Adénome pléomorphe de l’espace parapharyngé

Les tumeurs de l’espace parapharyngé sont rares, elles représentent 0,5% de l’ensemble des tumeurs de la tête et du cou. elles sont bénignes dans 70 à 80 % des cas selon les séries. elles ont pour origine les glandes salivaires dans 40 à 50% des cas, dominés par les adénomes pléomorphes. Nous rapportons un cas d’adénome pléomorphe de l’espace parapharyngé chez une femme âgée de 38 ans. La patiente a été opérée par voie trans-orale avec exérèse complète de la tumeur. L’examen anatomopathologique définitif a conclu à un adénome pléomorphe. Les suites opératoires étaient simples. on n’a pas noté de récidive après un recul de 2 ans.Mots clés : tumeur para pharyngé, glandes salivaires, adénome pléomorphe

Profil ganglionnaire des micro carcinomes papillaires de la thyroide

Management of papillary microcarcinomas of thyroid gland is subject to many discussions.Objective : Aim of this study: determinate lymph node status in these malignant tumors.Materials and methods : this study is about 20 cases of papillary microcarcinomas of thyroid gland, operated between 1994 and 2007,Results : Our study was about 18 women and 2 men with a middle-age of 46 years. We had found that 35% of microcarcinomas had a size higher than 0,5cm.Neck lymph node metastasis were present in 83% when the size of tumor was higher than 0,5 cm.Conclusion : Neck lymph node metastasis in micropapillary carcinomas is conditioned by many factors of which depend the therapeutic management.Keywords : Thyroid gland, papillary microcarcinoma, neck-lymph node dissection

Carcinome parathyroidien

Parathyroid cancer is uncommon and its etiology is largely unknown. It is difficult to diagnose. The preoperative syndrome is unusually severe primary hyperparathyroidism. Intraoperatively, many characteristics of the tumor may be highly suggestive. Confirmation requires pathological analysis of the operative specimens and the diagnosis is strengthened in the presence of associated Shantz and Castelman criteria. Specific immunohistochemical techniques have been shown to be contributive. The diagnosis can be further supported by the clinical course of local recurrence or metastatic spread.Treatment of this tumor is primarly surgical. In some cases, postoperative radiotherapy may improve locoregional control of the tumor. The disease control can be monitored by regula assay of serum calcium and the parathormone. We report a case of parathyroid carcinoma, with special emphasis on the diagnostic modalities of this tumor, its treatmentand its prognosis.Keywords: Hypercalcemia, Primary Hyperparathyroidism, Parathyroid carcinoma, Surgery

La maladie de cowden a propos d’un cas

La maladie de Cowden est une maladie héréditaire à transmission autosomique dominante caractérisée par des lésions associant des atteintes cutanées constantes et caractéristiques (lésions papuleuses au niveau de la face et des extrémités) et des lésions viscérales inconstantes notamment thyroïdiennes, mammaires, intestinales et rénales à haut risque de dégénérescence. Nous rapportons un cas chez une femme de 30 ans porteuse d’une craniomégalie, de polypes intestinaux, d’un fibroadénome des seins, de lésions papuleuses des gencives et d’un goitre multi-nodulaire. Elle a eu dans notre service une thyroïdectomie totale dont l’analyse anatomopathologique définitive de la pièce a révélé un micro-carcinome vésiculaire du lobe gauche de la thyroïde. Les lésions thyroïdiennes sont habituellement bien limitées, mais devant la multifocalité, le risque accru de récidive et de dégénérescence maligne, une thyroïdectomie totale doit être préconisée.Mots clès : Maladie de Cowden, Cancer de la thyro

Histiocytose langerhansienne multiviscerale avec atteinte auriculaire bilaterale a propos d’une observation

L’histiocytose langerhansienne multi-viscérale est une prolifération clonale des cellules de Langerhans, touchant plusieurs organes. Cette entité se voit surtout chez l’enfant. Dans ce travail, nous rappelons les aspects cliniques avec la fréquence d’atteinte oto-rhino-laryngologique, ainsi que les moyens de diagnostic et le traitement de cette affection rare. Nous présentons le cas d’un enfant âgé de 2 ans qui a été hospitalisé pour une pneumopathie interstitielle, associée à une otorrhée bilatérale. L’examen a montré un comblement des 2 conduits auditifs externes et des lésions cutanées squameuses. La biopsie a conclu à une histiocytose langerhansienne. Malgré la chimiothérapie, l’enfant est décédé après 11 mois.Mots-clés : Histiocytose langerhansienne, atteinte auriculaire

Adenome pleomorphe a localisation extra-parotidienne

Objectives : Pleormorphic adenoma is a benign tumor of salivary gland. It mainly occurs in the parotid gland. The submandibular and minor salivary glands are rarely sites of occurrence. We describe the features of pleomorphic adenoma occurring at these sites.Material and methods: Between 2000 and 2009, 15 cases of pleomorphic adenoma occurring externly to the parotid have been collected.Results: Tumors were seen in the submandibular gland in 40 % of cases, in the hard palate in 33 % of cases, in the upper lip in 20 % of cases and in the parapharyngeal space in 7 % of cases. The mean age of patients was 48 years. The majority of cases were female. All patients were operated. We didn't report recurrence or malignants tumors after one year follow-up.Conclusion: After the parotid gland, the most common site of a pleomorphic adenoma is the submandibular gland followedby minor salivary gland of palate and lips. Each localisation has his clinical and therapeutic particularities.Key words : pleomorphic adenoma, submandibular gland, minor salivary glan

Cholesteatome Congenital De L’oreille Moyenne A Propos De Deux Cas

But :Le cholesteatome congenital de l’oreille moyenne est une entite rare. L’objectif de ce travail est de discuter les particularites cliniques et therapeutiques de cette pathologie a travers deux observations de malades presentant un cholesteatome congenital operes et suivis au service d’ORL et de chirurgie cervico-faciale Fattouma Bourguiba Monastir, entre 2002 et 2008. Résultats : Il s’agissait de deux garcons, ages de 5 et 7 ans. La symptomatologie etait dominee par l’apparition d’une hypoacousie et l’examen otologique a revele un tympan complet dans les deux cas. La TDM des rochers a permis d’evoquer le diagnostic du cholesteatome congenital et d’apprecier les extensions locales des lesions. Les deux malades ont eu une tympanoplastie en technique fermee. Conclusion : L’evolution du cholesteatome congenital est insidieuse et le diagnostic est souvent tardif. Le traitement est chirurgical, domine par la tympanoplastie en technique fermee. Mots clès : Chlolesteatome congenital, hypoacousie, tympan complet, tympanoplastie en technique fermee, technique ouverte

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Objective: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. Design: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. Methods: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. Results: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. Conclusion: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age