Epidermoid carcinoma of the larynx: anatomo-pathological results of 58 cases

In this study was considered 58 patients diagnosed of squamous cell carcinoma of larynx and operated between 1991 and 1996 at the Ear Nose and Throat Service of the University Hospital Complex of Santiago de Compostela. They are all men but one female and the biggest percentage were T2 (39.7%) and T3 (37.9%) tumours. The macroscopic characters such as the average diameter of the pieces was 6.91 cm and 2.66 cm of the tumour. The most usual tumoral shape encounter was exofitic and ulcerous. And between the microscopic characters we valued the histologic grade of differentiation and the most usual were the well (44.8%) and moderated (41.4%) differentiated. The average of mitosis was 20.6 and 31 tumours presented necrosis.     

Epidermoid carcinoma of the palate

A retrospective study was made of 80 cases of epidermoid carcinoma of the palate that were treated at the UCLA Center for the Health Sciences between 1955 and 1977. Tumor size larger than 3 cm, extension to neighboring structures, and contralateral, bilateral, and "fixed" lymph node metastases substantially decreased survival. The presence of ipsilateral nodes and the modality of treatment used (surgery or irradiation) did not appear to affect the outcome. Three-year cure rates for all cases was 40%. Ninety percent of recurrences took place during the first two years after treatment, and additional cancers developed in the upper aerodigestive tract of 20% of the patients.     

Management of stage IV glottic carcinoma: therapeutic outcomes

OBJECTIVES/HYPOTHESIS: The best therapeutic approach for the treatment of stage IV glottic carcinoma is controversial. STUDY DESIGN: A retrospective study. METHODS: A retrospective study of Tumor Research Project data was performed using patients with stage IV glottic squamous cell carcinoma treated with curative intent by five different treatment modalities from 1955 to 1998 at Washington University School of Medicine and Barnes-Jewish Hospital (St. Louis, MO). RESULTS: Ninety-six patients with stage IV glottic carcinoma were treated by five modalities: total laryngectomy (TL) (n = 13), total laryngectomy with neck dissection (TL/ND) (n = 18), radiation therapy alone (RT) (n = 7) (median dose, 69.5 Gy), total laryngectomy combined with radiation therapy (TL/RT) (n = 10), and total laryngectomy and neck dissection combined with radiation therapy (TL/ND/RT) (n = 48). The overall 5-year observed survival (OS) rate was 39%, and the 5-year disease-specific survival (DSS) rate was 45%. The 5-year DSS rates for the individual treatment modalities included the following: TL, 58.3%; TL/ND, 42.9%; RT, 50.0%; TL/RT, 30.0%; and TL/ND/RT, 43.9%. There was no significant difference in DSS for any individual treatment modality (P =.759). The overall locoregional control rate was 69% (66 of 96). The overall recurrence rate was 39% with recurrence at the primary site and in the neck at 19% and 17%, respectively. Recurrence was not related to treatment modality. The 5-year DSS after treatment of locally recurrent cancer (salvage rate) was 30% (3 of 10) and for recurrent neck disease (28 of 67) was 42%. The incidence of delayed regional metastases was 28%; of distant metastasis, 12%; and of second primary cancers, 9%. There was no statistically significant difference in survival between node-negative (N0) necks initially treated (5-y DSS, 31%) versus N0 necks observed and later treated if necessary (5-y DSS, 44%) (P =.685). CONCLUSION: The five treatment modalities had statistically similar survival, recurrence, and complication rates. The overall 5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean survival of 10.1 years and a median survival of 3.9 years. Patients younger than age 55 years had better survival (DSS) than patients 56 years of age or older (P =.0002). Patients with early T stage had better survival than patients with more advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on survival. Tumor recurrence was not related to treatment modality. Patients with clear margins of resection had a statistically significant improved survival (DSS and CDSS) compared with patients with close or involved margins (P =.0001). Post-treatment quality of life was not significantly related to treatment modality. Patients whose N0 neck was treated with observation and appropriate treatment for subsequent neck disease had statistically similar survival compared with patients whose N0 neck was treated prophylactically at the time of treatment of the primary. A minimum of 7 years of follow-up is recommended for early identification of recurrent disease, second primary tumors, and distant metastasis. None of the standard treatment modalities currently employed has a statistical advantage regarding survival, recurrence, complications, or quality of life.     

累及喉气管的晚期甲状腺癌一期手术整复

目的：探讨晚期甲状腺癌累及喉、气管时的一期手术整复方法。方法：对18例存在喉气管受累的晚期甲状腺癌患者进行一期肿瘤全切及喉气管整复，其中7例喉受累患者全喉切除3例，喉部分切除4例；18例颈段气管受累患者中，8例直接切除肿瘤，10例切除受累气管壁后，修复方法包括：拉扰缝合1例，端端吻合3例、带蒂胸锁乳突肌骨膜瓣2例、岛状胸大肌肌皮瓣3例和颈部皮瓣1例。结果：住院期间肿瘤复发死亡1例。除3例全喉切除患者外，14例成功保留喉功能，其中拔除气管套管8例，堵管2例，继续带管4例。结论：对于累及喉气管的晚期甲状腺癌采用一期手术切除并整复不仅切实可行，而且可以提高此类患者的治愈机会，改善生活质量。     

The incidence of thyroid dysfunction following radiotherapy for early stage carcinoma of the larynx

External beam radiotherapy is currently the commonest form of treatment for early laryngeal cancer (T1/2) and thyroid dysfunction is a well recognised complication of this treatment. Overt hypothyroidism is a specific clinical disorder which in most patients will be recognized and treated. The problems associated with subclinical hypothyroidism (elevated TSH with normal T4), however, are only now being recognized and their management is to some extent still controversial. The aims of our study are to determine the incidence of clinical and subclinical hypothyroidism in those who have been treated solely with curative radiotherapy for early laryngeal cancer. We performed a retrospective observational study encompassing all patients who underwent curative radiotherapy for T1/T2 laryngeal cancer between 1998 and 2002. 33 patients were identified (mean 66.85 years, range 48–93). 19 patients had T1 lesions (58%), 14 had T2 lesions (42%) and 27 were N0 (82%). 23 patients were euthyroid post treatment (70%), 2 became overtly hypothyroid (6%) and 8 developed subclinical hypothyroidism (24%). There was no association between tumour stage (p = 0.97), nodal stage (p = 0.46) and thyroid status, however, there was an association between increasing age and deteriorating thyroid function (p = 0.01). Our study showed that of patients with early laryngeal cancers treated solely with curative radiotherapy 24% developed subclinical hypothyroidism and 6% were overtly hypothyroid (Elevated TSH and reduced T4). We feel patients should receive regular thyroid function testing following completion of treatment and should be adequately counselled on the risk of thyroid dysfunction following radiotherapy at pre-treatment visits.     

Sarcomatoid carcinoma of larynx

Surcomatoid Carcinoma are rare lesions reported in many organs including the larynx. This report describes such a mixed tumour occuring in the larynx. The clinico pathological features and treatment are described.     

Epidermoid carcinoma of the external auditory canal

The squamous cell carcinoma of the external auditory canal is extremely rare. The facial paralysis is usual, but pain seems to be the most common symptom. The mean age at diagnosis is 50 to 60 years, with chronic external otitis preceding. The CT-scan is the most important investigation before treatment: surgery and external radiotherapy. Surgical procedure must be large, with or without facial nerve dissection, following by irradiation of the temporal bone and cervical nodes. The generally poor prognosis is explained by the frequency of advanced disease at the time of diagnosis. This paper reports our 4 experiences, with a bilateral carcinoma case.     

Verrucous carcinoma of larynx

A 55 years male presented with hoarsness of voice (4 months), cough (1 month), difficulty in breathing (15 days). Patient underwent an emergency tracneostomy and further workup proved it to be a case of verrucous carcinoma of larynx. Patient was treated surgically with satisfactory result.     

Spindle cell carcinoma of the larynx with a verrucous carcinoma component: combined carcinoma of larynx

Squamous cell carcinoma (SCC) is the most common neoplasm of the larynx. There are three variants of SCC. Each variant presents distinctive biologic behaviors and clinical courses. Therefore reaching the exact diagnosis and distinguishing the variants is fateful. We describe a case of spindle cell carcinoma of the larynx with a verrucous carcinoma component. To our knowledge, this entity has never been documented before.     

New classification of stage IV squamous cell carcinoma of the oropharynx.

OBJECTIVE: The recent progress in reconstructive surgery for the treatment of head and neck carcinomas has made it possible to radically resect cancers. However. the choice of treatment for oropharyngeal carcinoma is rather difficult. Radical treatment sometimes results in severe complications, suggesting that some modes of treatment might reduce the quality of life. The 5-year survival rate of patients with stage IV oropharyngeal carcinoma is still very poor. It is necessary to re-classify stage IV squamous cell carcinoma of the oropharynx in relation to the prognosis. Foote et al. (Base of tongue carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck 1993:15:300-307) demonstrated the two subgroups of stage IV oropharyngeal squamous cell carcinoma, as favorable stage IV and unfavorable stage IV. In this study, we have re-examined the validity of these subsets and we have demonstrated the new subsets of stage IV squamous cell carcinoma of the oropharynx. METHODS: We have examined 221 cases of oropharyngeal squamous cell carcinoma at the Cancer Institute Hospital in Tokyo between 1971 and 1994. A total of 107 cases of stage IV were included. We analyzed these cases retrospectively. RESULTS: Based on the subsets demonstrated by Foote et al., there were no significant differences between the two groups in our cases, suggesting that these subsets were not useful for the choice of the treatment. In order to make a new classification in view of better choice of treatment, either radical treatment or palliative therapy, these cases were divided into two new groups of stage IV. one group with relatively good results (T1-3 N2 M0 and T4 NO-1 M0; new favorable stage IV), and the other with very poor results (any-T any-N M1 and any-T N3 M0 and T4 N2 M0; new unfavorable stage IV). Patients with the new favorable stage IV have a 5-year survival rate of 30.4%, and those with the new unfavorable stage IV had a survival rate of 0%. CONCLUSION: These new subsets of stage IV can be directly related to the prognosis, and are therefore useful in the choice of treatment.     

Mucoepidermoid carcinoma of the larynx

Mucoepidermoid carcinoma is classified among the salivary gland tumors and is commonly found in the parotid gland. In the larynx it is an uncommon tumor that occurs mostly in men. There have been only about 100 cases of laryngeal mucoepidermoid carcinoma reported in the literature. Three cases of mucoepidermoid carcinoma of the larynx are reported. First case--tumor T1N0 localised on the vocal cord was removed using Kleinsasser method. Second and third case--tumor T3N0 was removed by total laryngectomy. The inherent difficulties in histologic diagnosis are noted and treatment of mucoepidermoid carcinoma is discussed. The available literature is reviewed.     

Sarcomatoid carcinoma of the larynx

Sarcomatoid carcinoma of the upper aerodigestive tract is an unusual neoplasm with differential cellular differentiation. Microscopically, sarcomatoid carcinomas have an element of squamous-cell carcinoma and a pleomorphic sarcoma-like component, which may simulate granulation tissue, malignant fibrous histiocytoma, osteosarcoma, or malignant giant-cell tumor of soft tissues.     

Lymphoepithelial carcinoma of the larynx

Lymphoepithelial carcinoma (LEC) of the larynx is a rare neoplasm; with a review of the literature having disclosed only 34 documented cases. This neoplasm seems to behave in a fashion reminiscent of nasopharyngeal carcinoma. In contrast to nasopharyngeal carcinoma, most cases have not been associated with Epstein-Barr virus (EBV). The diagnosis often requires immunohistochemistry or electron microscopy for confirmation. We describe a case of this tumor involving the supraglottis. The patient was treated with supraglottic laryngectomy and bilateral modified neck dissection. The histopathological study of the surgical specimen revealed an undifferentiated carcinoma with aspects of lymphoeptihelioma. The patient underwent radiotherapy and his 2-year follow-up showed no evidence of local or distant metastasis.     

Verrucous carcinoma of the larynx

Summary Verrucous carcinoma of the larynx in a middle-aged male patient is reported. The related diagnostic problems are described in detail and clinical and morphological differentiating features from other variants of squamous cell carcinoma are outlined on the basis of literary data and our own experience.     

Metastatic renal carcinoma to larynx

The larynx is a most unusual site for metastatic cancer. A case of metastatic renal cell carcinoma of the larynx is presented to illustrate the following features: its exceptional indolent course; the difficulty in arriving at a correct diagnosis, and the good result following local excision.