Laser in treatment of laryngeal amyloidosis

Amayloidosis is the extracellular deposition of the fibrinous protein amyloid in one or more body sites. Amyloidosis may broadly be classifed as either primary or secondary. Primary amyloidosis is idiopathic (56 %), whereas the secondary form is associated with a chronic inflammatory or infectious process (5%). Amyloidosis is also related to multiple myeloma (26%), senescence (5%) and where tumor like deposits occur in isolated organ without systemic involvement (8%). Laryngeal amyloidosis is a rare disease. Surgery has been the mainstay of treatment either endoscopicalfy or by an external neck approach. One case of laryngeal amyloidosis, treated with endolaryngeal microsurgery and carbon dioxide laser is presented with a follow up of 8 years.     

原发性喉淀粉样变的临床分析

目的:探讨原发性喉淀粉样变的临床特点及诊治措施。方法:回顾性分析1996-2011年收治的5例原发性喉淀粉样变患者的临床资料并进行总结。患者均行手术切除病灶,其中4例行喉裂开喉肿物切除术,1例行支撑喉镜病灶切除,均未行放疗和糖皮质激素治疗。结果:5例患者均痊愈出院,其中2例出院后失访,可以随访到的3例患者目前均情况良好,未见复发。随访时间0.3～7.5年,平均3.3年。结论:原发性喉淀粉样变好发于中年人,发病部位最常见的是声带,其次为室带、会厌前间隙等。早期手术治疗是最重要的治疗方式,喉内镜及CT检查对该病的诊断有重要价值;病理组织活检特别是刚果红染色阳性是诊断该病最特异的依据。     

Light and electron microscopic studies of localized laryngeal amyloidosis

Summary We performed light and electron microscopic studies in a case of localized supraglottic laryngeal amyloidosis involving a 55-year-old woman. Tissue specimens were stained with hematoxylin and eosin, and alkaline Congo red with or without permanganate (KMnO₄) treatment, and were also examined with peroxidase-antiperoxidase immunohistochemistry. Biopsy specimens from the epiglottis showed diffuse replacement of the subepithelial region by amyloid, which showed a typical green birefringence under polarized light. Tissue affinity for Congo red was persistent after the KMnO₄ treatment. However, the tissue sections showed a positive reaction only to the anti-P component antibody. Electron microscopic studies revealed some disorders of the plasma cells, suggesting that these cells play an important role in focal production of amyloid fibrils.     

喉不典型类癌伴多发转移1例

患者,男,49岁,因咽痛1年余、活动后气促1周于2010年3月31日入院。患者1年前无明显诱因出现咽痛,之后发现左颈部包块且缓慢增大,3个月前出现说话含球音,痰中带血,吞咽痛明显,近1周活动后呼吸困难,一直未治疗。2个月体重下降3kg。     

原发性喉淀粉样变的临床分析

目的探讨原发性喉淀粉样变的临床特征及诊疗方法。方法回顾性分析首都医科大学附属北京同仁医院2015年4月~2016年4月收治的14例原发性喉淀粉样变患者的临床资料,14例患者中男2例,女12例;年龄24~61岁,平均年龄（47±10）岁;病程3个月至1.5年,平均（3.7±4.3）年。所有患者均在全麻下行支撑喉镜下CO2激光喉肿物切除术。结果1例因双室带前1/3肉芽组织生成术后症状改善不明显,术后第9天行全麻支撑喉镜下肉芽组织清除术。所有患者随访2个月至1年,声嘶症状均明显改善,均未见肿物复发。结论原发性喉淀粉样变病因不明,手术治疗是最重要的治疗方式,推荐支撑喉镜下CO2激光手术切除;病理组织检查刚果红染色阳性、偏振光呈苹果绿双折射是诊断该病最特异的依据。     

声门上区喉淀粉样变3例并文献复习

目的 探讨临床上易误诊为恶性肿瘤的声门上区喉淀粉样变的临床特点及诊治措施.方法 对3例声门上区喉淀粉样变患者行喉显微镜下CO₂激光辅助喉部病变切除术,并对临床资料进行分析.结果 3例患者均经喉显微镜CO₂激光手术治愈,术后随访1~2年,未复发.结论 喉淀粉样变临床表现缺乏特异性,但病理切片刚果红染色阳性可确诊本病;喉显微镜CO₂激光手术是有效的喉淀粉样变治疗手段.     

Laser debulking of obstructing laryngeal tumours

A consecutive series of 11 patients presenting with obstructing laryngeal neoplasms over an 8-month period have been treated by laser debulking of the tumour in order to avoid a tracheotomy. Providing that all members of the team are experienced in microlaryngeal laser surgery, this technique can be safely and effectively used in the management of obstructing laryngeal neoplasms.     

鼻、咽及喉部淀粉样变12例临床分析

目的:探讨鼻、咽及喉部淀粉样变性的临床特点。方法:12例淀粉样变性病患者中,1例与多发性骨髓瘤有关的淀粉样变性者累及鼻咽部、喉部及面部,确诊后转血液科化疗;1例鼻部右下鼻甲浆细胞瘤伴淀粉样变性者在局部麻醉鼻内镜下切除后转血液科化疗;5例喉部声带息肉伴淀粉样变性者,行支撑喉镜下息肉及淀粉样变性组织切除术;3例局灶性双侧声带累及声门下气管病变者在支撑喉镜下分别用电刀接支撑喉镜息肉手术刀(外套塑料输液器绝缘)加(或)CO2激光切除术;2例咽部淀粉样变性者分别行全身麻醉下扁桃体切除术和直达喉镜用电刀接支撑喉镜息肉手术刀(外套塑料输液器绝缘)会厌舌面根部病变切除术。结果:1例与多发性骨髓瘤有关的淀粉样变性者18个月后死于恶病质伴肺炎及多器官功能衰竭;1例鼻部右下鼻甲浆细胞瘤伴淀粉样变性者随访2年无复发;5例喉部声带息肉伴淀粉样变性者随访1～3年无淀粉样变复发;3例局灶性双侧声带累及声门下气管病变者中,1例随访3年无复发,2例分别在术后4个月和6个月前连合及声门下局部复发1次,再行支撑喉镜下分别用电刀接支撑喉镜息肉手术刀切除术,随访6个月无复发;2例咽部淀粉样变性者(右侧扁桃体和会厌舌面根部)随访2年无复发。结论:鼻、咽...     

Curative effect of cold micro forceps and CO2 laser in the treatment of laryngeal amyloidosis

Abstract

Background: Amyloidosis is a benign, slowly progressive disease. However, the treatment of laryngeal amyloidosis (LA) has not been studied systematically.

Objectives: To investigate the treatment results of cold micro forceps or carbon dioxide laser under microlaryngoscope in the treatment of LA.

Methods: A retrospective review was conducted for the cases collected from January 1990 to March 2016 at our department.

Results: One hundred and eighteen patients (44 males and 74 females, with an average age of 51.7 years) with LA were identified. The amyloidosis was not found in organs other than the larynges and tracheas. The patients most commonly presented with hoarseness and dyspnea. All patients underwent surgical removal of the amyloid deposits (via micro forceps or CO₂ laser). Twenty-nine patients developed recurrences requiring further treatments. The mean interval from treatments to recurrences in these patients was 16.5 months. Five patients were treated more than once. No significant difference was found between cold micro forceps and CO₂ laser methods in recurrences.

Conclusions: LA generally behaves as a benign disease. Resection of LA either via cold micro forceps or CO₂ laser under microlaryngoscope is both safe and effective methods. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence.     

Benign laryngeal lesions — a clinicopathological study of eleven years and a case report of pleomorphic lipoma

In a retrospective cohort study, conducted in Department of Oto-Rhinolaryngology, Head and Neck Surgery, M.LX Medical College, Allahabad from January 1989 to December 1999, 81 benign laryngeal lesions were evaluated. Majority (69, 85.2%) presented with hoarseness of voice and stridor was the presenting complaint in 12 ( 14.8%) cases. Vocal cord polyp (33, 40.7%) dominated the non-neoplastic group, while squamous papilloma (18, 22.4%) was the most common neoplastic lesion. Adult unset multiple papiUoma of unilateral vocal cord (4, 4.9%) was an unexpected finding in our series. A rare case of pleomorphic lipoma of larynx in a 68-year-old male patient along with its CT characteristics has been presented. Conservative microlaryngeal surgery offered the most satisfactory mode of treatment without any mortality and with minimal recurrence.     

Transoral robotic surgery for the treatment of laryngeal chondrosarcoma: A case report

Importance

Transoral robotic surgery has revolutionized the practice of head and neck surgery over the past decade, with indications now expanding to include laryngeal pathology. Although laryngeal chondrosarcoma is a rare entity, trends in otolaryngology literature suggest that it can frequently be managed with conservative approaches. We hope to inspire other head and neck surgeons to consider transoral robotic surgery for the treatment of such tumors so that outcomes data can be collected and studied.

喉基底细胞腺瘤1例

1病例报告 患者,女,63岁。因间断性呼吸困难1年加重1个月并伴有咳嗽带血,于2012年7月31日入院。体检：双侧鼻腔通畅,无异常分泌物和出血,咽黏膜慢性充血,扁桃体无肿大,喉发声正常,无声嘶,颈部未触及肿块及肿大淋巴结。     

Nasopharyngeal amyloidosis: a case report

Nasopharygeal amyloidosis is a rare entity described in the otolaryngology literature. It is usually isolated and does not represent a manifestation of systemic disease. Herein we discuss the first reported case of incidentally discovered nasopharyngeal amyloidosis leading to the diagnosis of systemic disease. A patient presented to the otolaryngology clinic with complaints of otalgia and eustachian tube dysfunction. He was noted to have a unilateral middle ear effusion and subsequent nasolaryngoscopy demonstrated a right nasopharyngeal mass at the eustachian tube orifice--this was biopsied and shown to be nasopharyngeal amyloidosis. Amyloidis is a condition which entails the abnormal deposition of proteins in tissue (local) and organs (systemic) throughout the body secondary to an alteration in the secondary structure of the protein into an insoluble form, termed amyloid. Amyloidosis in the head and neck most often presents in the larynx (60%), followed by the trachea (9%), orbit (4%), and nasopharynx (3%). The vast majority of these lesions represent isolated amyloidosis, which is not associated with a shortened lifespan or the sequelae associated with systemic disease. Treatment of local disease is typically excision followed by routine surveillance for recurrence. Treatment of systemic disease is complex, and should be managed by a Hematologist/Oncologist. Amyloidosis can be associated with malignancy, thus proper workup is important even when isolated lesions are discovered.     

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...     

Laryngeal amyloidosis: a case report

We report a case of Amyloidosis of larynx in a 60-year-old adult who reported to us with hoarseness of voice of 3?years long duration and no other symptoms. Patient was treated successfully with endoscopic curettage of the mass with no inadvertent ill effects.