Small-cell carcinoma of the larynx

Primary small-cell (also known as oat-cell) neuroendocrine carcinoma of the larynx is an infrequent tumor. We report a case of epiglottic oat-cell carcinoma in a 57-year-old man. Its association with other malignant neoplasms and aggressive behavior in spite of treatment are discussed.     

内皮素-1在喉癌组织中的表达

目的：研究内皮素-1（ET-1）在喉癌组织中的表达及其意义。方法：采用免疫组织化学SP法检测30例喉癌组织、20例喉良性病变组织及10例喉正常黏膜中ET-1的表达，结合喉癌临床分期进行统计学分析。结果：ET-1在3种组织中的阳性表达均差异有统计学意义（均P〈0．05），其中在喉癌组织中表达最高，喉正常组织中表达最低。ET-1在喉癌各临床分期标本中的表达均差异有统计学意义（均P〈0．05），分期越晚，表达越高。结论：ET-1在喉癌中呈高表达，对喉癌的发生、发展可能发挥重要作用。     

颈段气管袖状切除术的临床分析

目的：总结颈段气管袖状切除术的经验,以提高颈段气管肿瘤的治疗效果。方法：回顾性分析1985-01～2006—12颈段气管袖状切除术治疗的12例患者,其中腺样囊性癌6例,鳞状细胞癌4例,腺癌1例,颈段气管软化塌陷1例。气管切除长度3～6cm,其中气管切除长度≥5cm5例,喉体松解术7例,甲状腺次全切除术3例。用正常甲状腺组织包绕气管及吻合口9例,未包绕3例。结果：所有患者喉功能均得以保留,发声正常,吻合口生长良好,受到分离的气管段色泽红润。3年生存率为85．37％,5年生存率为56．61％。结论：颈段气管袖状切除术符合气管肿瘤的治疗原则。改进的术式有利于气管吻合口的愈合,有利于更干净、彻底地切除气管肿瘤。     

原发性异位甲状腺癌3例并文献复习

目的：探讨原发性异位甲状腺癌的临床特征及诊治原则。方法：回顾性分析我科1990年至今诊治的共3例原发性异位甲状腺癌患者的临床资料,并结合文献进行分析。结果：3例患者均为女性,年纪较轻,术前表现为颈部肿块,术后病理均证实为异位甲状腺乳头状癌,随访至今均无复发征象。结论：异位甲状腺是胚胎时期甲状腺始基迁移过程中发生异常所致,同样能发生癌变,其治疗原则在国内外颇有争议。本文报道的3例原发性异位甲状腺乳头状癌均予以手术切除,术后予以甲状腺素治疗,预后良好。     

Multiple granular cell tumor

Eleven cases of granular cell tumor were reviewed. In two of the cases multiple sites of involvement were seen. The tumor occurred in the oral cavity in both of these cases and each was initially wrongly diagnosed as squamous cell carcinoma. The most common site was the subcutaneous tissue (nine patients) and the tongue was involved in three cases. In one patient the parotid gland was involved. Eight of the patients were females and three were males; seven were black and four were white. The importance of differentiating between squamous cell carcinoma and granular cell tumor is stressed, as is the need for a simple wide surgical excision.     

The role of midfacial degloving in modern rhinological practice

The midfacial degloving approach has been available for twenty five years and is slowly increasing in popularity in the management of extensive benign lesions of the sinonasal region, for selected malignancy in this area and to afford access to the nasopharynx and infra-temporal fossa. The advantages, applications and low complication rate are presented in a cohort of 86 patients, ranging from three to 79 years of age with a mean follow-up of 5.5 years. Seventy-seven per cent of the group had benign pathology of which juvenile angiofibroma was the commonest (40 cases). The 20 cases of malignant disease were a heterogeneous group histopathologically including adenoid cystic carcinoma (four cases), malignant schwannoma (two cases), rhabdomyosarcoma (two cases) and squamous cell carcinoma (two cases). Five underwent bilateral radical maxillectomies combined with orbital clearance in one patient. Complications include oro-antral fistula (three cases) and epiphora (three cases) all of which were successfully treated.     

鼻腔鼻窦神经内分泌癌11例诊疗分析

目的 探讨鼻腔鼻窦神经内分泌癌的诊疗方法及预后.方法 回顾性分析浙江省肿瘤医院1998-2010年收治的11例鼻腔鼻窦神经内分泌癌患者的临床资料.其中小细胞神经内分泌癌10例,非典型类癌1例.参照Kadish分期本组患者A期2例,B期6例,C期3例.治疗方法采取单纯手术1例,单纯放疗1例,单纯化疗1例,放疗+化疗2例,以手术为主的综合治疗(手术结合术后放化疗)6例.结果 全部患者随访2个月至12年,综合治疗的6例中1例3年后死亡,1例4年后死亡,1例无瘤生存12年,另2例无瘤生存8年,1例仍在治疗随访中.其他治疗方案的5例中4例1年内死亡,1例1年半后死亡.结论 本病治疗并无统一方案,以手术为主的综合性治疗是较合适的治疗方案.神经内分泌癌易复发,预后较差,早期的准确诊断和综合治疗是提高本病生存率的关键.     

Incidental association of thyroid carcinoma and squamous cell carcinoma of head and neck

PURPOSE: This study was carried out to address the dilemma of managing incidentally associated squamous cell carcinoma of the head and neck and thyroid carcinoma. MATERIALS AND METHODS: The patient group consists of 229 consecutive cases of squamous cell carcinoma of the head and neck and who were treated surgically at the Uludag University School of Medicine Department of Otolaryngology over a four-year period between 1997 and 2000. RESULTS: Among these patients, 3 had additional thyroid papillary carcinoma metastases (1.3%, 3/229) within the surgical specimens of the surgical procedures performed for squamous cell carcinoma of the head and neck. Complementary thyroidectomy was recommended but could not be performed in one of three cases because of the patient's refusal, and the primary focus of thyroid carcinoma could be found in only one of these two cases who had undergone complementary thyroidectomy. All three patients received postoperative radioactive iodine and thyroid hormone suppression, and all are free of disease after 49, 46, and 19 months of follow-up, respectively. CONCLUSIONS: Management of thyroid carcinoma found incidentally during treatment of squamous cell carcinoma of the head and neck is still debatable, and all patients must be evaluated individually with regard to its benefit. Our limited experience suggests that total thyroidectomy may not be regarded as mandatory in managing these patients.     

喉癌相关抗原免疫电镜的定位研究

目的研究喉癌混合单克隆抗体相关抗原的定位,为喉癌的早期诊断及导向药物治疗奠定理论基础。方法采用三株喉癌单克隆抗体ＬＣ９、ＬＣ１１、ＬＣ１２混合对９０例病理证实的喉癌组织切片（病理Ⅰ级４９例,Ⅱ级４１例）、１４例喉癌前病变及１０例正常喉粘膜进行免疫组化染色（ＡＢＣ法）光镜观察,同时采用ＬＳＡＢ法对９例新鲜喉癌组织细胞行免疫过氧化物酶标记电镜包埋前染色,对混合单克隆抗体相应抗原进行超微结构的定位观察。结果喉癌组织中喉癌相关抗原检出率（９７．７％）与正常喉粘膜相比明显增高（Ｐ＜０．０１）;混合单克隆抗体相应抗原主要定位于细胞膜性结构,即细胞膜、核膜、线粒体膜和内质网膜。结论混合喉癌单克隆抗体具有良好的特异性,带有药物的单克隆抗体可通过膜性结构来攻击癌细胞,达到治疗作用。混合单克隆抗体检测的相关抗原均分布于细胞膜和／或细胞浆中,细胞核无着色。     

Acinic cell carcinoma of minor salivary gland origin

The occurrence of acinic cell carcinoma in the minor salivary glands appears to be exceptional. A review of the English language literature revealed about 80 previously reported cases. In this paper, the clinical behaviour and pathological findings in three cases are reported. The tumours took their origin from the hard palate, soft palate and lower lip. The three cases presented with malignant clinical behaviour; all three recurred. In one case the local recurrence was multinodular with capsular infiltration. Two cases developed regional lymph node metastasis, and one metastasized to the lung and liver. In one the tumour infiltrated bony structures, and nerve in another. These cases tend to support the belief of some authors that acinic cell 'tumours' are clinically malignant and should be included in the carcinoma group.     

Studies on localization of laryngeal carcinoma associated antigen by immunoelectromicroscopy]

OBJECTIVE: To study the localization of laryngeal carcinoma associated antigen (LCAA) in the carcinoma tissue. METHODS: Ninety cases of laryngeal carcinoma and 14 cases of laryngeal precancerous lesion and 10 cases of normal laryngeal mucosa were detected with three strains of monoclonal antibodies LC9, LC11, LC12 by immunochemistry. The positive sections of laryngeal carcinoma were observed under light microscope and electromicroscopy. RESULTS: The positive rates of LCAA were dramatically higher than that in normal epithelial and precancerous tissues (P < 0.01). The results showed that the mixed monoclonal antibody had tissue specificity. The MLC associated antigens only distributed in cell membranes and/or cytoplasm. No cell nucleus was stained. CONCLUSION: The LCAA is mainly located in cell membranous structure. This study may provide morphological basis for immunoimaging diagnosis and targeting chemotherapy by application of laryngeal carcinoma McAb.     

Cause of death in patients with well-differentiated thyroid carcinoma

OBJECTIVES: The aim of this study is to examine in detail patients dying of well-differentiated thyroid carcinoma. STUDY DESIGN: A retrospective chart review with follow-up. METHODS: Data were collected from 522 consecutive cases of differentiated thyroid carcinoma treated by one endocrinologist and four surgeons at Mount Sinai Hospital, Toronto, Ontario, Canada, from 1964 to 1999. RESULTS: Ten patients died as a direct result of thyroid carcinoma; 19 other deaths were unrelated. Five of 102 patients were men (5%) and 5 of 420 were women (1%); the median age at diagnosis was 68.5 years (range, 49-82 y). No cases were stage I; three, stage II; two, stage III; and five, stage IV. Pathologically papillary carcinoma was found in six of the patients who died, follicular carcinoma in three patients, and Hurtle cell carcinoma in one patient. The causes of death were local invasion or compression of the trachea in two cases and distant metastases in eight patients. Median survival was 3.5 years (range, 1 mo-20 y). CONCLUSIONS: All patients dying of well-differentiated thyroid carcinoma had neck nodes, extrathyroidal spread, or distant metastases at presentation and were older than 49 years of age. Many presented because of their distant metastases. Death resulting from local disease was unusual, with most patients dying of distant metastases.     

Metastatic carcinoma of the neck from unknown primary sites

Encountering a metastatic carcinoma of the neck from an unknown primary site is not unusual, despite intensive examinations of the entire body. In previous reports, the pathological diagnosis of these carcinomas was usually squamous cell carcinomas and rarely adenocarcinoma. We treated eight patients with metastatic carcinoma of the neck from unknown primary sites, including 4 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, one case of small cell carcinoma, and one case of clear cell carcinoma, during a 10-year period from January 1992 to December 2001. We clinically examined these eight cases, and focusing on the two cases of metastatic cervical adenocarcinoma from unknown primary sites. The 8 cases consisted of 5 cases of N2 and 3 cases of N3 disease. Three of the 5 N2 patients underwent a neck dissection, but all three of the N3 cases were judged to be inoperable. Disease-free survival was achieved in all 3 patients who underwent surgery. In this paper, we review 36 reports on metastatic carcinomas of the neck from unknown primary sites and statistically analyze 1454 cases. Pathologically, the majority of them (81.1%) were squamous cell carcinoma; adenocarcinomas accounted for only 7.6% of the cases. Notably, 65.0% of the patients with cervical metastatic adenocarcinomas were confirmed to have primary lesions outside the head and neck region. The prognosis of primary unknown metastatic cervical adenocarcinoma is reportedly poor, and the optimal treatment is still unclear, although surgery is recommended for primary unknown metastatic cervical squamous cell carcinoma. However, we suggest that intensive treatment, including surgery, radiotherapy, and chemotherapy, of metastatic lesions of the neck may play a key role in improving patient prognosis.     

Bilateral synchronous tonsillar carcinoma: a case series and review of the literature

We present the first dedicated case series of bilateral synchronous tonsillar carcinoma and discuss the role of bilateral tonsillectomy as a diagnostic tool. The occurrence of multiple head and neck tumours is well recognised; however, reports of bilateral synchronous tonsillar carcinoma are rare. A literature review reveals only 12 cases of bilateral synchronous tonsillar carcinoma described in the international literature in the past 15 years. We present a further three cases confirmed following bilateral tonsillectomy. In conclusion, bilateral tonsillectomy has in many centres been established as a standard diagnostic and therapeutic procedure for patients who have cervical metastases from a head and neck cancer of unknown primary site. It is likely the true incidence of bilateral synchronous tonsillar carcinoma is underestimated and under-reported. We recommend bilateral tonsillectomy for patients with suspected or proven unilateral tonsillar carcinoma as well as those with cervical metastases from unknown primary site.     

Acoustic analysis of pathological voice. Some results of clinical application

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.     

Ki67和VEGF与喉鳞状细胞癌预后关系的探讨

目的：探讨细胞增殖抗原标记物（Ki67）和血管内皮生长因子（VEGF）与喉鳞状细胞癌预后的关系。方法：用免疫组织化学方法研究Ki67和VEGF在32例喉鳞状细胞癌组织中的表达,其中术后3年局部复发5例（复发组）,转移3例（转移组）,死亡8例（死亡组）,生存24例（生存组）。结果：死亡组Ki67和VEGF的表达均明显高于生存组（均P〈0．01）。Ki67在复发组和转移组中高表达,均高于未复发组和未转移组（均P〈0．01）。VEGF在复发组中亦高表达,高于未复发组（P〈0．05）。Cox多因素回归分析发现,Ki67（危险比为3．236,P〈0．01）、喉癌的T分期（危险比为1．382,P〈0．05）和术前淋巴结转移情况（危险比为0．316,P〈0．05）是影响喉鳞状细胞癌预后的独立指标。结论：Ki67和VEGF与喉鳞状细胞癌的预后有关,两指标的高表达预示着喉癌较差的预后,有助于喉癌治疗方案的制定。     

Papillary thyroid carcinoma in a thyroglossal duct cyst: primary tumor or metastasis?

Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.     

Facial palsy from metastatic nasopharyngeal carcinoma at various sites: three reports

Nasopharyngeal carcinoma that causes clinically evident facial palsy is uncommon. This article describes and discusses a series of cases that illustrates how nasopharyngeal carcinoma caused facial palsy as a result of facial nerve involvement at three sites: the cerebellopontine angle, the middle ear, and the parotid. The maxim, "All that palsies is not Bell's," is particularly relevant with respect to patients who have previously been treated for advanced nasopharyngeal carcinoma. In these patients, recurrent or persistent nasopharyngeal carcinoma involving the cerebellopontine angle, temporal bone, or parotid should be excluded.     

Mucoepidermoid carcinoma of the larynx: report of three cases

Mucoepidermoid carcinoma of the larynx is very rare, with only a few individual cases or studies in small patient groups reported in the literature. Treatment modalities for this type of carcinoma are not uniform; in addition, errors in the recognition and pathologic diagnosis are not uncommon. During the period 1991-2000, 771 cases of malignant laryngeal tumours were recorded and histologically verified at the University Department of Otorhinolaryngology and Cervicofacial Surgery, Zagreb University Hospital Centre, three of them were mucoepidermoid supraglottic carcinomas. The experience acquired in the treatment of these tumours is presented along with a review of the literature.     

鼻内镜或鼻内镜辅助下鼻腔鼻窦恶性肿瘤切除术的初步分析

目的：探讨鼻内镜或鼻内镜辅助下切除鼻腔鼻窦恶性肿瘤的可行性和疗效。方法：回顾性分析我院收治的40例鼻腔鼻窦恶性肿瘤患者的临床资料。病理类型为内翻性乳头状瘤恶变5例,上颌窦癌2例,筛窦癌3例,恶性黑色素瘤11例,嗅神经母细胞瘤7例,神经内分泌癌2例,肌上皮癌4例,鼻腔软骨肉瘤2例,腺样囊性癌3例,恶性血管外皮细胞瘤1例。所有患者均行鼻内镜或鼻内镜辅助下肿瘤切除术,其中32例术后采用放化疗。结果：所有患者随访1～5年,其中22例随访1～3年,随访3年以上者18例。4例患者术后6个月～2年症状复发,再次行鼻内镜手术后疗效满意;3例术后出现颈淋巴结转移,其中2例行颈淋巴结清扫术,1例因无手术指征而行放、化疗;4例出现远处转移;8例死亡;其余21例在随访期间未见复发及转移。结论：鼻内镜或鼻内镜辅助下手术切除鼻腔鼻窦恶性肿瘤切实可行,但必须严格选择适应证,辅以术后综合治疗,可取得满意的疗效。