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Objective The aim of this review is to study natural history, presentation, treatment and prognosis of head and neck liposarcomas. Methods We carry a retrospective study about 15 patients diagnosed and treated in our department between 1969 and 2001. Therapeutic modalities included surgery, radiotherapy and chemotherapy. Results Tumors were mostly localized at the neck (4 cases) and the scalp (3 cases). Cervical lymphadenopathy was found in 1 case. Chest X-ray found showed metastases in 2 cases. Histological types of liposarcomas were the following: myxoid (5 cases), well differentiated (4 cases), pleomorphic (4 cases), round cell (1 case) and dedifferentiated (1 case). Twelve patients underwent surgery. Complete excision was performed in 7 cases. In the other 5 cases, exeresis was incomplete and 4 of them received postoperative radiotherapy. Three patients were not operated because of vascular involvement (1 case) or metastasis (2 cases), and they all received radiotherapy alone. After initial treatment, complete remission was achieved in 7 cases (46.7%). A recurrence occurred in 8 cases (53.3%). Two of these patients were reoperated and another one received chemotherapy. In the other 5 cases, the tumor was uncontrollable and no additional treatment has been proposed. Five-year survival rate was 87% for patients who underwent surgery alone, 75% for those who underwent surgery and postoperative radiotherapy, and 0% for those treated by radiotherapy alone. Conclusion The mainstay of treatment of head and neck liposarcomas is surgical excision and the prognosis is largely determined by the histological grade and the clinical stage.

Objectifs Etude de l’association entre carcinome de la thyroide et thyroidite de Hashimoto(TH). Materiel et methodes Il s’agit d’une etude retrospective entre 2001 et 2002 portantsur une serie de 78 patients operes avec a l’histologie un diagnostic d’une thyroidite de Hashimoto. Les caracteristiques cliniques et les examens complementaires realises avant lachirurgie ont ete notes. Resultats L’âge moyen etait de 44,6 ans avec 77 femmes et un seul homme. 12 patientsayant une TH, sous forme nodulaire, presentaient un cancer de la thyroide, dont onze casde carcinomes papillaires (14,1 %) et un cas de lymphome B non-Hogkinien la thyroi de.La taille tumorale est en moyenne de 26 mm allant de 4 a 60 mm. Il y avait un microcancer(taille Conclusion On ne retrouve pas une incidence anormalement elevee de carcinome de lathyroide sur cette population hautement selectionnee de TH.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 123 - N° 3 - p. 115-119

Resume Objectifs. – Le carcinome epidermoide hypopharynge est associe a l’un des pronostics les plus defavorables des cancers de la sphere ORL. L’objectif de ce travail etait d’analyser ses modalites therapeutiques a l’institut Salah-Azaiz (Tunis) et de comparer leurs resultats. Patients et methodes. – Cette etude retrospective porte sur 271 carcinomes epidermoides de l’hypopharynx, colliges au service de chirurgie carcinologique cervicofaciale et ORL de l’institut Salah-Azaiz sur une periode de 25 ans (1977 a 2002). L’âge moyen des patients etait de 56 ans ; le sex-ratio etait en moyenne de 1,2 (homme/femme). L’indication d’un traitement a visee curative a ete initialement retenue pour 149 (55 %) patients, qui ont ete les seuls retenus pour l’analyse des resultats. Resultats. – Nous avons retenu l’indication d’un protocole incluant chirurgie et radiotherapie postoperatoire pour 26,2 % des patients. Le taux de mortalite postoperatoire etait de 5,1 % ; le taux de morbidite operatoire etait de 46,2 %. Pour 13,5 % des patients, la radiotherapie postoperatoire a ete definitivement interrompue en raison d’une alteration progressive de l’etat general en cours de traitement. Nous avons pose l’indication d’une radiotherapie exclusive pour 59,7 % des patients. L’âge moyen etait de 56 ans et le sex-ratio de 1,2. La telecobaltotherapie externe etait delivree en fractionnement et etalement classiques. La radiotherapie a du etre definitivement interrompue en cours de realisation dans 32,6 % des cas devant une aggravation de l’etat general ; le taux de morbidite liee a la radiotherapie etait de 33,3 %. Un protocole de conservation d’organe avec chimiotherapie neoadjuvante a ete propose a 21 patients (14,1 %). L’âge moyen etait de 53 ans (28 a 65 ans) et le sex-ratio (homme/femme) de 0,5. Le taux de survie globale etait de 25,5 % a un an, 18,1 % a deux ans, 11,4 % a trois ans et 7,4 % a cinq ans. Tous les patients a qui a ete proposee une chimiotherapie sont decedes en cours de traitement. Les taux de survie a deux et a cinq ans des patients traites par chirurgie et irradiation et par irradiation exclusive etaient respectivement de 21,5 et 12 %, et 18,3 et 10 %. La difference de survie entre ces deux populations therapeutiques n’etait pas significative (p = 0,08). Conclusion. – Tandis que la chimiotherapie neoadjuvante apparait dans notre serie comme grevee d’une lourde mortalite, l’association chirurgie–radiotherapie et la radiotherapie exclusive semblent d’une efficacite similaire dans le traitement du carcinome hypopharynge.

Resume Objectifs. – Le carcinome epidermoide hypopharynge est associe a un pronostic defavorable, auquel l’envahissement ganglionnaire cervical et les metastases a distance contribuent. L’objectif de cette etude etait d’evaluer la frequence, le mode et la signification pronostique de ses metastases regionales et a distance. Patients et methodes. – Les auteurs rapportent une etude retrospective portant sur 271 carcinomes epidermoides de l’hypopharynx, colliges au service de chirurgie carcinologique cervicofaciale et ORL de l’institut Salah-Azaiz de 1977 a 2002. La frequence et les caracteres histocliniques des metastases regionales et a distance ont ete evalues, ainsi que leur signification pronostique chez les 155 patients traites dans un but curatif. Resultats. – 39,1 % des cancers etaient classes N0, 24,4 % N1, 10,7 % N2 et 25,8 % N3 (UICC 2002). Les adenopathies cervicales etaient significativement plus frequentes pour les tumeurs classees T3T4 que pour les T1T2 (soit, pour les tumeurs des sinus piriformes, celles de la region retrocricoarytenoidienne, celles de la paroi posterieure et celles etendues de l’hypopharynx, respectivement : p = 0,001, p = 0,007, p = 0,047, et p = 0,0005). Trente-deux patients ont beneficie d’un evidement ganglionnaire cervical. Parmi ceux dont le cancer a ete classe N0, il a ete trouve 46,9 % d’atteintes ganglionnaire (N+) ; les frequences de la rupture capsulaire n’etaient pas significativement differentes pour les cancers classes N0N1 et pour ceux qui etaient N2N3 ( p = 0,11). Les taux de survie globale a deux et a cinq ans etaient respectivement de 32,5 et 20,5 % pour les patients dont la tumeur etait classee N0, 10,9 et 0 % si elle etait N3. Les differences de taux de survie a deux et a cinq ans entre les patients dont la tumeur etait N0N1 et ceux dont elle etait N2N3 etaient significatives ( p = 0,04). Un echec ganglionnaire cervical a ete constate chez 18,5 % des patients. Le site tumoral n’influencait pas significativement le taux d’echec ganglionnaire ( p = 0,98), non plus que le statut clinique N ( p = 0,34). La rupture capsulaire etait un facteur significatif de prediction d’un echec ganglionnaire ( p = 0,007). Le taux de dissemination metastatique a distance etait de 2,6 % au premier examen, et secondairement de 12,3 %. Les metastases a distance etaient significativement plus frequentes chez les patients dont le cancer etait initialement classe N2N3 que chez ceux dont il etait N0N1 ( p = 0,03), ainsi qu’en cas de rupture capsulaire ( p = 0,0009). Conclusion. – Le carcinome epidermoide de l’hypopharynx est caracterise par une grande lymphophilie, qui est liee a l’extension locale, et par la grande frequence des metastases ganglionnaires occultes. Le statut clinique ganglionnaire ne semble pas influencer la probabilite de survie ; cependant, la rupture capsulaire constitue un facteur de prediction d’un echec ganglionnaire cervical et de metastases a distance. Les metastases a distance sont frequentes, particulierement en cas de tumeur etendue aux plans local ou regional, et la probabilite de survie est dans ce cas nulle a un an.

Objectif Repertorier les seconds cancers observes au niveau de la tete et du cou apres traitement par chimiotherapie et/ou radiotherapie pour un carcinome indifferencie du cavum en Tunisie. Patients et methodes C’est une etude retrospective des dossiers des patients ayant developpe une tumeur secondaire (TS) apres traitement d’un carcinome indifferencie du cavum. Pour etre retenue dans cette etude, la tumeur secondaire doit etre d’histologie differente de l’UCNT initial, localisee dans le champ d’irradiation et survenant apres un delai minimum de 3 ans. Resultats Sur une serie de 2 346 patients traites de 1984 a 2001 a Tunis, Sousse et Sfax, nous avons observe 11 tumeurs secondaires, soit une frequence de 0,46 %. Les patients avaient ete traites pour des UCNT du cavum en majorite etendus T3-T4 (72 %) ou N2-N3 (63 %). L’âge median etait de 20 ans (11 a 48). Le sex-ratio etait de 0,3 (3 H/8 F). Le protocole therapeutique avait comporte une association de chimiotherapie et de radiotherapie dans 8 cas et une radiotherapie seule dans 3 cas. La chimiotherapie etait premiere dans 4 cas combinant adriamycine (40-90 mg/m2)-cisplatine (100 mg/m2) et adjuvante a la radiotherapie dans 4 cas. La dose moyenne de radiotherapie etait de 72 Gy (70 a 75). Le delai median de survenue des TS etait de 9 ans (3 a 17). Il s’agissait de carcinomes epidermoides bien differencies des VADS dans 4 cas, de fibrosarcomes cervico-mandibulaires (2 cas), osteosarcomes du massif facial (2 cas), d’un glioblastome temporal et de deux carcinomes basocellulaires du nez et de la tempe. Le traitement de la tumeur secondaire a comporte une chirurgie seule dans 4 cas et une chimiotherapie seule dans 7 cas. Aucun des patients n’a ete reirradie. La survie mediane etait de 17 mois, 4 patients sont decedes, et 7 sont vivants dont 4 en remission (24+, 36, 36 et 48+ mois) et 3 en evolution tumorale (8, 16 et 18 mois). Conclusion Les tumeurs secondaires apres traitement du cancer du cavum sont rares mais de mauvais pronosticn, justifiant leur detection et leur depistage.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 133 - N° 1 - p. 63-64

Secondary tumours to radio- and/or chemotherapy have rarely been reported after treatment for head and neck cancers. We report a case of mandibular fibrosarcoma observed 7 years after chemoradiotherapy for undifferentiated nasopharyngeal carcinoma in a patient treated when 20 years old.

Epidermoid carcinoma is the most common malignant tumor of the lips. They often develop on precancerous lesions. Leukoplasia is the most frequent precancerous lesion. We report a case of a 35 years old man, who suffered from discoid lupus erythematous since 20 years; and wasn't treated from. He consulted for a squamous ulceration of the under lip, developed from one year. The biopsy concluded to an epidermoid carcinoma. He was treated with surgical excision with reconstruction and homolateral triangular recovery. Keywords : Squamous cell carcinoma, epidermoid carcinoma, discoid lupus erythematosus, precancerous lesion.

Objectives : Thyroid anaplasic carcinoma is a rare variety of thyroid cancer and one of the most aggressive tumors known to affect humans. It accounts for less than 2%of thyroid cancers and it is often extremelymalignant and rapidly fatal. Material and methods : It is a retrospective study of 12 cases of thyroid anaplasic carcinoma hospitalized over one 16 years period (1990-2005) Our aim is to study the clinical aspects and to discuss the therapeutic modalities of this cancer. Results : The average age of our patients was of 68 years (51-79), there are10 women and 2 men. The signs of local compression were present in 10 cases and the physical examination objectified a goiter among 11 patients with an average size of 7 cm. Lymph nodes were observed in two cases and metastases were noted among 7 patients. Two patients had a tracheotomy in urgency with thyroid biopsy in 5 cases, total thyroidectomy in 4 cases and partial thyroidectomy in 3 cases Bilateral neck dissection was realized in two cases. The radiotherapy was palliative in one case. The survival was less than one year for all patients Conclusion : Thyroid anaplasic carcinoma is a very aggressive tumor, the prognosis is very bad with a survival exceeding rarely a year. Despite multimodality approaches, it still carries a dismal prognosis. Keywords : cancer, thyroid, anaplasic, chirurgic, radiotherapy, chemotherapy

Introduction : The clear cell sarcoma (melanoma of soft tissue) is a rare tumor of young adults. Hi occur most commonly in the extremities. We report the case of a man of 70 years, with previous history of a malignant melanoma of the cervical trachea treated by radiotherapy, who present 18 years after Tracheo-esophageal tumor. The tumor was totally removed. Final pathologic diagnosis is a recurrence of his sarcoma cell clear. Three years later, the patient has no signs of recurrence. The aim of this work is to study the clinical features, the prognosis of these cancers and the modality of her treatments. Keywords : the clear cell sarcoma, melanoma of soft tissue, radiotherapy, surgery.

Introduction : L’hypocalcemie est la complication la plus preoccupante de la thyroidectomie totale. Elle impose un traitement substitutif et un suivi a vie. Objectifs : Le but de cette etude est d’evaluer l’incidence de l’hypocalcemie apres chirurgie et d’etudier sa correlation avec les caracteristiques cliniques, biologiques et le type de chirurgie pratique. Materiels et methodes : Etude retrospective portant sur 488 cas de thyroidectomies, operees entre 1992 et 1996. L’hypocalcemie est definie par une calcemie inferieure a 80 mg/l «2 mmol/l ». Les patients, toujours dependants d’un traitement substitutif un an apres la chirurgie, ont ete consideres comme ayant une hypocalcemie definitive. Resultats : Dans notre etude, 368 patients ont eu une thyroidectomie totale et 120 ont eu une thyroidectomie subtotale. Le goitre multinodulaire etait la pathologie la plus frequente, note dans 359 cas, suivie des cancers thyroidiens note dans 83 cas. L’hypocalcemie postoperatoire a ete retrouvee chez 54 patients (11,06%) dont 25 etaient asymptomatique. Cette hypocalcemie s’est revelee definitive chez 14 d’entre eux (2,8%). Nous n’avons pas trouve de correlation statistiquement significative entre l’hypoparathyroidie definitive et les caracteristiques cliniques biologiques et le type de chirurgie. Conclusion : Dans la plupart des cas, l’hypocalcemie est liee a un hypoparathyroidisme transitoire, secondaire au traumatisme ou a la devascularisation des parathyroides. L’hypoparathyroidie definitive est rare, elle est toujours secondaire a une lesion irreversible des parathyroides. Les caracteristiques cliniques initiales des patients et les examens biologiques precoces ne permettent pas de predire l’evolution. Mots-cles : Thyroide, chirurgie, hypocalcemie, parathyroide.

L’angiomyxome agressif est une tumeur mesenchymateuse developpee aux depens du tissu conjonctif avec un site de predilection pour les parties molles du perine feminin. Cette tumeur croit progressivement mais n’est pas metastatique. Le traitement indique actuellement est l’exerese chirurgicale large sans consequences fonctionnelles lourdes. La tumeur a une tendance a la recidive locale, qui est frequente, liee a la difficulte d’une exerese initiale complete. Les auteurs rapportent ici le cas d’un angiomyxome agressif de la joue, qui a ete traite par chirurgie et chimiotherapie. Les aspects cliniques, histologiques et therapeutiques de la tumeur ont ete discutes. Mots-cles : L’angiomyxome agressif, tumeur mesenchymateuse, exerese, recidive.

Les auteurs rapportent un cas de localisation au sinus piriforme d’un carcinome a petites cellules. Ce type histologique a ete souvent decrit dans la pathologie tumorale pulmonaire. Sa localisation au sinus piriforme etant exceptionnelle. Nous presentons dans ce document les aspects endoscopiques, radiologiques, anatomopathologiques et therapeutiques de cette tumeur qui a ete diagnostiquee chez un patient de 56 ans. Mots-cles : Sinus piriforme, carcinome a petites cellules, endoscopie, radiologie, anatomopathologie, traitement.

Objectif : Le but de notre etude est l’evaluation de l’atteinte mandibulaire dans les carcinomes epidermoides de la cavite orale et de l’oropharynx. Materiel et methodes : Il s’agit d’une etude retrospective a propos de 34 patients colliges sur 6 ans (1999-2004) et ayant un carcinome epidermoide de la cavite orale et/ou de l’oropharynx avec envahissement mandibulaire confirme a l’anatomopathologie. L’atteinte mandibulaire a ete evaluee par l’examen clinique, l’orthopantomographie, la tomodensitometrie, et par les constatations peroperatoires du chirurgien. Tous les patients ont eu un evidement ganglionnaire, une exerese tumorale associee a une mandibulectomie segmentaire interruptrice ou conservatrice. Resultats : L’envahissement mandibulaire a ete suspecte cliniquement chez 70,5% des patients devant l’adherence de la tumeur a l’os. Apres examen clinique et imagerie, cette atteinte a ete diagnostiquee chez 88,2% des patients. Dans 11,8% des cas, l’atteinte n’a ete suspectee qu’en peroperatoire. L’examen histologique a confirme l’atteinte osseuse chez tous les patients. La mandibulectomie segmentaire a ete pratiquee chez 17 patients devant l’atteinte du canal mandibulaire. Vingt-huit patients ont eu une radiotherapie postoperatoire a la dose moyenne de 64 Gy. Les taux de recidive, de metastase et de deces etaient respectivement de 11,7%, 17,6% et 17,6% pour les patients qui ont eu une mandibulectomie segmentaire, et de 23,5%, 17,6% et 23,5% pour ceux qui ont eu une mandibulectomie conservatrice. Par ailleurs, 76,5% et 29,5% des patients ayant eu respectivement une mandibulectomie segmentaire et une mandibulectomie conservatrice avaient une gene fonctionnelle importante lors de l’alimentation. Conclusion : L’examen clinique, l’imagerie et l’examen peroperatoire sont d’un apport capital dans l’evaluation de l’atteinte mandibulaire. Une atteinte epargnant le canal mandibulaire justifie une mandibulectomie conservatrice permettant d’avoir de meilleurs resultats esthetiques et fonctionnels tout en assurant un controle carcinologiquement satisfaisant. Mots cles : envahissement mandibulaire, carcinome epidermoide, cavite orale, oropharynx, mandibulectomie segmentaire, mandibulectomie conservatrice

locoregionale rendant le traitement difficile et mutilant. Dans ce travail, nous rapportons notre experience dans la prise en charge diagnostique et therapeutique de ces tumeurs. Materiels et methodes : Notre etude retrospective a concerne 31 cas de cancers de l’orbite colliges sur 13 ans (1993- 2005). Tous les patients ont beneficie d’un examen clinique complet, d’une imagerie du massif facial (TDM et/ou IRM) et d’une biopsie de la tumeur. Le traitement a ete base sur la chirurgie, la radiotherapie et/ou la chimiotherapie. Resultats : La symptomatologie clinique etait dominee par les signes ophtalmologiques et les algies faciales. L’imagerie a montre dans tous les cas un processus expansif tissulaire a point de depart orbitaire, avec lyse osseuse orbitaire chez 16 patients (51,6%), une extension au massif facial chez 7 patients (22,6%), endocrâniennes chez 6 patients (19,4%) et des formes bilaterales atteignant les deux orbites dans 3 cas (9,7%) l’anatomopathologie montrait une predominance des lymphomes malins non hodgkiniens (32,3%) et des carcinomes epidermoides (32,3%), suivis des rhabdomyosarcomes embryonnaires (19,4 %). Douze patients ont ete traites par chirurgie et radiotherapie postoperatoire, dix patients par une association radio-chimiotherapie, et neuf autres par une chimiotherapie neo-adjuvante. La survie globale etait de 67,8% a 3 ans, 48,4% a 5 ans et 22,6% a 10 ans. Conclusion : Les cancers de l’orbite sont de mauvais pronostic. Un diagnostic precoce et un traitement radical et adapte au type histologique permet d’ameliorer la survie et la qualite de vie chez les patients atteints de ces tumeurs. Mots-cles : Orbite, cancer, lymphome, carcinome epidermoide, rhabdomyosarcome

No Abstract. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 17 2006: pp. 16-18

To study of the association between thyroid carcinoma and Hashimoto's thyroiditis (HT).[corrected] Retrospective study of 78 patients undergoing surgery between 2001 and 2002, with a pathological diagnosis of Hashimoto's thyroiditis. The clinical data and complementary tests performed before surgery are reported.The mean age was 44.6 years, with 77 females and only one male. There were 12 cases of thyroid cancer associated with HT, mostly with the nodular form, with 11 papillary carcinoma (14.1%) and one non-hodgkin B lymphoma of the thyroid. Tumor size varied from 4 to 60 mm with a mean of 26 mm. There was one microcancer (size10 mm).We did not find an increased incidence of thyroid cancer associated with this highly selected population of HT patients.

To report the epidemiological and clinical features of nasal and paranasal sinus cancers collected during a period of 35 years at the Salah Azaiez Institute of Tunis.This retrospective study concerned patients with histologically confirmed nasal and paranasal sinus cancers treated at our institute from 1969 to 2004. We collected the following data: age, sex, residence (rural or urban), site, occupation and professional exposure, histological type and tumor extension.We identified 265 cases (163 M; 102 F; Sex-ratio=1.65) with a mean age of 60 years (3 months - 91 years). Epidermoid carcinoma (47%) and adenocarcinoma (16%) predominated followed by sarcoma (14%) and melanoma (6%). We observed only 2 cases (0.7%) of ethmoidal adenocarcinoma.Nasal and paranasal cancers in Tunisia are linked more to chronic rhino-sinusal inflammation than professional exposition (wood).

To collect second cancers occurring in the head and neck area after treatment by chemotherapy and/or radiotherapy for undifferentiated nasopharyngeal carcinoma in Tunisia.This is a retrospective study of patients developing second cancers after treatment for nasopharyngeal UCNT by radiotherapy and/or chemotherapy. To be retained in this study, second tumour had to be histologically different from the initial UCNT, localised in the irradiated area and occurring after a minimal delay of 3 years.We collect 11 cases of second cancers occurring among 2346 patients treated from 1984 to 2001 in Tunisia (0.46%). Patients have been treated for nasopharyngeal UCNT mainly advanced T3-T4 (72%) or N2-N3 (63%). Median age was 20 years (11 to 48) with a sex-ratio of 0.3 (3 M/8 F). Treatment protocol included primary chemotherapy in 4 cases (adriamycin-cisplatin) or adjuvant (in 4) associated to the loco-regional irradiation at a mean dose of 72 Gy (70 to 75). Median delay of second cancer occurrence was 9 years (3 to 17). Tumors were epidermoid carcinomas in 4 cases, fibrosarcomas (2), osteosarcomas (2), glioblastoma (1) and basocellular carcinomas in 2. Second tumors have been treated by surgery alone in 4 cases and chemotherapy alone in 7 patients. No patient have been reirradiated. Median survival was 17 months, 4 patients died and 7 are still alive including 4 in complete remission (24+, 36, 36 and 48+ months) and 3 with progressing disease (8, 16 and 18 months).Even very rare, second cancers after treatment for UCNT need to be detected and have a poor prognosis.

Hypopharyngeal squamous cell carcinoma is associated to one of the most unfavorable prognosis among the cancers of the head and neck. The purpose of this study is to analyze its therapeutic modalities in the Salah-Azaïz Institute (Tunis) and to compare their results.This retrospective study concerns 271 hypopharyngeal squamous cell carcinomas, compiled in the Carcinologic Surgery Department of Head and Neck of the Salah-Azaïz Institute over a period of 25 years (from 1977 to 2002). The average age of the patients was of 56 years; sex-ratio was on average of 1.2 (man/woman). The indication of a curative treatment was initially retained for 149 (55%) patients, who were the only ones retained for the analysis of results.We retained the indication of a protocol including surgery and postoperating radiotherapy for 26.2% of the patients. Postoperation mortality rate was 5.1%; the operating rate of morbidity was 46.2%. For 13.5% of the patients, postoperating radiotherapy was permanently interrupted because of a gradual deterioration of the patients' health in the course of treatment. We retained the indication of exclusive radiotherapy for 59.7% of the patients. The average age was of 56 years and the sex-ratio of 1.2. The external radiotherapy was conventional. Radiotherapy had to be permanently interrupted in progress in 32.6% of cases on account of an deterioration of the patients' health; the rate of morbidity of the radiotherapy was 33.3%. We indicated a protocol of conservation of organ with induction chemotherapy for 21 patients (14.1%). The average age was of 53 years (28-65 years) and sex-ratio (man/woman) of 0.5. The global survival was 25.5% at one year, 18.1% at two years, 11.4% at three years and 7.4% at five years. All the patients selected for chemotherapy died in the course of treatment. The rates of survival in two and five years according to protocols surgery-radiotherapy and exclusive radiotherapy were respectively: 21.5 and 12%, and 18.3 and 10%. The difference between the rates of survival of this two protocols is not significant (P =0.08).Although the induction chemotherapy entails a particularly high death rate in our series, the association surgery-radiotherapy and the exclusive radiotherapy seem to be similarly efficient for the treatment of the hypopharyngeal carcinoma.

Lymph nodes and distant metastases contribute to the poor prognosis of hypopharyngeal squamous cell carcinoma. The purpose of this study is to estimate the frequency, mode and prognosis factors related to regional and distant metastasis.The authors' report is based on a retrospective study concerning 271 hypopharyngeal squamous cell carcinoma, compiled in the service of Surgery of Head and Neck Cancers of the Salah-Azaïz Institute (1977-2002). Frequency and histoclinical characters of cervical and distant metastases have been assessed, as well as their prognosis factors among 155 patients treated in a curative purpose.39.1% of the tumours were classified N0, 24.4% N1, 10.7% N2 and 25.8% N3 (UICC 2002). The cervical nodal invasion was significantly more frequent for the classified tumors T3T4 than for the T1T2 (for pyriform sinus, postcricoid esophagus, posterior wall, and total hypopharynx, respectively : P =0.001, P =0.007, P =0.047 and P =0.0005). A cervical lymphatic evidement was preferred in thirty two patients. Among N0, 46.9% were N+; The frequencies of the capsular effraction were not significantly different for the N0N1 from for the N2N3 (P =0.11). The two and five years survival rates were respectively 32.5 and 20.5% for N0, and 10.9% and zero for N3. The survival differences after two and five years between the N0N1 and the N2N3 were significant (P =0.04). A regional failure was noticed for 18.5% of the patients. The tumoral site did not influence significantly the rate of nodal failure (P =0.98), neither the clinical status N (P =0.34). Capsular effraction was a significant factor for the regional failure (P =0.007). Distant metastasis significantly occurred more frequently among the patients initially classified N2N3 than those classified N0N1 (P =0.03), and in case of capsular effraction (P =0.0009).Hypopharyngeal squamous cell carcinoma has a high rate of lymph nodes metastasis, correlated to the local extension, and a high rate of occult nodal metastasis. Lymph node clinical status does not seem to have influenced the patients survival; however, capsular effraction constitutes a major prognosis factor of regional failure and distant metastasis. Distant metastases are frequent, particularly in case of wide local and regional tumoral extension.

The incidence of thyroid papillary microcarcinoma appears to be increasing and therapeutic modalities remain controversial. This retrospective study concerns 25 cases, from 1978 to 1999. The circumstances of diagnosis were: a cervicotomy for thyroid nodule (88% of cases), cervical node metastases (8%), and osseous metastases (4%). The sensitivity of ultrasounds was 22.2%, that of scintigraphy was 9.1% and that of extemporaneous histological examination was 18.2%. Multifocality was found in 16% of cases and bilaterality in 16.6%. Treatment modalities were guided by histological examination. Adjunctive radioiodine ablation was used for 20% of the patients. The treatment of the osseous metastases was completed with external irradiation. The average follow up was 4.8 years (4 months to 19 years), with a rate of survival without disease of 100%.

Secondary tumours to radio- and/or chemotherapy have rarely been reported after treatment for head and neck cancers. We report a case of mandibular fibrosarcoma observed 7 years after chemoradiotherapy for undifferentiated nasopharyngeal carcinoma in a patient treated when 20 years old.

To report on the epidemiological and therapeutic features of a series of Tunisian patients treated for primitive sinonasal lymphoma.Our retrospective study concerns patients with histologically proven primitive sinonasal lymphoma diagnosed and treated at our institution from 1975 to 1997. Initial work-up included: clinical plus ENT examination, WBC, ESR, LDH, abdominal ultrasonography, bone marrow biopsy and facial CT-scan taken since 1985. All slides are reviewed and reclassified using the Kiel system. Treatment is based on radiotherapy with or without chemotherapy (mainly with the CHOP protocol).We collected 25 patients (22 males and three females, sex-ratio = 7) with a mean age of 48 years (18 to 78). Mean delay of consultation is 4 months and patients consulted mainly for nasal obstruction (65%), more rarely epistaxis (40%) or rhinorrhea. ENT examination showed a fungating nasal fossa tumor in 20% of cases, predominantly unilateral (80%), associated to cervical nodes in 25% of cases. High-grade lymphomas represented 60% of the cases, and 60% of the patients were stage IE. All stage IEs have been treated by exclusive radiotherapy while more advanced stages received combined chemo- and radiotherapy (eight patients). The five-year actuarial survival rate was 69% for the whole population, with a better prognosis for localized stage and low-grade lymphomas.Radiotherapy remains a standard treatment for sinonasal lymphomas, permitting us to cure localized stages. In extended stages (more than IE), combined chemoradiotherapy seems to be a good option, especially in case of bulky tumors as observed for the other nodal and extra-nodal head and neck lymphomas.

Keloid scars are unsightly, especially when located on the face or bare zones. The purpose of this study was to evaluate the therapeutic results of intraoperative brachytherapy in the management of keloids.This retrospective study was based on the study of 82 patients with keloids treated in Salah Azaiz Institute (Tunisia) between 1982 and 1994 (65 women and 17 men). The mean age of patients was 23.4 years (+/- 8.4). A total of 114 lesions have been treated with surgical resection and intraoperative brachytherapy using an iridium source placed under the surgical scar. The length of iridium was chosen with the result that the radioactive thread exceeded 5 mm on each side of the surgical scar. The iridium source was loaded less than six hours after resection. Average iridium activity was 1.5 +/- 0.3 mCi/cm. Average iridium length was 56.8 +/- 34 mm. The referred isodose chosen for the target volume included the surgical scar and a margin of 5 mm around the iridium source, which was placed under the surgical scar. The average administered dose was 20.4 Gy (+/- 3.2 Gy).The 2-year local control rate was 87% for the whole group of lesions treated (n = 114). Local control rate of keloids processed by resection and intraoperative brachytherapy as the first treatment (59 cases) was 96% at two years. This rate was better than the local control of lesions that had been previously treated with anterior surgical resection (84% in 55 cases). For the latter group, lesions treated with a dose of more than 20 Gy had better local control, but the difference was not statistically significant (87 vs. 65% at two years, P = 0.41).Intraoperative brachytherapy is effective for improving local control of keloids and preventing a recurrence. A rigorous technique and an adequate dose according to previous surgical treatment allows very good results.

Primary thyroid lymphoma (PTL) is defined as a lymphoma involving only the thyroid gland or both thyroid gland and neck lymph nodes, without contiguous spread or distant metastases from other areas of involvement at diagnosis. Despite its rarity, PTL should be promptly recognized because its management is quite different from the treatment of other neoplasms of the thyroid gland. In the present study, we report a case of PTL treated by surgery and adjuvant chemotherapy. Otherwise, literature review allowed us to define main characteristics of this located lymphoma.

SUMMARYSynthesized lipophilic tyrosyl ester derivatives with increasing lipophilicity were effective against Leishmania (L.) major and Leishmania infantum species in vitro. These findings prompted us to test in vivo leishmanicidal properties of these molecules and their potential effect on the modulation of immune responses. The experimental BALB/c model of cutaneous leishmaniasis was used in this study. Mice were infected with L. major parasites and treated with three in vitro active tyrosyl esters derivatives.Among these tested tyrosylcaprate (TyC) compounds, only TyC10 exhibited an in vivo anti-leishmanial activity, when injected sub-cutaneously (s.c.). TyC10 treatment of L. major-infected BALB/c mice resulted in a decrease of lesion development and parasite load. TyC10 s.c. treatment of non-infected mice induced an imbalance in interferon γ/interleukin 4 (IFN-γ/IL-4) ratio cytokines towards a Th1 response. Our results indicate that TyC10 s.c. treatment improves lesions’ healing and parasite clearance and may act on the cytokine balance towards a Th1 protective response by decreasing IL-4 and increasing IFN-γ transcripts. TyC10 is worthy of further investigation to uncover its mechanism of action that could lead to consider this molecule as a potential drug candidate.