients were included: 69 treated with radiotherapy (RT) ± chemotherapy (CT) and 35 with nodal surgery with or without primary tumour resection, which was completed in 30 patients by adjuvant RT ± CT. Positron-emission tomography-computed tomography (PET-CT) guided surveillance after RT ± CT was standard.Two-year overall survival (OS) and locoregional control (LRC) were 39.4% and 37.5%, respectively. In univariate analysis, body mass index (BMI), performance status (PS), p16 status and haemoglobin value influenced OS and disease-free survival (DFS). In multivariate analysis, p16 positive status and BMI ≥ 25 remained independent prognostic factors for better OS (p = 0.023) and DFS (p = 0.002). Only under/normal weight remained an independent and adverse significant prognostic factor in multivariate analysis for regional control (RC). Patients treated with primary RT ± CT had slightly better 2-year OS (43.5%Patients with N3 LAHNSCC have poor prognosis, but long term LRC is achievable, especially in overweight patients and those with a good PS.Il carcinoma squamocellulare della testa e collo con N3 (6 cm): risultati e fattori prognostici in 104 pazienti.Analizzare i risultati e fattori predittivi in pazienti con carcinoma a cellule squamose della testa e del collo localmente avanzato non metastatico con N3 (6 cm) (LAHNSCC N3) trattati con un approccio conservativo o con intervento chirurgico.Sono stati inclusi 104 pazienti: 69 trattati con radioterapia (RT) ± chemioterapia (CT) e 35 con chirurgia linfonodale con o senza resezione del tumore primario, di cui 30 pazienti con RT ± CT adiuvante. La sorveglianza dopo RT ± CT è stata eseguita mediante tomografia computerizzata a emissione di positroni (PET-TC).La sopravvivenza globale (OS) a 2 anni e il controllo locoregionale (LRC) erano rispettivamente del 39,4% e del 37,5%. Nell’analisi univariata, l’indice di massa corporea (BMI), il performance status (PS), lo stato di p16 e il valore dell’emoglobina hanno influenzato l’OS e la sopravvivenza libera da malattia (DFS). Nell’analisi multivariata, la positività di p16 e il BMI ≥ 25 sono rimasti fattori prognostici indipendenti per una migliore OS (p = 0,023) e DFS (p = 0,002). Lo stato di malnutrizione o normale status nutrizionale sono rimasti fattori prognostici significativi indipendenti e negativi nell’analisi multivariata per il controllo regionale (RC). I pazienti trattati con RT ± CT primaria avevano una OS a 2 anni leggermente migliore (43,5% contro 33,3%, p = 0,31).I pazienti con LAHNSCC N3 hanno una prognosi sfavorevole, ma è possibile ottenere un LRC a lungo termine, specialmente nei pazienti in sovrappeso e in quelli con un buon PS.

Introduction Minimally invasive surgery has become the standard surgical attitude in primary hyperparathyroidism. It requires precise preoperative lesion localization. The aim of the present study was to evaluate the performance of ultrasonography and 99mTc-sestamibi scintigraphy in minimally invasive surgery for primary hyperparathyroidism. Materials and methods A retrospective study included all patients managed surgically for primary hyperparathyroidism between January 2008 and November 2017 in the University Hospital of Brest (France). Two hundred and seventy-three patients underwent ultrasonography and 99mTc-sestamibi scintigraphy. Results determined intrinsic (sensitivity and specificity) and extrinsic (positive and negative predictive values) performance on per-patient and per-gland analysis. Demographic, preoperative, interventional and cure data were compared according to ultrasonography and scintigraphy results, distinguishing 3 patient groups: concordant n = 156, discordant n = 99, negative n = 18. Results On per-gland analysis, sensitivity was 70% for ultrasound, 74% for 99mTc-sestamibi scintigraphy and 81% for associated ultrasound-scintigraphy; positive predictive values were 89%, 91% and 96%, respectively. Gland volume and concomitant thyroid pathology rates differed significantly (both p = 0.003) between the 3 imaging results groups. Conclusion The performance of associated ultrasound-99mTc-sestamibi-scintigraphy provided a positive predictive value of 96%. Combining the two techniques reduced surgical morbidity.

Resume Introduction La chirurgie mini-invasive dans la prise en charge de l’hyperparathyroidie primaire est devenue la technique de reference. Elle necessite une localisation precise des lesions en preoperatoire. L’objectif de ce travail etait d’evaluer les performances de l’echographie et de la scintigraphie au 99mTc-sestamibi dans la prise en charge chirurgicale mini-invasive de l’hyperparathyroidie primaire. Materiel et methodes Cette etude retrospective a inclus tous les patients pris en charge chirurgicalement, pour une hyperparathyroidie primaire, entre janvier 2008 et novembre 2017, au CHU de Brest. Deux cent soixante-treize patients ont beneficie d’une echographie et d’une scintigraphie. Les resultats de l’echographie et de la scintigraphie ont permis de determiner les performances intrinseques (sensibilite et specificite) et extrinseques (valeur predictive positive et negative) dans une analyse par patient et par glande. Les donnees demographiques, preoperatoires, interventionnelles et la guerison ont ete comparees en fonction des resultats de l’echographie et de la scintigraphie (3 groupes en analyse par patient : concordant n = 156, discordant n = 99, negatif n = 18). Resultats En analyse par glande, la sensibilite en analyse etait de 70 % pour l’echographie, de 74 % pour la scintigraphie et de 81 % pour le couple echographie–scintigraphie. La valeur predictive positive etait de 89 % pour l’echographie, de 91 % pour la scintigraphie et de 96 % pour le couple echographie–scintigraphie. Le volume glandulaire et la presence d’une pathologie thyroidienne concomitante differaient significativement (p = 0,003 et p = 0,003) entre les 3 groupes selon les resultats d’imagerie. Conclusion Les performances du couple echographie–scintigraphie permettent une valeur predictive positive de 96 %. Ces deux techniques ont permis de limiter la morbidite chirurgicale.

Introduction Haemangiomas of the temporal bone are rare tumours and haemangiomas involving the middle ear are even rarer. The exceptional nature of these lesions makes their management particularly complicated. Case report The authors report the case of a 16-year-old girl, who presented with an osteolytic lesion of the left petrous temporal bone that proved to be a haemangioma with extension to the middle ear, causing conductive hearing loss. Discussion Surgical biopsy is essential to establish the diagnosis of haemangioma because imaging alone only rarely provides a definitive diagnosis. Surgery is the reference treatment to prevent recurrence. Arteriography is an essential part of the preoperative assessment in order to limit the risk of bleeding.

Background External ear canal exostoses are usually bilateral and broad-based, secondary to external ear canal chronic cold exposure, especially water. Objectives The objectives were to analyze the influence of the surgeon’s experience on the 3-year recurrence and on the complication. We also studied the influence of prolonged exposure to cold water on the incidence of recurrence. Material and Methods This monocentric retrospective study included 98 ears operated for canalplasty between 2009 and 2016 by nine different operators including one senior, a junior, and seven beginner surgeons. Senior, Junior, and Beginner groups were compared. Results 3-year recurrence rate was higher in the Beginner and Junior groups than in the Senior group (69% and 38% vs 18%, P = .001). Although there was a difference between the Beginner (69%) and Junior (38%) groups, it was not significant ( P = .407). Among the recurrences, 48% had continued exposure to cold water while only 7% of the ears without recidivism were still exposed ( P < .001, OR = 1.25 [4.4; 36.1]). The complication rates were similar between groups, concerning pain (8% vs 30% vs 12%), per procedure perforation (17% vs 10% vs 16%), scarring disorders (25% vs 20% vs 13%), and osteitis (8% vs 0% vs 1%). Hearing was unaffected. Conclusions This is the first study evaluating the risk of recurrence of external ear canal exostoses after canalplasty based on the surgeon’s experience. This risk of recurrence seems to decrease with the surgeon’s experience. There was no difference in complication rates.

Objectives To analyze the clinical features of hearing impairment and to search for correlations with the genotype in patients with GJB2 mutations. Design Case series. Setting Collaborative study in referral centers, institutional practice. Patients A total of 690 hearing-impaired patients were genotypically and phenotypically described. The mutations of GJB2 and GJB6 were studied. Heterozygous patients were searched for another mutation by microsatellite approach. Main outcome measures Prevalence of GJB2 mutations, microsatellite approach, hearing-impairment. Results In 498 patients (72,17% of the cohort), no mutation was found. Homozygotous patients were 59 (8,55%), with 51 for c.35delG, 6 for p.M34T and 2 for GJB6 . Compound heterozygous were 64 (9,28%) with 56 c.35delG-others mutations. Genotypes with biallelic non sense mutations had a high risk of severe to profound hearing impairment. It was frequently milder in compound heterozygotes than in c.35delG homozygotes. Heterozygous patients were 69 (10%) with 21 c.35delG, 20 p.M34T and 28 others mutations. We selected patients with a complete historical medical file (clinical and audiometric data). Then, we performed a microsatellite approach (multiplex PCR of short DNA fragments) to localize a new pathologic allele. Seventeen heterozygous patients were studied. Six patients (35%) showed the same haplotype. They were compound heterozygous bearing a new pathologic allele. Conclusion Genotype may affect deafness severity, but environmental and other genetic factors may also modulate the severity and evolution of GJB2-GJB6 deafness. A new haplotype for GJB2 is described but the exact mutation remains unknown.

Cetuximab, a chimeric monoclonal antibody against EGFR sensitizes tumors to radiotherapy (RT), but is associated with skin and mucosal toxicity. We report outcomes and tolerance of definitive RT in association with cetuximab in patients with locally advanced squamous cell carcinoma (LASCC) of the head and neck. Between 2006 and 2011, 92 consecutive patients with LASCC of the head and neck were treated with RT and concomitant weekly cetuximab. Median age was 61.7 years. Most patients presented with oropharyngeal tumors (52.2%) and stage IV disease (77.2%). Sixty-nine patients received at least 7 cycles of cetuximab. Cetuximab was stopped at the first infusion following allergic reactions in four patients. During RT, 37% of patients developed grade ≥ 3 dermatitis; grade ≥ 2 cetuximab-induced rash occurred in 43 patients (46.7%). Severe mucositis (grade ≥ 3) affected 57.6% of patients. Ten percent of patients did not receive the full course of RT, and temporary discontinuation due to acute toxicity was frequent and affected 37 patients (53%). The median RT overall treatment time (OTT) in patients with interrupted RT was 56 days (47–75) compared to 51 days (47–65) in patients who did not require toxicity-related radiation interruptions (p

Resume Introduction Les tumeurs du sac endolymphatique sont des tumeurs benignes, invasives d’evolution lente, envahissant l’os temporal, se manifestant par une surdite unilaterale. Elles peuvent etre sporadiques ou s’integrer dans un syndrome de von Hippel-Lindau (VHL). Resume du cas Nous rapportons le cas d’une tumeur developpee dans l’utricule dont l’aspect histologique et immunohistochimique correspond a une tumeur du sac endolymphatique, chez un patient indemne de VHL. Discussion Les tumeurs du sac endolymphatique sont des lesions lysant l’os temporal, situees dans la partie posterieure de l’os petreux. D’apres deux etudes concernant des patients atteints de von Hippel-Lindau, les tumeurs du sac endolymphatique seraient developpees aux depens du canal endolymphatique. Notre observation d’un developpement intra-labyrinthique d’une tumeur du sac endolymphatique sporadique est en faveur de cette hypothese pour les formes sporadiques et plaide pour une labyrinthectomie associee au geste d’exerese tumorale afin d’eviter les recidives.

Introduction Endolymphatic sac tumours are benign, slowly growing tumours that invade the temporal bone, and present clinically in the form of unilateral hearing loss. They can be sporadic or occur in the context of Von Hippel-Lindau disease (VHL). Case summary The authors report a case of endolymphatic sac tumour arising in the utricle presenting histological and immunohistochemical features corresponding to endolymphatic sac tumour in a patient without VHL. Discussion Endolymphatic sac tumours invade the posterior part of the petrous temporal bone. According to two studies concerning patients with Von Hippel-Lindau disease, endolymphatic sac tumours arise from the endolymphatic duct. This case of intralabyrinthine sporadic endolymphatic sac tumour supports this hypothesis for sporadic forms, indicating the need for labyrinthectomy associated with tumour resection to avoid recurrence.