Pleomorphic adenoma. Diagnostic difficulties. Value of ultrastructural and immunohistochemical studies. Apropos of 2 cases

2 cases of pleomorphic adenoma with unusual histological feature are related. In the 1st case, the tumor was mistaken for a schwannoma. The electron microscopic study only permitted the diagnosis; in the 2nd case, the tumor, obviously malignant, was firstly diagnosed as synovial sarcoma; in this case also, ultrastructural study permitted to recognize a malignant mixed tumor with an unusual "sarcomatous" change of its myoepithelial component.     

Intracranial lipoma. Report of a case and differentiation from other tumours of the cerebellopontine angle.

Teratomata of the cerebellopontine angle are rare. A case of a lipoma of this localization occurring in a 50-year-old man with an interesting case history is reported. The differential diagnosis of tumours of the internal auditory meatus and the surrounding structures is discussed. In cases with an uncharacteristic clinical history suggesting involment of the VIIIth cranial nerve, it is important to focus attention on the existence of rare lesions of the internal acoustic porus. The diagnosis can only be established with operation and biopsy.     

The Interesting Case No. 42. Differential diagnosis of epistaxis

Epistaxis is a symptom and one of the most frequent medical emergencies. In most cases haemorrhages concern the anterior parts of the septum, in particular the Locus Kiesselbachi. Thus they are harmless and therapy is easy to handle. We report a case of a 55-year-old lady with relapsing epistaxis due to a pseudoaneurysm after surgery of a meningioma of the sphenoid bone. This type of epistaxis is rare and may culminate into a life-threatening event. The case demonstrates the importance of an exact differential diagnostic evaluation by use of modern imaging techniques for severe and life-threatening symptomatic nose-bleeding.     

Mixed tumor of parotid in childhood.

The case of a mixed tumor of the parotid gland in an 8-year-old girl is reported. The low frequency of this neoplasm in children is the reason why we show this new case. A short survey of the literature is made, with a special reference to the incidence in childhood.     

Paroxysmal ataxic dysarthria.

This report reviews 13 cases in which a dysarthria appeared, remitted, and reappeared within seconds. The speech pattern of each case was characteristic of ataxic dysarthria. A cinefluorographic film for one of the subjects provided a rare opportunity to study the articulatory dynamics of this disorder. Multiple sclerosis either was given as a diagnosis or was strongly suspected in each case, and carbamazepine has been an effective treatment. Speculations concerning the origin of the paroxysmal and ataxic character of the dysarthria are presented along with a preliminary checklist for identifying the disorder.     

Liposarcoma of the neck. Report of a case

A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5-year-old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice. Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5-year-old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.     

Dyskeratosis congenita and nasopharyngeal atresia.

Dyskeratosis congenita is a multisystem disorder with an increased incidence of neoplasia and opportunistic infections. A case is reported as a cause of complete nasopharyngeal atresia.     

Undifferentiated small-cell neoplasm of the petrous apex. A case report.

We present a rare case of undifferentiated small-cell neoplasm involving the temporal bone petrous apex. The symptoms, physical examination, importance of roentgenographic findings, and pathologic findings are reviewed. While not absolutely conclusive, the collective evidence in this case supports a diagnosis of small-cell carcinoma of the lung with metastasis to the petrous apex. A discussion of temporal bone malignancies, their frequencies, and characteristics is included. To our knowledge, a review of the literature over the past 25 years reveals no other published cases of an undifferentiated small-cell carcinoma in the temporal bone.     

Cystic ameloblastic fibroma.

A seven-year-old white male presented with an enlarging mass in the mandible which was a cystic ameloblastic fibroma. This case, the third reported in the literature, demonstrated several unusual histopathologic findings and presented several controversies in management.     

Subdural empyema complicating acute frontal sinusitis. Four cases report

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.     

Traumatic esophagopericardial fistula.

The pathological state of esophagopericardial fistula is a rare phenomenon. Its etiology may be either traumatic or disease induced. In either event, it is a most serious condition with a frequently fatal outcome. This case report concerns itself with an iatrogenic induced esophagopericardial fistula which was successfully treated by a thoracotomy and pericardotomy.     

Post-adenoidectomy inflammatory pseudotumor.

PROBLEM: Inflammatory pseudotumor is a rare pathology in the head and neck area. Multiple post-adenoidectomy complications have been described in the literature without alluding to such an entity. METHOD: A case report of an inflammatory pseudotumor following an adenoidectomy. MAIN RESULTS: Pseudotumor of the nasopharynx should be added to the list of possible complications of adenoidectomy. CONCLUSION: Inflammatory pseudotumor of the nasopharynx is a rare complication that confronts the otolaryngologist and the pathologist with a diagnostic challenge. Surgical excision remains the best therapeutic option.     

Complications resulting from treatment of severe posterior epistaxis.

Recent advances in nasal endoscopy and arterial embolization have improved the treatment of severe posterior epistaxis. This report reviews the therapeutic options, including a case of epistaxis that did not respond to nasal packing but was successfully controlled with superselective arterial embolization. The discussion includes an outline of potential complications of epistaxis treatment, including a case of nasal septal perforation.     

Paraganglioma of the inferior laryngeal paraganglia. A case report.

Laryngeal paragangliomas are uncommon, usually benign neoplasms. The overwhelming majority of these tumors are supraglottic, arising from the superior laryngeal parasympathetic paraganglia. Few paragangliomas of the infraglottic region have been described. We describe the case of a 35-year-old man with a family history of carotid body tumors who presented with an infraglottic paraganglioma.     

Pyknodysostosis. An unusual form of osteopetrosis

The case reported here illustrates a rare variety of hereditary osteodysplasia, the pyknodysostosis. The patient, a 34-years-old man, had an history of prior fractures. He took medical advice for a mandibular osteitis consecutive to a tooth extraction. The clinical examination detected a dwarfism accompanied by cranial deformities and abbreviated terminal phalanges of the fingers. The histological study was performed on the mandibular sequestrum and on the adjacent bone. Besides of chronic osteitis, it exhibited an intense osteo-condensation with changes in collagen frame by polarized lumen. As to the 2 molars implanted in the sequestrum, they were ankylosed because of the loss of periodontal ligament. About this case, the differential diagnosis with osteopetrosis and cleidocranial dysostosis and the pathogenesis of the disease are discussed.     

Temporal bone findings in keratitis, ichthyosis, and deafness syndrome. Case report.

In 1981, the term KID syndrome was suggested for patients with congenital ichthyosis associated with deafness and keratitis. We had a chance to examine the temporal bone of an infant with this syndrome. This patient showed no auditory brain stem response in either ear. Temporal bone studies revealed cochleosaccular abnormality. These findings are offered as a possible explanation for the patient's deafness. The pathologic inner ear findings of congenital deafness syndromes associated with ichthyosis have been heretofore reported in Refsum's syndrome and in a case with universal alopecia. In these cases, the temporal bone pathologic findings were a result of cochleosaccular abnormality. From our case and previous reports, it is suggested that the deafness associated with congenital ichthyosis might be the result of cochleosaccular abnormality.     

Abscess of the lingual tonsil.

Abscess of the lingual tonsil is an unusual entity that may cause diagnostic difficulty. The pathophysiologic mechanism of formation was correlated with normal posterior tongue histology in a case of lingual tonsillar abscess.     

Ameloblastoma of the mandible with intracranial metastasis. A case study.

Ameloblastoma is an aggressive locally recurring neoplasm of odontogenic epithelium. We describe a case of a mandibular ameloblastoma with a 17-year history of local recurrences followed by two metachronous intracranial metastases. Central nervous system metastasis without pulmonary involvement is previously unreported in a living patient with ameloblastoma. The behavior of this tumor qualifies it as a malignant ameloblastoma.     

Extramedullary plasmacytoma of the nasopharynx. Typical versus atypical presentation

Extramedullary plasmacytoma are rare plasma cell neoplasias. Eighty percent of these tumours grow in the ENT region. We report a typical case of a woman with a single tumour in the nasopharynx. Actually she is in complete remission after surgical and radiotherapic treatment. We also report an atypical case of a woman with a tumour in the nasopharynx associated with a cervical metastatic adenopathy and a plasmacytoma of bone. The treatment of this widespread disease was systemic chemotherapy. An update on this subject is done.