Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients

Abstract

Background: T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer.

Objective: This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy.

Methods: Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma.

Results: The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy.

Conclusion: Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.     

Laryngeal amyloidosis: localized versus systemic disease and update on diagnosis and therapy

The clinical and pathological characteristics, possibility of systemic disease, and effect of local therapy were studied in laryngeal amyloidosis. Records of all patients with localized laryngeal amyloidosis in a single tertiary referral center were examined retrospectively at diagnosis and after local therapy. Of 188 new patients with amyloidosis between 1990 and 2003, 5 patients had localized laryngeal amyloidosis. A sixth patient with localized laryngeal amyloidosis turned out to have systemic AL (immunocyte-derived) amyloidosis 8 years later. Free light chains were found in this patient, as well as in 1 of the other 5 patients. Amyloid interfering with laryngeal or airway function was removed during microlaryngoscopy with a carbon dioxide laser or cold endoscopic excision. The best results were seen when glottic deposits were removed by cold endoscopic excision, and supraglottic deposits by a carbon dioxide laser. Four patients had recurrent disease. A systematic workup, including measurement of free light chains, helps to rule out systemic disease.     

Laryngeal pemphigus without skin manifestations and review of the literature

Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.     

Churg–Strauss syndrome with pachymeningitis refractory to steroid therapy atone – a case report

Churg–Strauss syndrome (CSS) is a rare syndrome of unknown cause, which is characterized by bronchial asthma and hypereosinophilia followed by systemic symptoms of angiitis. In 1951, Churg and Strauss first distinguished this disease from periarteritis nodosa. Our patient in particular was also complicated with otorhinological symptoms, which have less frequently been reported in CSS cases. We have detailed her clinical symptoms.     

甲状腺癌右侧喉不返神经与颈交感神经交通1例报道

目的 总结1例少见的甲状腺癌术中发现右侧喉不返神经和颈交感神经交通并汇合后入喉患者的病例资料，以引起临床医生的重视。方法 分析1例30岁女性体检发现甲状腺结节，术前细针穿刺细胞学结果考虑甲状腺乳头状癌，在全麻下行手术治疗，术中探查发现该患者右侧喉不返神经和颈交感神经交通并汇合后入喉，术中给予精细解剖，喉返神经完整，手术顺利完成。结果 术后患者发声正常，没有声音嘶哑、饮水呛咳等并发症。术后4 d顺利出院，术后6周患者门诊复查纤维喉镜提示双侧声带活动正常。结论 在甲状腺手术中，需要加深对喉返神经解剖及其变异的认识，按层次仔细分离和解剖，以保护喉返神经的完整性。     

Distant muscular (gluteus maximus muscle) metastasis from laryngeal squamous cell carcinoma

Clinical evidence of non-lymphatic distant metastasis has been reported in approximately 10% of cases of head and neck squamous cell carcinoma (HNSCC). The lungs are the commonest site of distant metastasis of HNSCC, followed by the bones, liver and skin. A 65-year-old male underwent supraglottic laryngectomy and left modified neck dissection for a carcinoma of the laryngeal surface of the epiglottis extending to both false cords. Eight months later the patient underwent right radical modified neck dissection for hypodermal metastatic disease involving the underlying (sternocleidomastoid) muscle. Thirty-two months later, surgical excision of a lesion in the right gluteus maximus muscle was performed. Histological study diagnosed a muscular metastasis with the same morphological aspect as the laryngeal carcinoma. The patient showed no evidence of cervical or distant recurrence at follow-up after 13 months. Although skeletal muscles represent approximately 50% of total body mass and receive a large proportion of total cardiac output, haematogenous metastases to skeletal muscle are extremely uncommon. Most skeletal muscle metastases are of pulmonary origin. Distant skeletal muscle metastasis from HNSCC is an extremely rare occurrence. Treatment options, depending upon the clinical setting, include observation, radiotherapy, chemotherapy and excision; these approaches rarely alter the patient outcome. The prognosis associated with skeletal muscle metastasis is thought to be poor, consistent with the fact that it generally occurs as a feature of systemic spread.     

喉硬结病的临床特点与治疗

目的探讨喉硬结病的临床特点和治疗方法。方法回顾性分析1981年5月～2002年12月收治的43例经病理证实的喉硬结病患者的临床资料和治疗方法。结果43例中声嘶43例次、呼吸困难19例次。喉部病变以萎缩期为主2例，肉芽肿期为主35例，瘢痕期为主6例。主要病变局限于声门区13例，局限于声门下区1例；累及声门上区和声门区18例，累及声门区和声门下区8例，声门上区、声门区和声门下区均受累3例。采用抗生素治疗24例，手术治疗7例，放射治疗2例。采用抗生素治疗24例中，18例治愈，另2例复发后再进行抗生素治疗治愈；24例中4例伴2度或3度喉阻塞者行预防性气管切开术。1例伴2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。6例伴喉狭窄的瘢痕期患者通过手术成形治愈。1例采用放射治疗后4年复发，1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论硬结病可侵犯喉部导致发声困难和喉阻塞，抗生素治疗对多数喉硬结病患者有效，治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

喉癌术后复发及颈部转移临床治疗的远期疗效观察

目的：探讨治疗喉癌术后复发及颈部转移的有效方法。方法：回顾性分析我院1990年4月～1998年4月收治的喉癌术后复发及颈部转移患者70例，其中局部复发癌3i例，气管造口复发癌15例，颈淋巴结转移24例。结果：31例局部复发癌中，19例二次手术者术后15例生存，4例死亡；未行手术治疗的12例分别在1～3年内死亡。15例气管造口复发癌中，9例二次手术者术后5例生存，4例死亡；未行手术治疗的6例均在18个月内死亡。24例颈淋巴结转移者中，15例二次手术者术后8例生存，7例死亡；9例未行Ⅱ期手术者2年内死亡。结论：喉癌术后定期复查及系统的临床随访，有利于喉癌术后复发及颈部转移的早期发现和早期治疗；二次手术是喉癌术后复发及颈部转移临床治疗的重要措施；放射治疗或化学治疗作为综合治疗手段有一定疗效，但其疗效有限。     

Limited form of Churg-Strauss syndrome presenting as a mass in the neck

A 53-year-old man was referred to the ENT department with a large mass in the left supraclavicular fossa. The histological diagnosis showed the mass to have arisen due to a granulomatous vasculitis consistent with Churg-Strauss syndrome (CSS). CSS usually comprises asthma, eosinophilia and systemic vasculitis although limited forms of the disease exist where one of these diagnostic criteria is missing. This is one such case as the patient was non-asthmatic.     

Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review

Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.     

Polypoid type of laryngeal sarcoidosis – case report and review of the literature

A 45-year-old mentally retarded woman was discovered to produce a stridor upon inhalation. Fiberoptic laryngoscopic study revealed a smooth-surfaced, wide, and pedunculated tumor on the right arytenoid and the right aryepiglottic fold. Histopathological study revealed that the tumor was characterized by granulomatous inflammation. The condition was diagnosed as laryngeal sarcoidosis. The tumor was resected surgically. Surgical resection of the tumor and injection of corticosteroid should be performed for polypoid-type laryngeal sarcoidosis. The case is discussed in detail, along with a review of the literature pertaining to sarcoidosis of the larynx. Received: 13 December 1999 / Accepted: 6 April 2000     

Helical CT scanning of laryngeal deviation

OBJECTIVE: To evaluate helical computed tomography (CT) scanning in patients with laryngeal deviation. MATERIALS AND METHODS: Five patients with laryngeal deviation and three control subjects underwent helical CT. The laryngeal deviation was idiopathic in one patient and acquired in four. Three-dimensional (3D) images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial images were reconstructed for assessment. RESULTS: The thyroid cartilage was inclined and twisted to the right in three patients, inclined to the right and twisted to the left in one patient, and inclined to the left and twisted to the right in one patient. The infero-posterior part of the thyroid cartilage, and the cricoid and arytenoid cartilages were shifted to the left in four patients. The vocal cords were at the level of C4 approximately C4/C5 in two patients, C4/C5 in one, C4/C5 approximately C5 in one, and C5 approximately C5/C6 in one. In four patients, inclination of the laryngeal cavity to the right may have induced left false vocal cord protrusion. The levels of the two false vocal cords differed in all patients. When the inclination and twisting were corrected on the computer, 3D images of the laryngeal cartilages of the patients became almost the same as those of the control subjects, except for slight deformity of the thyroid cartilage. The width of the right and left thyroid alae was measured on the computer, and was almost equal in all patients. 3D airway surface models of the left hemilarynx resembled those of the right hemilarynx when the angle of view was changed on the computer. CONCLUSION: Three-dimensional images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial CT scans were obtained using helical CT. This method allows the 3D observation of laryngeal deviation, and viewing of images from various directions on the computer was useful to understand the characteristics of laryngeal deviation.     

Combined use of endoscopic CO2 laser excision of a marginal laryngeal tumor, radical neck dissection, and perioperative laterofixation of the opposite vocal cord

We report the use of endoscopic laser excision of a marginal laryngeal tumor, radical neck dissection, and laterofixation of a paralyzed vocal cord in a 66-year-old man who had an early-stage right supraglottic endolaryngeal tumor and ipsilateral neck metastasis. He had a left vocal cord paralysis after a left pneumonectomy that was performed 5 years previously. The primary laryngeal tumor was excised by endoscopic CO₂ laser resection, and a simultaneous radical neck dissection was carried out. Postoperatively, severe inspiratory dyspnea developed because of the surgical intervention on the right side causing moderate laryngeal edema and limited movement of the right vocal cord in addition to the paralyzed left side. An endolaryngeal laterofixation of the paralyzed left vocal cord was performed to provide the patient with an adequate airway instead of tracheostomy. This patient had a ¶2 years’ follow-up without recurrence of tumor. In the meantime movement of the right vocal cord has returned, so that the patient’s voice was socially acceptable and he has a functioning larynx.     

A case of laryngeal neurinoma with neurofibromatosis 2

We present a case of a laryngeal neurinoma in a patient with neurofibromatosis 2. A 39-year-old man presented to our hospital with multiple complaints including progressive bilateral hearing loss, dizziness, dyspnea, dysphagia, and a 9-year history of right lower leg weakness. Magnetic resonance imaging demonstrated multiple lesions including bilateral cerebellopontine angle tumors, a foremen magnum tumor, multiple tumors of the spinal cord, a laryngeal tumor, and several retrocervical tumors. Fiberoptic laryngoscopy revealed a large submucosal supraglottic tumor. The laryngeal tumor was visualized through microlaryngoscopy and excised with a KTP laser directed through a quartz fiber.     

内皮素-1与基质金属蛋白酶-9在喉癌中的表达与临床病理特征的相关性研究

目的:探讨内皮素-1(ET-1)和基质金属蛋白酶-9(MMP-9)在喉癌中的表达情况及其与临床病理特征之间的相互关系。方法:采用免疫组织化学SP法检测58例喉癌、28例声带息肉及19例喉部正常黏膜组织中ET-1、MMP-9的表达。结果:喉癌组织中ET-1的表达率为81.03%(47/58),与声带息肉(57.14%)和喉部正常黏膜组织(57.89%)对比,差异有统计学意义(P<0.05)。MMP-9在喉癌中的表达率为72.41%(42/58),与声带息肉(50.00%)和喉部正常黏膜组织(47.37%)对比,差异有统计学差异(P<0.05)。ET-1、MMP-9的表达与喉癌的临床分期、浸润深度及有无淋巴结转移均有一定关系。结论:ET-1与MMP-9的高表达可能与喉癌的发生、发展关系密切,可为喉癌的靶向及个性化治疗策略提供一定的理论依据。     

Prognostic significance of p53 gene mutations in laryngeal cancer

OBJECTIVE/HYPOTHESIS: We examined whether p53 gene mutations were predictive of clinical behavior in laryngeal cancer. STUDY DESIGN: Retrospective study of 45 patients with laryngeal cancer from 1985 to 1997. METHODS: DNA was extracted from tumor tissue and subject to polymerase chain reaction single-strand conformational polymorphism (PCR-SSCP) as well as DNA sequencing. The clinical outcome was correlated to the presence or absence of a p53 mutation. RESULTS: The p53 gene was analyzed by direct DNA sequencing and was found to be mutated in 33% (15/45) of patients. The presence of a p53 mutation was associated with a significant improvement in overall survival (80% vs. 43%, P < .03) and a trend toward improved disease-free survival (87% vs. 60%, P = .08). When other prognostic factors were adjusted, multivariate analysis revealed a trend toward improvement in overall survival as well as disease-free survival. CONCLUSION: Depending on the location of a p53 mutation, the suppressive functions or clinical outcome may or may not be affected. Fifty-three percent of mutations were detected in nonconserved regions as opposed to 17% as reported in colon cancer. In colon cancer, mutations in conserved regions of the p53 gene predicted a poorer survival, whereas nonconserved gene mutations were not predictive. In our group of patients. p53 mutations predicted a better prognosis, which may be due to a large proportion of mutations that lie within nonconserved areas. The predictive power of p53 gene mutations may depend on functional loss and inactivation of highly conserved areas and must be tested in a prospective trial.     

Laryngeal melanosis: a case report and review of the literature

We present a case with laryngeal melanosis and discuss the clinical significance of this condition. A 58-year-old male patient was referred to the otolaryngology department with a 2-month history of hoarseness. He had a history of smoking 20 cigarettes a day for 40 years. Videolaryngosgopic examination showed chronic laryngitis findings with multifocal pigmented pachydermic areas. Multiple biopsies were performed by laryngomicrosurgery. Pathological examination revealed laryngeal melanosis. As the number is not much enough, the association of laryngeal melanosis and carcinogenesis seems to be controversial. In the point of management, we have to be aware of the risks of laryngeal melanosis, such as developing neoplasm, and monitor the patients closely by periodical examinations and biopsies and advise the patients to stop smoking.     

Otological manifestations of Churg-Strauss syndrome

OBJECTIVES/HYPOTHESIS: To describe the clinical features, pathogenesis, and management of the otological complications in Churg-Strauss syndrome (CSS). STUDY DESIGN: Retrospective review of five patients with documented CSS who had otological manifestations in the later stages of CSS. METHODS: The history, treatment, and outcome were evaluated using office and hospital chart data in these five cases. RESULTS: In all cases, otological manifestations occurred during an advanced stage of CSS and was characterized by the presence of dense aural discharge, granulomatous eosinophilic infiltration into mastoid and middle ear, and subacute severe to profound hearing loss. In all cases, the recurrent aural discharge and granulomatous infiltrate was unresponsive to conventional treatment including repeated myringotomies and aggressive antibiotics. Systemic steroid administration resulted in a rapid, complete cessation of aural discharge and reversal or stabilization of hearing loss. Otological manifestations have been stable over a range of follow-up from 1 to 20 years on a maintenance regimen of steroids. CONCLUSIONS: Temporal bone involvement in CSS is rare. Surgical intervention of the temporal bone is relegated to complications that may include infectious mastoiditis and intracranial involvement. Recognition of the association between CSS and otological disease is important because it is highly responsive to systemic steroids, and early steroid treatment may prevent progression to irreversible hearing loss, infectious otomastoiditis, or intracranial complications.     

喉硬结病的临床特点与治疗

目的　探讨喉硬结病的临床特点和治疗方法。方法　回顾性分析 1981年 5月～ 2 0 0 2年12月收治的 4 3例经病理证实的喉硬结病患者的临床资料和治疗方法。结果　 4 3例中声嘶 4 3例次、呼吸困难 19例次。喉部病变以萎缩期为主 2例 ,肉芽肿期为主 35例 ,瘢痕期为主 6例。主要病变局限于声门区 13例 ,局限于声门下区 1例 ;累及声门上区和声门区 18例 ,累及声门区和声门下区 8例 ,声门上区、声门区和声门下区均受累 3例。采用抗生素治疗 2 4例 ,手术治疗 7例 ,放射治疗 2例。采用抗生素治疗 2 4例中 ,18例治愈 ,另 2例复发后再进行抗生素治疗治愈 ;2 4例中 4例伴 2度或 3度喉阻塞者行预防性气管切开术。 1例伴 2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。 6例伴喉狭窄的瘢痕期患者通过手术成形治愈。 1例采用放射治疗后 4年复发 ,1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论　硬结病可侵犯喉部导致发声困难和喉阻塞 ,抗生素治疗对多数喉硬结病患者有效 ,治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

West Nile virus induced vocal fold paralysis

OBJECTIVE: West Nile virus has recently become a public health concern in the United States, after an outbreak in New York City in 1999. It is a mosquito-borne virus that causes a spectrum of disease from flu-like symptoms to encephalopathy, muscle weakness, and, in some cases, death. STUDY DESIGN: Case Report. METHODS: A patient infected with West Nile virus presented with progressive muscle weakness, and later developed bilateral vocal fold paresis. His clinical presentation, physical and laboratory examination findings, and course of illness will be discussed. RESULTS: After a prolonged hospital stay, and presumptive treatment for Guillain-Barré, repeat CSF analysis revealed infection with the West Nile virus. The patient developed bilateral vocal fold paralysis during his hospital course. At long-term follow-up, the patient's left vocal fold paralysis persisted, while the right vocal fold paralysis had resolved. CONCLUSIONS: Although several viruses have been associated with recurrent laryngeal nerve injury, this is the first report of West Nile virus induced vocal fold paralysis.