Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings

IntroductionSquamous cell carcinoma is the most common laryngeal neoplasm and accounts for approximately 95% of all malignant neoplams of the larynx. However, various benign and malignant tumors and inflammatory diseases may affect the larynx.ObjectiveThe purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx.MethodsThis retrospective study was conducted in 18 patients who were diagnosed with non-squamous cell carcinoma lesions of larynx at our institution between 2007-2017. Clinical symptoms, examination findings, imaging characteristics, histopathologic diagnosis and treatment modalities were analyzed.ResultsThere were 9 malignant lesions (2 chondrosarcoma, 1 neuroendocrine tumor-atipical carcinoid, 1 Natural Killer/T-cell lymphoma, 1 diffuse large B-cell lymphoma, 3 plasmocytoma-multiple myeloma involvement, 1 adenocarcinoma metastasis), 3 benign neoplasms (chondroma, paraganglioma, lipoma), 2 tumor-like lesions (Brown tumor and inflammatory myofibroblastic tumor), 3 inflammatory lesions (Wegener granulomatosis, Behçet's disease and tuberculosis involvements), and 1 vascular malformation. The most common presenting symptom was hoarseness (66.6%). Paraganglioma was seen as hypervascular lesion on computed tomography and magnetic resonance imaging and showed intense tracer uptake on 68Gallium-DOTA-peptide PET/CT. Chondroid matrix calcifications were detected in chondroma and chondrosarcoma-grade 1. In patients with vascular malformation and lipoma, the typical imaging findings made it possible to diagnose.ConclusionImaging studies may provide clues for diagnosis of non-squamous cell laryngeal lesions. Clinical and imaging findings and previous clinical history should be evaluated together in clinical management of laryngeal lesions.     

Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity

IntroductionPatients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.ObjectivesTo evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.MethodsThe study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.ResultsThis study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the “minor inflammatory” and “major inflammatory” processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).ConclusionAlthough associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.     

The basaloid variant of squamous cell carcinoma of the larynx

IntroductionBasaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known.ObjectiveIn this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. Study design: retrospective cohort study. Evidence level: Level 2b.Material and methodsRecords of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed.ResultsAmong 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively.ConclusionBSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant.     

Tissue expression,serum and salivary levels of vascular endothelial growth factor in patients with HNSCC

IntroductionVascular endothelial growth factor is thought to be an important angiogenic factor involved in tumor growth, progression, and metastasis.ObjectiveThe present study evaluated the relation between tissue expression, serum and salivary levels of vascular endothelial growth factor in head and neck squamous cell carcinomas, and their correlation with clinicopathologic features.MethodsSamples were collected from 30 patients with head and neck squamous cell carcinomas and 24 healthy volunteers. Immunohistochemical analysis was used for tissue expression and enzyme-linked immunosorbent assay was employed to measure serum and salivary levels.ResultsNo vascular endothelial growth factor staining was observed in normal tissues, whereas vascular endothelial growth factor expression was seen in 6 patients (20%). Mean serum level of VEGF was 83.7 ± 104.47 in patients and 50.04 ± 32.94 in controls. Mean salivary level of vascular endothelial growth factor was 174.41 ± 115.07 in patients and 149.58 ± 101.88 in controls. No significant difference was found by Mann–Whitney test between controls and patients (p = 0.411, p = 0.944, respectively). No correlation was found between vascular endothelial growth factor tissue expression and its serum and salivary level.ConclusionOverexpression of vascular endothelial growth factor was found in head and neck squamous cell carcinoma patients, suggesting its role in the pathogenesis of head and neck squamous cell carcinoma, but no relation was found between tissue expression, serum levels, and salivary levels of this marker.     

Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy

IntroductionChemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck.ObjectiveTo determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO.MethodsData were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy.ResultsA total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%; p = 0.049).ConclusionThe presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.     

Histologic correlation of expression of Ki-67 in squamous cell carcinoma of the glottis according to the degree of cell differentiation

IntroductionSquamous cell carcinoma is the most common neoplasm of the larynx and glottis, and its prognosis depends on the size of the lesion, level of local invasion, cervical lymphatic spread, and presence of distant metastases. Ki-67 (MKI67) is a protein present in the core, whose function is related to cell proliferation.AimTo evaluate the expression of marker Ki-67 in squamous cell carcinoma of the larynx and glottis and its correlation to pathological findings.MethodsExperimental study with immunohistochemistry analysis of Ki-67, calculating the percentage of the cell proliferation index in glottic squamous cell carcinomas.ResultsSixteen cases were analyzed, with six well-differentiated and 10 poorly/moderately differentiated tumors. There was a correlation between cell proliferation index and degree of cell differentiation, with higher proliferation in poorly/moderately differentiated tumors.ConclusionThe cell proliferation index, as measured by Ki-67, may be useful in the characterization of histological degree in glottic squamous cell tumors.     

Apoptosis and expression of argyrophilic nucleolus organizer regions in epithelial neoplasms of the larynx

IntroductionOccurrence of apoptosis and expression of proliferative markers are powerful tools to establish a prognosis in the follow-up of cancer.ObjectiveTo evaluate the growth fraction in papillomas and laryngeal squamous cell carcinomas with three degrees of differentiation through apoptosis and the expression of nucleolus organizer regions.MethodsRetrospective study from which paraffin material was submitted to microtomy and hematoxylin–eosin and silver staining. Stained slides were used to quantify the apoptotic index and the number of nucleolus organizer regions by morphometry.ResultsApoptosis was significantly more frequent in well differentiated carcinomas and in papillomas, and a higher growth fraction of expressed nucleolus organizer regions and cells that expressed a greater than average number of nucleolus organizer regions were more frequently noted in undifferentiated carcinomas.ConclusionsThus, it was possible to verify that a high apoptotic index was associated with a lower chance of tumor differentiation in carcinomas, while a greater number of total nucleolus organizer regions, cells expressing nucleolus organizer regions above average and a higher growth fraction were associated with greater likelihood of abnormal cell proliferation and increased tumor differentiation.     

Downregulation of Notch4 – a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma

Introduction

Oral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them.

喉鳞癌P_（53）基因突变与癌恶性度的关系

应用结合聚合酶链反应的单链多态性分析（ＰＣＲ－ＳＳＣＰ）及ＤＮＡ序列分析（ＰＣＲ－ＤＮＡＳｅｑｕｅｎｃｉｎｇ）方法，检测６０例喉鳞癌石蜡包埋组织中Ｐ＿（５３）基因第５～第８外显子的突变。发现１９例发生Ｐ＿（５３）基因的点突变或碱基缺失，均引起氨基酸改变；临床ＩＩＩ、ＩＶ期的突变检出率为５０％，远高于Ｉ、ＩＩ期检出率（１２．５％、２２．２％）低分化癌突变检出率为６６．６％，高于中、高分化癌（４０．９％、１３．８％）。结果说明，Ｐ＿（５３）基因突变与喉鳞癌恶性度密切相关。应用上述敏感快速的方法检测Ｐ＿（５３）基因突变对判断喉癌恶性度及估计预后有参考意义。     

Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy

IntroductionCancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy.ObjectiveTo evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy.MethodsIt was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo.ResultsAll patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula.ConclusionOverall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.     

Prognostic role of margin status in open and CO2 laser cordectomy for T1a–T1b glottic cancer

Introduction

Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer.

Swallowing-related quality of life after head and neck cancer treatment

OBJECTIVES: To determine the role of treatment modality in swallowing outcome after head and neck cancer treatment and to identify potential risk factors for posttreatment dysphagia. STUDY DESIGN: Cross-sectional survey of patients with no evidence of disease 12 months or more after the treatment of a stage III or IV squamous cell carcinoma of the oropharynx, larynx, or hypopharynx. METHODS: Potential subjects were stratified by tumor site and tumor T-stage to achieve a balanced comparison between chemoradiation (n = 18) and surgery/radiation (n = 22) groups. Outcome measures included a dysphagia risk factor survey, the MD Anderson Dysphagia Inventory (MDADI), and the Short-Form 36 (SF-36). RESULTS: Patients who received chemoradiation for oropharyngeal primaries demonstrated significantly better scores on the emotional (P =.03) and functional (P =.02) subscales of the MDADI than did patients who underwent surgery followed by radiation. There were no significant differences between chemoradiation and surgery/radiation groups for laryngeal and hypopharyngeal primaries. Additional risk factors for posttreatment dysphagia include prolonged (>2 weeks) nothing by mouth (NPO) status (P =.002) and low SF-36 Mental Health Subscale score (P =.002). CONCLUSION: The study suggests that chemoradiation may provide superior swallowing outcome to surgery/radiation in patients with oropharyngeal primary. Patients with depressed mental health and prolonged feeding tubes may be at higher risk of long-term dysphagia.     

Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients

IntroductionTransoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision.ObjectiveThe aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery.MethodsWe carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: “free” if macroscopic margin-tumor distance was at least 2 mm, as “close” if it was less than 2 mm and “positive” if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO₂ 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4–8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated.ResultsFive-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients.ConclusionThis study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO₂ laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.     

Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis

IntroductionElective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis.ObjectiveThe present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival.MethodsForty surgically treated patients were retrospectively included.ResultsTen cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR = 39.3; p = 0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis.ConclusionMetastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor     

T3和T4期梨状窝癌的综合治疗

目的评价不同治疗方式治疗梨状窝癌T3、T4病变的治疗效果。方法回顾性分析了1974年1月-1999年12月中国医学科学院肿瘤医院头颈外科初治的287例T3、T4梨状窝癌患者。根据治疗方式，分为4组：单纯放疗组（Ra组）134例，平均放疗剂量68．8Gy；术前放疗加手术组（R＋S组）125例，平均术前放疗剂量45．5Gy，其中32例行喉功能保留手术；单纯手术组（Sa组）13例，全部为非喉功能保留手术；手术加术后放疗组（S＋R组）15例，全部为非喉功能保留手术，平均术后放疗剂量56．3Gy。结果Kaplan-Meier方法计算Ra组、R＋S组、Sa组和S＋R组的5年生存率分别为23．13％、46．51％、18．33％和44．44％。综合治疗（R＋S组和S＋R组）与单纯治疗（Ra组和Sa组）的5年生存率分别为46．22％和22．60％，两组间差异有统计学意义（P=0．000）。Cox模型对生存时间的多因素分析显示，对生存时间有影响的是治疗模式（P=0．000）和放疗效果（P=0．0070）Ra组、R＋S组、Sa组和S＋R组的喉功能保存率分别为14．08％、13．61％、0和0。Ra组、R＋S组、Sa组和S＋R组的并发症的发生率分别为14．93％、37．60％、53．84％、33．33％。结论术前放疗有助于T3、T4梨状窝癌患者喉功能的保留。     

喉鳞状细胞癌原发灶和淋巴结转移灶中PTEN和Survivin的表达及意义

目的:探讨喉鳞状细胞癌(LSCC)原发灶与淋巴结转移灶在分子水平的差别及意义。方法:采用免疫组织化学SP法检测18例转移淋巴结阳性(N )的LSCC患者,对其原发灶、转移灶及无转移淋巴结中PTEN和Survivin的表达进行检测;另取22例声带息肉(VCP)组织标本作为对照组。结果:无转移淋巴结患者的标本中均未见PTEN和Survivin的表达。LSCC、N 、VCP中PTEN阳性率分别为94.4%(17/18)、94.4%(17/18)和95.5%(21/22),3者阳性率比较,差异无统计学意义。N 的PTEN表达强度较LSCC为强,其表达强度差异有统计学意义(P<0.05);Survivin在VCP中未见阳性表达,在LSCC和N 中阳性率分别为55.6%(10/18)、50.0%(9/18),三者阳性率比较差异有统计学意义(P<0.01),但LSCC和N 中的阳性表达率和表达强度三组比较均无统计学意义(P<0.05)。结论:LSCC原发灶与淋巴结转移灶中分子水平的特点存在差异。     

喉癌血清DBP异质性和癌组织PCNA表达检测及临床意义

应用环状免疫单扩散法及免疫组化技术对44例喉癌病人血清及32例癌组织进行血清DBP异质性和组织PCNA表达检测,发现各期喉癌病人血清中均存在DBP异常表达,并与化疗及复发有关;而与分型、淋巴结转移及病理分化无关;且血清DBP阳性喉癌组织中PCNA的表达率较高。提示它有较高的增殖活性,血清DBP异质性与喉癌的发生发展有密切关系。     

Clinical and otorhinolaryngological aspects of extranodal NK/T cell lymphoma,nasal type

IntroductionExtranodal NK/T-Cell lymphoma, nasal type (NKTLN) is a disease that mainly affects the nasal cavity and the paranasal sinuses. Early nasal symptoms are nonspecific, simulating sinus infection. With disease progression, necrosis of the nasal mucosa increases, hindering histological diagnosis. Thus, multiple biopsies may be necessary until definitive diagnosis. Most studies on NKTLN address the hematological and immunological aspects of the disease.ObjectivesTo present data from a Brazilian quaternary hospital, with emphasis on the clinical aspects of the disease, and to correlate the findings with the most recent literature data.MethodsCase study of seven patient files.ResultsPatients were evaluated on their medical history, number of biopsies necessary, association with Epstein–Barr virus, treatment, and outcome. All patients had nonspecific nasal complaints and underwent at least three cycles of antibiotic therapy. The earlier a biopsy was performed, the fewer biopsies were required to diagnose the disease and start treatment. However, this fact did not translate into better prognosis.ConclusionThe otolaryngologist plays a fundamental role in the prognosis of NKTLN and can shorten time between symptom onset and treatment of the patient.     

晚期喉癌患者的生存质量与其个性特征和应对方式的相关性研究

目的　探讨晚期喉癌患者的生存质量与其个性特征、应对方式等心理因素的关系。方法　对晚期喉鳞状细胞癌生存质量 (说话、工作和活动能力 )较差组 (Ⅰ组 )、生存质量较好组 (Ⅱ组 )的患者及健康人 (对照组 )各 30例分别进行生存质量 (UniversityofWashington qualityoflife ,UW QOL)、艾森克个性特征测验 (Eysenckpersonalityquestionnaire,EPQ)、应对方式问卷 (copingstylequestionnaires,CSQ)的调查 ,并作相关分析。 结果　UW QOL评分平均值 ( x±s) :Ⅱ组患者的总分(6 96 0± 15 3 3)分、活动能力 (85 7± 2 2 2 )分、娱乐 /休养 (76 2± 2 0 1)分、职业 (5 6 5± 2 3 5 )分、讲话 (72 7± 2 5 6 )分 ,显著高于Ⅰ组的 (5 83 8± 12 1 7)分、(6 2 5± 2 0 6 )分、(5 3 3± 2 1 8)分、(35 9±2 1 7)分、(35 2± 2 3 7)分 ,P <0 0 1;外貌 (82 4± 2 2 1)分也高于Ⅰ组的 (6 7 6± 2 3 4 )分 ,P <0 0 5。EPQ评分 :Ⅱ组患者P(48 5± 8 2 )分、N(48 6± 9 9)分别低于Ⅰ组患者的P(5 3 3± 9 3)分、N(5 3 6± 8 7)分 ,P <0 0 5 ;而E(5 8 4± 9 7)分显著高于Ⅰ组 (5 0 9± 9 7)分 ,P <0 0 1。CSQ评分 :Ⅱ组患者解决问题 (0 85± 0 2 0 )分、求助 (0 6 7± 0 2 1)分显著高于Ⅰ组的 (0 6     

Survivin蛋白在喉鳞状细胞癌中的表达及意义

目的:探讨Survivin蛋白在喉鳞状细胞癌(LSCC)组织中的表达及其相关性。方法:采用免疫组织化学SP法检测64例LSCC、28例正常喉黏膜及20例喉良性病变组织中的Survivin、Bcl2蛋白的表达,结合临床病理特征进行统计分析。结果:64例LSCC组织中,Survivin蛋白表达阳性43例;28例正常喉黏膜和20例喉良性病变中分别表达1例和2例。Survivin蛋白在声门上型LSCC中表达32例,声门型中表达11例;中低分化的标本中表达34例,高分化的标本中表达9例;在临床分期的Ⅲ、Ⅳ期标本中表达33例,在Ⅰ、Ⅱ期标本中表达10例。以上各项指标之间差异具有统计学意义(均P<0.05)。在有淋巴结转移的标本中表达30例,无淋巴结转移的标本中表达13例,两者之间差异具有统计学意义(P<0.01)。在LSCC组织中Survivin与Bcl2蛋白表达有明显相关性(P<0.05)。结论:Survivin过度表达提示LSCC临床分期晚、分化程度低、易发生淋巴结转移,对于LSCC的早期诊断和预防具有重要参考意义。Bcl2与Survivin的表达可能在LSCC的发病机制中起协同作用。