IJOHNS  Vol.8 No.1 , January 2019
Histological Profile of ENT and Cervico-Facial Lesions in Mali
ABSTRACT
Aim: Our goal was to determine the histological profile of ENT lesions. Method: We carried out a retrospective and descriptive study in the ENT department and Cervico-Facial Surgery at the university hospital center Gabriel Touré (MALI) from 1995 to 2014. It made it possible to collect 450 cases. Result: We found a male predominance; 51.11% or a sex ratio of 1.04. The mean age of patients was 38.04 years with a standard deviation of 19.49 years and extremes of 3 months and 91 years. Benign tumors were the most frequent (154 cases or 34.22%) including 75 cases of adenomas and 43 cases of papillomas. Cancers accounted for 48.11% (or 153 cases) of all tumors and 34% of lesions. Carcinomas accounted for 81.04%, malignant lymphomas 13.72% and sarcomas 5.22% of cases. Among the 140 cases (31.11%) of inflammatory pseudotumors, we found 12 cases of tuberculosis and 15 cases of rhinoscleroma. Three (3) cases of dysplasia were observed. Conclusion: Interest should be focused on histology in order to initiate appropriate therapy.

1. Introduction

Otorhinolaryngology (ENT) disorders are one of the main reasons for consultation in General Medicine and Pediatrics [1] . Given the diversity of the causes mentioned and the complexity of the lesions, the practitioner must resort to paraclinical examinations. Histological examination is essential because it allows an accurate diagnosis of most lesions [2] for appropriate treatment [3] .

The head and neck tumoral pathology includes benign tumors, cancers and inflammatory pseudo-tumors [2] . Benign tumors respond to surgery in general. As for cancers of the head and neck region, they affect about 40,000 patients/year in the USA [4] and rank fourth among human cancers, 10% of cancers in France, with an incidence of 16,000 new cases and a death toll of 5406 (5th leading cause of death in humans) in 2005 [5] . Studies reporting ENT histological lesions globally are rare [6] in Mali, most often focusing on specificities [7] [8] .

Our goal was to determine the histological profile of ENT lesions.

2. Materials and Method

This is a retrospective and descriptive study of ENT and Cervico-facial lesions, histologically examined, collected in the ENT department and cervico-facial surgery of the Gabriel Toure University Hospital Center from 1995 to 2014.

The study focused on patients with upper airborne (VADS) or cervicofacial lesions that were subjected to tissue sampling in consultation, hospitalization, or the operating room for pathological examination. The fixation was carried out with formalin on the spot, then the samples sent to the laboratory of Pathological Anatomy in vials.

450 patients were selected with a precise histological diagnosis and a precise localization of the lesion in the period indicated above.

Patients who did not receive pathological examination, or a doubtful diagnosis, or those with two or more discordant results, unspecified anatomical site, poorly performed specimens and lesions whose date of diagnosis did not correspond to the period indicated above have been excluded.

We carried out a systematic examination of the anatomopathological results of the patients. The data was entered on Excel 2013 and the analysis was done on SPSS 20.0. The statistical test is used with Chi2 with P < 0.05.

The variables concerned sociodemographic data, the anatomical site of the lesion, the benign or malignant nature and the histological type.

3. Results

3.1. Socio-Demographic Aspect

Over 20 years, we collected 450 cases. The male sex (Table 1) accounted for 51.11% with a sex ratio of 1.04. The average age was 38.04 years with a standard deviation of 19.49 years and extremes of 3 months to 91 years. The age group 30 - 39 years was the most represented with 17.33%.

3.2. Topographic Appearance

The nasolabial lesion site accounted for 26% followed by larynx with 21.33% (Table 2).

Table 1. Distribution by age and sex.

Table 2. Breakdown by lesion topography (Headquarters).

Other: Temporal region, Back-to-auricular region, Sub mental region, Supraorbital region, Frontal region, Upper maxillary.

3.3. Histological Profile

3.3.1. Benign Tumor

The histological result revealed a predominance of benign tumor with 154 cases (34.22%) (Table 3). A predominance of these lesions was observed in the thyroid with 41 cases (9.11% of all ENT and cervicofacial lesions and 26.62% of benign tumors); followed by nose and sinuses (31 cases or 20.12% of benign tumors).

Table 3. Distribution according to the result of histological examination.

Benign neoplasms vs. Malignant: Pr (|Z| > |z|) = 0.9676. Benign neoplasms vs. Inflammatory pseudo-tumors: Pr (|Z| > |z|) = 0.5981. Malignant neoplasms vs. Inflammatory pseudo-tumors: Pr (|Z| > |z|) = 0.5703. Malignant neoplasms vs. dysplasia: Pr (|Z| > |z|) = 0.3161. Benign neoplasms vs. dysplasia: Pr (|Z| > |z|) = 0.3193.

Among benign tumors adenomas are the most common with 75 cases (i.e. 16.67% of all ENT and cervico-facial lesions or 48.70% of benign tumors or 24.42% of all true tumors of our series). There is a female predominance of benign tumors with a sex ratio of 0.61.

They are observed at all ages with a higher frequency in the age group 10 - 29 years (50 cases or 32.46% of benign tumors). After the adenomas come papillomas with 43 cases (i.e. 27.92% of benign tumors and 9.55% of all ENT lesions).

3.3.2. Malignant Neoplasm

We found 153 cases (34%) of malignant tumors including 124 cases of all types of carcinoma (representing 27.56% of all ENT and cervicofacial lesions or 40.39% of the cases of tumors observed or 81.04 % of cancers). A predominance of these malignant lesions was found in the larynx with 45 cases (i.e. 10% of all ENT lesions or 29.41% of cancers or 14.65% of true tumors); followed by nose and sinuses (30 cases, i.e. 19.60% of cancers or 9.77% of true tumors or 6.66% of all lesions). A male predominance of these cancers was observed with a sex ratio of 2.19. They were seen at all ages with a higher frequency in the age group 50 - 59 years with 31 cases (20.26%).

• Squamous cell carcinoma

Squamous cell carcinoma accounted for 67.32% (103 cases) of all cancers, 83.06% of carcinomas and 22.88% of all lesions. In 72.72%, this was a male subject.

• Lymphoma

Lymphomas were seen almost at all ages 0 to 70 years with a frequency of 4.67% (21 cases) on all lesions and 13.72% of cancers, Its frequency among the under 40s was 71.42% (15 cases). A male predominance with a sex ratio of 2.16 was noted. The most common site was the ganglion with 9 cases, 42.85%, followed by palatine tonsils and nasosinus cavities, each with 5 cases (23.80%). We also observed it at the level of the tongue and in the cavum with one case each.

• Sarcomas

Sarcomas (Mixoid sarcoma, Osteosarcoma, Angiosarcoma, Kaposi’s sarcoma, Embryonic rhabdomyosarcoma, Liposarcoma) were recorded, 8 cases (1.78% of all lesions and 5.22% of cancers). They were children and adults. The sex ratio is 1.66. The most frequent site was the nasal cavity (4 cases, or 50%) followed by the larynx (2 cases, 25%). We have also observed it in the ganglion and in the temporal region.

3.3.3. Inflammatory Pseudo-Tumors

Inflammatory pseudo-tumors were represented by 140 cases (31.11%). It was about:

• Specific chronic infections

We noted 27 cases (19.28% of pseudo-tumors and 6% of all ENT lesions). They were represented by 12 cases of tuberculosis (2.66% of all ENT lesions) and 15 cases of Rhinoscleroma (3.33% of all ENT lesions).

• Inflammatory polyps

Represented by 23 cases (16.42% of the pseudo-tumors) of which 19 were in the naso-sinus cavities.

• Non-specific chronic inflammations

Represented by 58 cases or 41.42% of pseudo-tumors. These pseudo-tumors were seen at all ages and a sex ratio of 0.92. We found a predominance of these inflammatory pseudo-tumors in the naso-sinus cavities with 53 cases (41.08%).

3.3.4. Dysplasia

We observed three cases distributed respectively between the larynx, the amygdala and at the level of the nasal vestibule. They were all severe and the subjects were men with an age of 6; 50 and 26 years old.

4. Discussion

Histological examination is an essential examination in the management of ENT and cervicofacial disorders. In our context of under medicalization access to these examinations is necessary before the excision of all previously undiagnosed conditions. Their gravity in the ENT sphere housing the sense organs, communication and various anatomical structures from the confines of the brain to the thorax [3] must be an argument guiding any practitioner to perform a biopsy before any suspicious lesions; some of them are often part of neglected tropical diseases [9] .

After the standard examination of haematylene eosin (HE) stained sections, considered a prerequisite for diagnosis, the pathologist often uses complementary techniques: (“HC” Histochemistry, “IHC” Immunohistochemistry, “ME” Electron Microscopy Molecular Biology) [2] ; which is a limitation of this study, the only service of Anatomie-Pathologie of the country did not have it. Currently some private structures are starting to get some.

The distribution of sex is a function of the histological type. This finding is illustrated by data from the literature [10] . The female predominance of colloidal adenoma in our study is similar to that of the Whickham survey where it is reported that the F/H ratio is 6.6/1 [11] . As for the malignant tumors dominated by squamous cell carcinoma, we are getting closer to the international findings where squamous cell carcinoma of the upper air-digestive tract (VADS) represents the major part of the oncology of the neck and the face [12] [13] [14] [15] . More than 90% of these men are men with a long history of smoking, heavy chronic alcoholism and arduous working conditions [13] .

The occurrence of squamous cell carcinoma is poorly distributed in the age groups. We noted its rarity in children (two cases) and a high prevalence in the elderly. The authors reported that the occurrence of carcinomas are rare in the juvenile age, and meet in the fifth and sixth decade of life [13] [14] .

Nasosinus lesions accounted for 47.33% (213 cases) and carcinomas were the most common, as in the Tshisau and Kharoubi series, where carcinomas accounted for 50% - 70% of all primary cancers of the nasal cavity [16] [17] . Papilloma was the second most common tumor of nasosinus tumors after carcinoma.

Nowadays it is described as a rare tumor and accounts for 0.5% to 4% of benign naso-sinus tumors [18] . Rhinoscleroma is a chronic disease caused by an enterobacterium (Klebsiella rhinoscleromatis) that has a remarkable tropism for the upper airways. It is a cosmopolitan disease with high endemic areas in countries with low socio-economic development [19] . The predominance of the female sex and the predilection between 20 and 40 years is the prerogative of rhinoscleroma; we shared the same results [8] [10] [19] .

Squamous cell carcinoma accounts for 90% of all laryngeal malignancies [20] . Their incidence is gradually increasing in young adults and women, especially in urban areas. This finding corroborates with our study in which carcinoma constituted 95.55% of laryngeal cancers. The rarity of sarcoma in our study is a report reported by the authors, they are exceptional in the larynx [15] .

Laryngeal papillomas are the preserve of children, who can see each other before 10 years of age in two-thirds of cases [21] . This condition accounted for 38.46% in children under 15 years.

Papillary thyroid carcinoma has the reputation of being the most frequent thyroid cancer as in the work of Bouchair [22] . Vesicular, trabecular and anaplastic carcinomas are reported by authors following papillary carcinoma [23] [24] [25] , which joins our study.

The prevalence of parotid benign tumors reaches 60% to 74.5% with the pleomorphic adenoma in mind. Benign tumors were the most common in our study. The parotid is the most important gland of the salivation system. All tumor varieties can be seen at any age and regardless of sex [26] [27] . We noted two cases of parotid carcinoma.

The twelve cases of tuberculosis found in our study were distributed unequally. The lymph node involvement was predominant followed by laryngeal and tonsillar involvement. Tuberculosis continues to exist, despite the eradication campaigns, it remains a frequent occurrence in endemic countries [10] [28] .

5. Conclusion

Histology is a crucial element in the diagnostic process. Expertise is most often needed to confirm the diagnosis of these often rare, and often unrecognized lesions. This precise diagnosis guarantees a suitable treatment.

Cite this paper
Samaké, D. , Sidibé, Y. , Koné, F. , Niangaly, H. , Diamouténé, K. , Konaté, N. , Neuilly, N. , Camara, N. , Diarra, K. , Haidara, A. , Soumaoro, S. , Guindo, B. , Singaré, K. , Timbo, S. , Kéïta, M. and Mohamed, A. (2019) Histological Profile of ENT and Cervico-Facial Lesions in Mali. International Journal of Otolaryngology and Head & Neck Surgery, 8, 61-69. doi: 10.4236/ijohns.2019.81007.
References
[1]   Legent, F., Fleury, P., Narcy, P. and Bauvillain, C. (1999) ORL Pathologie Cervico-Faciale. 5th Edition, Masson, Paris, 385 p.

[2]   Asselah, F. (2007) Bases Anatomo-Pathologiques des maladies. Médecine 3rd Année, Office des Publications Universitaires, Alger, 247 p.

[3]   Brasnu, D., Ayache, D., Hans, S., Hartl, D., Papon, J.-F. and Traité, d’O.R.L. (2008) Médecine Sciences Flammarion. Masson, Paris, 875 p.

[4]   Haddad, R., Annino, D. and Tishler, R.B. (2008) Multidisciplinary Approach to Cancer Treatment: Focus on Head and Neck Cancer. Dental Clinics of North America, 52, 1-17.

[5]   Périé, S., Meyers, M., Mazzaschi, O., De Crouy Chanel, O., Baujat, B. and Lacau St Guily, J. (2014) épidémiologie et anatomie des cancers ORL. Bull Cancer, 101, 404-410.

[6]   Keita, M., Kampo, M.I., Timbo, S.K., Traoré, C.B., Diallo, M., Doumbia-Singaré, K. and Ag Mohamed, A. (2009) Morbidité par tumeurs de la sphère tête et cou à Bamako. Mali Médical, 24, 1-6.

[7]   Ag Mohamed, A. (1993) Le Rhinosclérome au Mali. JFORL, 42, 189-194.

[8]   Ag Mohamed, A. (1994) Angiofibromes des fosses nasales: A propos de 12 cas observés au Mali. Rev Méd Trop, 54, 247-248.

[9]   Rey, J.-L. and Milleliri, J.-M. (2016) Derrière les maladies tropicales négligées, il y a des malades… trop négligés. Medecine et Sante Tropicales, 26, 116-117.

[10]   Diop, E.M., Diouf, R., Ndiaye, I.C., Tending, G., Tall, A. and Touré, S. (2000) Maladies Tropicales Oto-Rhino-Laryngologiques. Encycl Méd Chir (Encyclopedie Médico-Chirurgicale Oto-Rhino-Laryngologie), Oto-Rhino-Laryngologie, 20-925-A-10, 16 p.

[11]   Sadoul, J.-L. (2005) Nodules du corps thyroïde. EMC, Elsevier SAS, Paris, 10-009-A-10.

[12]   Badoual, C., Péré, H., Cros, J. and Roussel, H. (2009) Carcinome épidermoïde des voies aérodigestives supérieures: Quoi de neuf en 2009. Annales de Pathologie, 29, 265-273.
https://doi.org/10.1016/j.annpat.2009.07.004

[13]   Delagranda, A., Bouvier, V., Berkaoui, J., Ferdynus, C., Dufour, X. and Fernandez, C. (2014) épidémiologie de tous les nouveaux cancers ORL diagnostiqués à la Réunion pendant la période 2009 à 2013 (5 ans) soit 713 cas. Communications orales du lundi 13 octobre/Annales françaises d’Oto-Rhino-Laryngologie et de pathologie Cervico-Faciale, 131

[14]   Hans, S. and Brasnu, D. (2010) Cancer des voies Aéro-Digestives supérieures. Réflexions en Médecine Oncologique, 7, 1-31.

[15]   Marandas, P. and Marandas, N. (1996) Généralités sur les cancers des voies Aero-Digestives supérieures. In: Tan Ba Huy, P., ed., ORL, Ellipses, Paris, 510.

[16]   Tshisau, K.M., Mubikayi, L., Sabue, M. and Muyunga, K. (1989) Profil histologique du cancer primitif des fosses nasales en milieu zairois. Les Cahiers d’O.R.L, 24, 688-695.

[17]   Kharoubi, S. (2002) Profil histologique des tumeurs des fosses nasales: Revue générale à propos de 23 cas. JFORL, 51, 271-277.

[18]   N’Gattia, K.V., Kacouchia, N.B., Mobio, N.M., Kouassi, Y.M., Vroh, B.T.S., Yoda, M., Kouassi-Ndjeundo, J., Buraima, F., Tanon-Anoh, M.-J. and Kouassi, B. (2014) Papillome inversé naso-sinusien: Notre expérience de la prise en charge diagnostique et chirurgicale en Côte d’Ivoire. Revue Médicale de Bruxelles, 35, 4-9.

[19]   Benzekri, L. (2000) Sclérome au Maroc à propos de 11 cas. JFORL, 49, 338-342.

[20]   Lefebvre, J.-L. and Chevalier, D. (2005) Cancers du larynx. EMC, Elsevier SAS, Paris), Oto-Rhino-Laryngologie, 20-710-A-10.

[21]   Lacau St Guily, J., Susini, B., El-Chater, B., Torti, F. and Périé, S. (2006) Tumeurs bénignes du larynx. EMC, Elsevier Masson SAS, Paris, Oto-Rhino-Laryngologie, 20-700-A-10.

[22]   Bouchair, A. (2005) Nodules thyroïdiens et Goitres multi-nodulaires: Indications, Techniques et Résultats du traitement chirurgical. Thèse de Doctorat en Sciences Médicales soutenu publiquement le 12 Septembre 2005 à la Faculté de Médecine de Annaba, Algérie, 261 p.

[23]   Cochand-Priollet, B., Wassef, M., Dahan, H., Polivka, M. and Guillausseau, P.-J. (2003) Tumeurs de la thyroïde: Corrélations cytologiques et histologiques; apport des nouvelles technologies. EMC ORL, 20-878-A-10.

[24]   Raingeard, I., Chalancon, A. and Vlaeminck-Guillem, V. (2012) Physiologie de la glande thyroïde. In: Périé, S. and Garrel, R., Eds., Pathologies chirurgicales de la glande thyroïde, Société Franôaise d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou., 695 p.

[25]   Leenhardt, L., Ménégaux, F., Franc, B., Hoang, C., Salem, S., Bernier, M.-O., Dupasquier-Fédiaevsky, L., Le Marois, E., Rouxel, A., Chigot, J.-P., Chérié-Challine, L. and Aurengo, A. (2005) Cancers de la thyroïde. EMC-Endocrinologie, 2, 1-38.
https://doi.org/10.1016/j.emcend.2004.10.003

[26]   Diom, E.-S., Thiam, A., Tall, A., Ndiaye, M., Toure, S. and Diouf, R. (2015) Profil des tumeurs de la glande parotide: Expérience sur 93 cas colligés en 16 ans. Annales Franôaises d’Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale, 132, 9-12.
https://doi.org/10.1016/j.aforl.2014.08.001

[27]   Bonfils, P. (2007) Tumeurs des glandes salivaires. EMC, Elsevier Masson SAS, Paris, Oto-Rhino-Laryngologie, 20-628-B-10, 18 p.

[28]   Ag Mohamed, A. (1994) Tuberculose nasale à propos d’un cas. Médecine d’Afrique Noire, 41, 319-320.

 
 
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