Squamous cell carcinoma antigen in patients with cancer of the larynx.

The purpose of this study was to evaluate the clinical usefulness of squamous cell carcinoma antigen (SCC Ag) in patients with squamous cell carcinoma of the larynx. Plasma specimens were obtained from 70 patients with cancer of the larynx before and after treatment and during follow-up. Disease status and the marker levels were determined blind to each other. Microparticle enzyme immunoassay (IMx SCC) was used to measure the SCC Ag level. Applying standard normal limits the sensitivity of the marker at diagnosis was 25.7%. SCC Ag levels were generally lower after therapy than before. Relapse occurred more often in patients with an abnormal pretreatment SCC Ag level, which was more frequent in those with nodal invasion. The marker level increased in 70% of the patients with relapse before the clinical detection of recurrence. SCC Ag is of limited usefulness in the primary diagnosis of cancer of the larynx, but is useful in detecting recurrence of cancer.     

Destructive tumours of the larynx mimicking osteosarcoma: two cases of osteoblastoma with organ-saving resection and follow-up

Osteoblastoma of the larynx is an extremely rare type of locally progressive and destructive tumour which is mimicking osteosarcoma radiologically and histologically. Since prognostic and therapeutic strategies for benign osteoblastoma differ from the more common osteosarcoma of the larynx, a meticulous pre-operative histological diagnosis is required to avoid over-therapy. We report about two patients with osteoblastoma of the larynx with organ-saving resection and long-period follow-up without tumour recurrence. A review of the literature detected five further osteoblastomas of the larynx, all in elderly men, like our observations. This situation is quite different from the usual osteoblastomas of bone, which occur in young adults of both sexes equally.     

Laryngeal preservation in cases of advanced laryngeal cancer treated with platinum based induction chemotherapy before local treatment.

In this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery. The median age of our patients was 60 (46-75) years and median performance status was 80 (60-100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent. After a median follow-up of 26 (15-40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx. We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotherapy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well, the patient's larynx is preserved without compromizing the overall survival.     

Plasmocitoma extramedular de laringe. A propósito de un caso

Extramedullary plasmacytoma of the larynx and localized laryngeal amyloidosis are two entities that are extremely rare in children. We report the case of an 11-year-old child presenting with progressive dysphonia, with a diagnosis of extramedullary plasmacytoma and localized laryngeal amyloidosis. The treatment he received and subsequent follow-up were compared with the few cases found in the literature.     

Value of Papanicolaou exfoliative cytology in diagnosis of cancers of the upper aerodigestive tract]

Exfoliative cytology of the pharynx and larynx is a valid tool in the diagnosis of tumours. It is useful in the follow-up of chronic epithelial lesions of these regions and after tumour therapy. Cytological findings in group "Pap III" demand careful follow-up possibly with biopsy. For all other groups a biopsy is only indicated if there is a strong clinical suspicion of a tumour in the individual case. The simple technique of exfoliative cytology makes it an important part of aftercare of patients with malignancy, especially squamous cell carcinoma of the pharynx and larynx. The validity of the method depends on the care with which the specimen is taken and on the experience of the investigator.     

Leiomyosarcoma of the larynx. Based on one case

Leiomyosarcoma is a malignant tumour of smooth muscle cells. Usually is found in the gastrointestinal and female genital tracts, but is extremely rare in the larynx. Diagnosis is based in immunohistochemical studies. From the related literature is concluded that this tumour has a very aggressive behavior, with a very bad prognosis in spite of a radical surgery. A case of glottic Laryngeal Leiomyosarcoma (LL) treated with partial surgery is presented, There isn't any evidence of recurrent or metastases after a two years follow-up.     

Combined treatment of concurrent laryngeal and tracheal stenosis.

This report describes a one-stage combined surgical procedure for laryngeal and tracheal stenosis presenting concurrently. The technique links together three new procedures. Autogenous hyoid bone transposition on a muscle pedicle for reconstruction of the larynx, together with implantation of a silicone T-tube in conjunction with a custom-carved silicone stent, for maintenance and resurfacing of both strictures. This technique has produced satisfactory results in four cases. In two of the patients there is sufficient follow-up to indicate the efficacy of this method.     

Panel discussion: The management of advanced laryngotracheal stenosis. Management of combined advanced glottic and subglottic stenosis in infancy and childhood

Severe glottic and subglottic stenosis in infants and children is a formidable disease for a child and a difficult reconstructive problem for the surgeon. Twelve consecutive patients are described in this series, 7 of whom had complete airway obstruction; 9 patients have been extubated with satisfactory voices. Long-term follow-up indicates no cases of decreased development of the larynx.     

窄带成像技术在咽喉肿瘤诊治中的应用

咽喉部恶性肿瘤是一种临床发病率低,发现时已到晚期,五年生存率低的一种疾病。对于如何提高咽喉部恶性肿瘤的早期发现这一问题,严重困扰着耳鼻喉科医师。目前咽喉部最常用的检查是白光电子喉镜。随着窄带电子喉镜(NBI)的出现,通过观察咽喉部黏膜及黏膜下毛细血管袢的形态,相对于普通白光电子喉镜,为早期发现咽喉部恶性肿瘤提供了可能性,同时在术中应用做到微创治疗及术后随访均起到重大作用。现就从NBI的起源原理,在咽喉恶性肿瘤中的应用优点、难点、临床应用发展前景等方面综述NBI技术在咽喉恶性肿瘤疾病中的应用。     

Supraglottic laryngectomy. Still on-going

IntroductionHorizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery.ObjectiveTo show functional and oncological long-term results of HSL.Material and method110 patients treated with HSL with a minimum of 5 years follow-up.ResultsLocal control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients.ConclusionHSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results.     

Glandular carcinoma of the larynx: the UCLA experience.

Glandular carcinomas of the larynx are rare tumors that constitute less than 1% of all laryngeal malignancies. A retrospective case review of 12 patients with glandular carcinomas of the larynx is presented to identify patient and tumor characteristics, therapeutic modalities, and treatment outcomes. Ten patients underwent surgical excision of the primary tumor, by either supraglottic laryngectomy, vertical partial laryngectomy, or total laryngectomy. Seven of these patients also received postoperative radiotherapy. After a median follow-up period of 23 months, 7 of the 12 patients (58.3%) died as a result of uncontrolled locoregional disease or distant metastases. The 5-year survival rate was 57% in patients who underwent combination therapy versus 50% for those patients who received surgery alone. Surgical resection is the primary treatment modality used in the majority of cases. Neck dissection is reserved for patients with clinically apparent adenopathy, adenocarcinoma, or high-grade mucoepidermoid carcinoma. Combination therapy with surgical resection and radiotherapy may be more effective in achieving tumor remission than is surgical resection alone.     

Oat-cell carcinoma of the larynx.

The diagnoses of three cases of laryngeal oat-cell carcinoma were confirmed by electron microscopy. As in pulmonary oat-cell carcinoma, the prognosis in these cases is poor; of our three cases and the previously reported cases of this tumor type in the larynx, all but one of the patients, for whom there is adequate follow-up information, have died of widespread metastases. Aggressive radiation therapy and systemic chemotherapy appear indicated if improved survival is to be achieved.     

Pathomorphological aspects of transoral resection of hypopharyngeal carcinoma with preservation of the larynx. Patient selection, treatment results

BACKGROUND: In primary surgery of hypopharyngeal cancer, transcervical resection was chosen in order to preserve the larynx. This treatment produces good oncological results but also a high degree of morbidity so that in recent years transoral resection has been recommended. For wider application of this method it is very important to apply clearly defined criteria for selection of patients. MATERIAL AND METHODS: To define the criteria for selection for transoral microsurgical resection, we analyzed step serial sections of 33 whole organ specimens of hypopharyngeal squamous cell cancer (SCC) after primary radical surgery, mostly carcinoma of the piriform sinus. Criteria concerning the primary and the involvement of the neck nodes were differentiated. Twenty of 84 patients with hypopharyngeal cancer of different stages were treated by transoral resection and delayed neck dissection between 1994 and 1996. Most of the patients were irradiated postoperatively because of neck metastases. The therapeutic results after a minimum period of 24 months follow-up is listed according to Kaplan-Meyer. RESULTS: Three types were defined according to their site, growth, and spread into the larynx: Type I comprises limited exophytic, highly differentiated SCC with a minor tendency for metastasis originating in the upper half of the sinus. These tumors are well suitable for transoral resection. Type II includes tumors spreading superficially without deeper invasion of the larynx, especially of the laryngeal framework. These can be totally resected and the larynx preserved in spite of extended metastasis. Type III, the most frequent type, grows with ulceration and deeply infiltrates into the larynx and the neck. These tumors cannot be resected transorally. Primary radical resection is indicated. Up to 25% of all hypopharyngeal SCC could be treated by transoral resection, mostly with delayed neck dissection and postoperative irradiation. Functional results were excellent in all cases. Eating, voice, and air passage were normal. Oncological results with 80% disease free five-year survival rate were very good. Three patients died because of recurrences in the neck, only one because of a recurrence in the larynx. The rate of patients with a second primary, however, was extremely high (50%). CONCLUSIONS: By strictly following the pathological and clinical criteria for selection, about 25% of the SCC of the hypopharynx can be treated by transoral resection combined with neck dissection and postoperative irradiation with good oncological and excellent functional results, preserving the larynx without endangering the life of the patients.     

Laryngeal neurofibroma. A case report and literature review

Neurofibroma is a rare pathology on the larynx. We distinguish two types of neurofibromas: plexiform and not plexiform in which the difference is at the cytoarchitectural level. The plexiform type is usually associated to the Von Recklinhausen disease, also know as neurofibromatosis type 1. They usually affect the supraglottic structure, and more frequently they are described in aritenoids, ariepiglottic folds, and posterior commissure. We present a case located at the glottic level of plexiform type, with a postsurgical follow-up of five years. We make a revision of the aethiopathogenesis, evolution and prognostic of these pathology in the bibliography.     

Cartilagenous tumors of the larynx: A review of literature and two case experiences

Cartilagenous tumors of the larynx are uncommon. A review of the experience from four major hospitals affiliated with McGill University, Montreal, from 1960-1977 revealed only two cases. The treatment and follow-up of these cases is discussed. A thorough review of English literature from 1816 revealed 177 reported cases. Management of benign and malignant cartilagenous tumors of the larynx is discussed and literature is compared.     

Laryngeal embryonal rhabdomyosarcoma: a case of cervical metastases 13 years after treatment and a 25-year review of existing literature

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood, the majority of which are of the embryonal rhabdomyosarcoma (ER) variety. Present day treatment protocols involve a combination of aggressive surgery, chemotherapy, and radiation therapy. Embryonal rhabdomyosarcoma of the larynx is rare and unlike ER of other regions exhibits excellent response to multimodality treatment without the need for extensive surgery. We report a case of cervical metastases in a 29-year-old man 13 years after treatment of his laryngeal ER. To our knowledge, this is the first reported case of late neck metastases in ER of the larynx and the second reported case of delayed presentation of recurrent disease. A 25-year review of all published reports of ER of the larynx was conducted that highlights the move toward organ preservation with the multimodality treatment protocols. Embryonal rhabdomyosarcoma of the larynx is highly responsive to combination chemoradiotherapy, allowing for excellent cure rates without the need for extensive surgery. Late relapses warrant long-term follow-up.     

Photodynamic therapy and the treatment of neoplastic diseases of the larynx

Photodynamic therapy (PDT) is an innovative treatment involving the use of light-sensitive drugs to selectively identify and destroy diseased cells. Therefore, photodynamic therapy has the potential to treat and cure precancerous and early cancerous lesions (carcinoma in situ [CIS], T1 and T2) of the larynx while preserving normal tissue. Eleven patients with recurrent leukoplakia and carcinomas of the larynx were treated with PDT with follow-up to 27 months. One patient with a Tl verrucous carcinoma, 5 patients with T1 squamous cell carcinomas of the vocal cord failing radiotherapy, 1 patient with a T2 squamous cell carcinoma of the vocal cord failing radiotherapy, and 3 patients with CIS and severe atypia were treated with PDT and obtained a complete response and are disease free. One patient with a T3 carcinoma of the larynx was treated with PDT but died 4 weeks post-treatment of unrelated causes and could not be assessed. Photodynamic therapy is a promising therapy for treatment of precancerous and cancerous lesions of the larynx. This therapy may be particularly beneficial for the treatment of recurrent carcinomas of the larynx that have failed conventional radiotherapy, thereby preserving voice and eliminating the need for destructive laryngeal surgery.     

Epithelial hyperplasia of the larynx a clinical follow-up study

In this retrospective study, the records of 40 patients with epithelial hyperplasia of the larynx, seen between 1980–1991, were reviewed to determine the incidence of malignant transformation during long term follow-up. The mean follow-up time was 58.6 months. The initial pathological diagnoses were hyperkeratosis in one case, parakeratosis in one, dyskeratosis in 12 and dysplasia in 26. During follow up, nine patients developed carcinoma in situ and/or invasive carcinoma. Of these, two patients had been diagnosed with dyskeratosis without dysplastic cells at the initial biopsy. It is therefore important to follow up patients with epithelial hyperplasia of the larynx even when no dysplastic cells are found at the time of diagnosis.     

Amyloidosis of the larynx. A clinical case and literature review

The larynx is a rare site of deposition for amyloidosis. We are reporting the clinical case of a 73 years female with hoarseness of 2 years evolution due to a laryngeal mass which was informed as located primary amyloidosis after anatomopathologic exam (AP) and its extension study. A laryngeal microsurgery was performed and then we proceeded to send the patient to Internal Medicine Service with periodic controls by ORL. Surgery is the treatment of choice by microsurgery, laryngofissure or Laser with local excision. The prognosis of localized forms is better than systemic ones although recurrences are common and it is recommended a long-term follow-up. A bibliographic review about this pathology has been made.     

Plasmacytoma of the larynx

Plasmacytoma involving the larynx is very rare. To the best of our knowledge there are only 79 cases reported in the world literature. We are adding 3 more cases; 2 cases were associated with multiple myeloma and 1 was considered to be a solitary or extramedullary plasmacytoma. The clinical picture was hoarseness and upper airway obstruction. In plasmacytoma of the larynx multiple biopsies are often nondiagnostic, sometimes revealing only chronic inflammation and amyloid infiltration in the tissues. Most authors agree that the treatment of choice is conservative surgical excision and radiation therapy. Surgery may also be reserved to excise residual scar tissue and fibrosis after treatment mainly to improve the airway and eliminate the tracheostomy tube. To confirm the definitive diagnosis of solitary plasmacytoma of the larynx, long-term follow-up of many years is necessary in order to rule out multiple myeloma.