喉及喉咽部非上皮源性恶性肿瘤

目的讨论临床罕见喉腔及喉咽部非上皮源性恶性肿瘤的临床特征、诊断及治疗。方法自１９８５～１９９６年１２年间，共诊治喉及喉咽部非上皮源性恶性肿瘤２６例，其中喉２３例，喉咽部３例；男２１例，女５例；年龄１６～６５岁。喉肉瘤１１例，髓外浆细胞瘤１例，恶性淋巴瘤９例，恶性黑色素瘤２例，喉咽部平滑肌肉瘤１例，恶性黑色素瘤２例。对２１例患者首选手术切除，并根据其不同的组织病理学特性选择放射治疗或／和化学治疗。结果经６个月～１０年随访，１２例存活４～１０年，其中喉肉瘤６例，声门上区恶性淋巴瘤２例，喉恶性黑色素瘤２例，喉咽部平滑肌肉瘤、恶性黑色素瘤各１例。结论此类肿瘤的共有特征为：①肿瘤表面粘膜多光滑；②喉腔肿瘤较少发生颈淋巴结转移；③临床及病理学诊断、组织学分级较困难，免疫组化检查有助于确诊。     

喉腔及喉咽部原发性恶性黑色素瘤——4例报告并文献复习

喉腔及喉咽部原发性恶性黑色素瘤极为罕见。1985年～1997年8月,共收治喉腔、喉咽部粘膜原发性恶性黑色素瘤各2例,肿瘤多伴有溃疡并缺乏色素,临床表现为声音嘶哑、吞咽困难、咯血、咽部不适等,易与该部位常见的鳞状细胞癌相混淆。其中完整详实的病史、全面彻底的体格检查可提供重要的诊断依据,免疫组化病理有助确诊。大范围彻底的手术切除、根治性颈淋巴结清扫术可作为局限性原发病变的首选治疗。对术后可疑残留病变,可辅以放疗或化疗。     

Carcinosarcoma of the larynx and hypopharynx

INTRODUCTION: A carcinosarcoma is an uncommon neoplasm with both malignant epithelial and malignant mesenchymal components. The tumor entity has been described in many epithelial organs. Manifestation in the larynx and the hypopharynx is rare. PATIENTS: This report recounts two patients, one with a carcinosarcoma of the vocal cords and the other with a hypopharynx tumour. On the background of the literature we discuss the peculiarities of histology, pathogenesis, clinical features and therapy. DISCUSSION: Carcinosarcomas of the larynx and hypopharynx are typically described in elderly men. Smoking, alcohol and previous irradiation of the head and neck are predisposing etiologic factors. Clinical symptoms correspond to other neoplasms of the area--a short anamnesis is typical. In most cases the endoscopy reveals the presence of an exophytic lesion with intact epithelial surface. Crucial for the diagnosis is the revelation of a carcinoma together with sarcoma in the histology and immunohistochemistry both in the primary and secondary side. The histogenesis of carcinosarcoma is not yet clear--it seems that a pluripotent cell produces both tumour components. Most authors recommend complete surgical excision of the primary, regional lymphadenectomy and postoperative irradiation. Despite of an often large tumor volume the preservation of the larynx seems to be possible in many cases, because exophytic tumours are pre-potent. Survival rates are similar to those of patients with squamous cell carcinoma.     

喉腔及喉咽部平滑肌肉瘤3例报告

为了解发生于喉腔及喉咽部的平滑肌肉瘤的临床特点，报告１例喉咽部平滑肌肉瘤和２例喉腔平滑肌肉瘤患者早期症状都不明显，且无特异性，临床表现与该部常见鳞癌极为相似，术前明确诊断有一定困难。     

Use of computed tomography in the diagnosis of malignant tumors of the hypopharynx and larynx

CT is a non-invasive examination technique, which is able to demonstrate laryngeal and pharyngeal anatomy in a three-dimensional manner and give qualified information in addition to the clinical findings. In the classification of laryngeal and hypopharyngeal cancer, CT is superior to conventional radiological methods. CT complements direct and indirect laryngoscopy in showing tumour infiltration of surrounding structures.     

Surgical pathology of cancer of the larynx and hypopharynx

A study was designed to determine the influence of certain surgical pathologic findings on tumor spread and survival in patients with cancer of the larynx and hypopharynx. All patients with primary epidermoid carcinoma of the larynx and hypopharynx, treated by either surgery or preoperative irradiation and surgery, between 1955 and 1971 were included in the study. The patient population consisted of 791 patients all of whom were eligible for three-year follow-up. Information from a retrospective study of the surgical pathology reports regarding resection margins, size and differentiation of the primary tumor, histopathologic characteristics of the primary tumor and neck dissection, number, position and size of positive lymph nodes and post treatment staging, was correlated with tumor spread and survival.     

Nodal patterns in carcinoma larynx and hypopharynx

The therapeutic choice for a malignant neoplasm is usually governed by the probability and location of lymph mode metastases. In the present study 47 cases of carcinoma larynx and 44 cases of carcinoma hypopharynx were throughly investigated and reviewed. Among the laryngeal malignancies supra glottic and transglottic tumours were equally frequent (46.8%). Among the hypopharyngeal malignancies, pyriform fossae were most frequently invloved (90.9%). In laryngeal malignancies (51.06%) as well as hypopharangeal malignancies (77.27%) T⁴ tumour were more common. Overall incidence of cervical metastases was (63.83%) in laryngeal carcinoma and (45.45%) in hypopharyngeal carcinoma respectively. In majority of laryngeal carcinoma cervical modes were present at level B followed by level E. In hypopharyngeal malignancies mode B and E were only involved. There was definite correlation between ‘T’ of the primary tumour, and node status but there was no correlation between ‘T’ and node level. The study stresses on the relevance of nodal pattern examination and radiological investigations in all cases of carcinoma larynx and hypopharynx.     

Neuroendocrine neoplasms of the larynx

Neuroendocrine neoplasms of the larynx are a rare group of tumors that include carcinoid tumor, atypical carcinoid tumor, and small cell carcinoma. These neoplasms pose interesting diagnostic, prognostic, and therapeutic dilemmas, and they are, as a whole, aggressive tumors with a tendency for local and distant spread. The authors of this study examined six new cases of laryngeal neuroendocrine neoplasms. One case manifested itself as a primary atypical carcinoid tumor and caused a “carcinoid syndrome.” The remaining five cases were small cell carcinomas of the larynx. Histologic, immunocytochemical, DNA flow cytometric, and p⁵³ studies were performed on all cases. The expression of neuron-specific enolase and chromogranin were the most useful markers in this group of tumors. Overexpression of p⁵³ protein was present in the majority of cases, including the atypical carcinoid tumor. The implications of these studies for diagnosis, classification, and treatment are discussed.     

Double adenoid cystic and squamous cells carcinoma of the hypopharynx and larynx. A contribution to the issue of multicomponent neoplasms

Bicomponent cancer of the piriform fossa and larynx of 55 years old man has been described. The patient was treated surgically and by radiotherapy. The performance of laryngectomy and partial pharyngectomy with conservative bilateral neck dissection was used as surgical treatment. In histopathological findings of postoperative specimens two types of neoplasms: squamous cells and adenoid-cystic cancers were stated. The authors presented opinions on the affection arising of multicomponent tumours of the aerodigestive truct.     

Cyclin D1 and p53 overexpression predicts multiple primary malignant neoplasms of the hypopharynx and esophagus

BACKGROUND: Multiple primary upper aerodigestive tract carcinomas can occur in up to 15% of patients. We have shown previously that half of the patients with multiple upper aerodigestive tract squamous cell carcinomas are initially seen with synchronous tumors. Most metachronous squamous cell carcinomas become manifest within 3 years. OBJECTIVE: To examine the expression of 2 proteins-cyclin D1 and p53--in an attempt to predict the occurrence of multiple primary malignant neoplasms (MPs). MATERIALS AND METHODS: Monoclonal antibodies to cyclin D1 (DCS-6 [dilution, 1:50]. Novocastra Laboratories Ltd, Newcastle, England) and p53 (DO-7 [dilution, 1-100], Dako Corp, Carpinteria, Calif) proteins were used. Resection specimens from a total of 47 patients, 12 patients with MP and 35 patients with nonmultiple primary malignant neoplasms, were analyzed. Those in the nonmultiple primary malignant neoplasm group had longer than 3 years' follow-up to ascertain the absence of MP. RESULTS: Tumor overexpression of cyclin D1 was significantly associated with the development of MP (P<.01). Tumor overexpression of p53 was also frequent in patients with MP although statistical significance was not achieved. The combination of these 2 parameters was an even greater predictor of MP (P<.001). CONCLUSIONS: Overexpression of cyclin D1 and p53 proteins was highly correlated with the development of MP. Additional studies are necessary to confirm this finding. Immunohistochemical evaluation of primary squamous cell carcinomas for cyclin D1 and p53 overexpression may become an important fact of surgical pathologic reporting for primary upper aerodigestive tract squamous cell carcinomas.     

Nonsquamous neoplasms of the larynx

While squamous cell carcinoma is the most common neoplasm to involve the larynx, several other histologic tumor types can occur. The laryngologist should consider a nonsquamous neoplasm when the tumor is long-standing, pigmented, covered by intact mucosa, or there is a history of neoplasia. Careful endoscopy, often using microlaryngoscopy, and careful handling of the tissue will ensure accurate diagnosis.