下咽癌侵犯喉结构的 CT 评价

目的：评估下咽癌侵犯喉结构（ 包括声门旁间隙、会厌前间隙、杓会厌襞、甲状软骨、环状软骨及杓状软骨） 的 Ｃ Ｔ 诊断价值。方法：对２１ 例下咽癌的 Ｃ Ｔ 扫描与病理检查结果进行对比分析,以确定其准确性,并同喉镜检查＋ 喉侧位片进行比较。结果： Ｃ Ｔ 对于判断下咽癌侵犯喉结构的准确率远较喉镜检查＋ 喉侧位片高,假阳性及假阴性结果较少,优势明显。结论：应将 Ｃ Ｔ 扫描纳入下咽癌常规临床检查。     

螺旋CT在喉及下咽癌的临床应用价值

目的 探讨螺旋ＣＴ多平面重组（ＭＰＲ）、三维重建（3D）和领导 具喉镜（CTVL）在喉及下咽癌的临床应用价值。方法 24例喉及下咽癌患者进行轴位螺旋CT扫描。同时做MPR、3D和CTVL成像,并与纤维喉镜和手术所见进行对照分析。结果 螺旋CT轴位结合MPR图像对术前肿瘤分期和诊断颈部淋巴结转移的准确性均为96%;25%的患者MPR显示肿瘤侵犯的范围优于轴位,3D重建可立体显示肿瘤的侵犯范围及其与血管、气管的关系;头端CTVL显示的喉及下咽部腔内肿瘤的部位、大小及侵犯范围与纤维喉镜所见相似,4例从足侧观察肿瘤与声带和前联合的关系弥补了纤维喉镜的不足,结论 螺旋CT轴位结合MPR、3D和CTVL图像可以更完整地提高喉及下咽癌的全面资料。     

CT仿真喉镜对喉肿瘤的临床诊断价值

目的探讨CT仿真喉镜对喉肿瘤的诊断价值.方法对5名健康者、19例喉癌、5例声带及披裂息肉、4例乳头状瘤共33例患者,行螺旋CT扫描后经软件处理获得CT仿真喉镜图像,所有病例均与纤维喉镜和手术所见对照分析.结果CT仿真内镜显示喉内正常解剖结构与纤维喉镜一致;对喉肿瘤诊断敏感性为72.7%;显示病变范围优于纤维喉镜;对较小病变形态显示略差于纤维喉镜.结论CT仿真喉镜(以下简称CTVL)是纤维喉镜的很好补充手段,具有发展潜力.     

Computed tomography of larynx in normal and pathological conditions

Eighteen patients (five normal and thirteen pathological) larynx were evaluated with high-resolution computed tomography (CT). In normal larynx CT helped us to show those areas which are invisible or difficult to examine by clinical examination, direct laryngoscopy, and conventional radiology e.g. pre-epiglotic space, paraglottic space, and the laryngeal framework. In pathological conditions, CT provided informations regarding deep penetration and inferior extension of tumour, cartilaginous invasion or laryngeal neoplasm from those arising from adjacent extralaryngeal structures. Though early invasion of laryngeal cartilage by neoplasm may occasionally be difficult with CT, yet it helped to determine the type of management in these types of cases.     

Unusual presentation of laryngeal foreign bodies — report of two rare cases

Aspiration of a foreign body into the respiratory tract is a common and serious problem in childhood but is rare in adults. Two interesting cases in which the diagnosis of foreign body in the larynx was not suspected preoperatively are being reported. A three and half year old female child was diagnosed as a case of bronchitis and was later found to have a metallic spring in the supraglottic region which was removed by direct laryngoscopy under general anesthesia. The other patient, a 32-year-old male, was diagnosed to have a fibrous lesion in the larynx one year previously, and on laryngoscopy a vegetable, spiculated foreign body was found after excising the fibrous lesion on the left false cord. Both the cases are symptom free 18 months after endoscopy.     

An extremely rare case of synchronous occurrence in the larynx of intravascular lymphoma and in situ squamous cell carcinoma

We present the first case of laryngeal intravascular lymphoma coexisting with in situ squamous cell carcinoma. The patient, a 53 years old man, presented with hoarseness starting a year ago and underwent laryngoscopy, which revealed two nodular lesions on his right vocal cord. The histological and immunohistochemical examination of the biopsy specimens established the diagnosis of in situ squamous cell carcinoma coexisting with intravascular lymphoma of T-cell origin. Taking in consideration all the available references, the larynx has not until now been reported as a primary site of involvement of intravascular (angiotropic) lymphomas, nor as a secondary location in the systematic course of this disease. Furthermore no cases have been reported in the literature, concerning the synchronous affection of the larynx by this lymphoma and in situ laryngeal carcinoma, or other type of neoplasm.     

Improved detection of recurrent laryngeal tumor after radiotherapy using FDG-PET as initial method

BACKGROUND AND PURPOSE: Timely detection of recurrent laryngeal tumor after radiation is an important predictive factor for curation as well as preservation of laryngeal function. Direct laryngoscopy under general anesthesia with taking of biopsies is the standard diagnostic procedure to detect recurrence when suspicion is raised. This, however, is an invasive and potentially damaging technique. Hence, a non-invasive diagnostic procedure, such as (18)FDG-PET to stratify patients for direct laryngoscopy could be useful. (18)FDG-PET is interpreted visually so that observer variation may affect clinical practice. In the present study, we therefore investigated this aspect of reproducibility. PATIENTS AND METHODS: Thirty consecutive patients suspected of recurrent laryngeal carcinoma after radiotherapy underwent (18)FDG-PET and direct laryngoscopy under general anesthesia with taking of biopsies. (18)FDG-PET scans were reported by nine nuclear medicine physicians and residents, using a three-point scaling system. The reference was the absence or appearance of a local recurrence in the 12 months following (18)FDG-PET. RESULTS: Eight patients had biopsy proven recurrent laryngeal carcinoma. Sensitivity of (18)FDG-PET was 88% (95% CI 53-98%) and specificity was 82% (95% CI 62-93%). The observers had a moderate to reasonable agreement (weighted kappa 0.45 (95% CI 0.20-0.69)) vs. the clinical gold standard and interobserver kappa was 0.54 (95% CI 0.40-0.69). CONCLUSION: (18)FDG-PET seems to be a promising technique to detect recurrent laryngeal carcinoma after radiotherapy, and selecting patients for direct laryngoscopy. This will avoid futile invasive procedures. Interobserver agreement and variability is reasonable using this technique, but training is necessary. Studies comparing different strategies to select patients for direct laryngoscopy in case of suspected recurrence are warranted.     

Radiological evaluation of chronic laryngotracheal stenosis

Sixteen cases of chronic laryngotracheal stenosis were assessed. They underwent complete ENT evaluation including indirect laryngoscopy, direct laryngoscopy, microlaryngoscopy and tracheoscopy. Preoperatively plain X-ray of soft tissue neck and computed tomography (CT) was done. Good correlation was seen between the endoscopic assessment of the stenotic segment and the CT finding.     

Is Direct Laryngoscopy Obsolete? “Trans Nasal Oesophagoscopy” the Complete Endoscopic Solution in Head Neck Practice

Direct laryngoscopy (DL) is the standard of care for the evaluation of suspicious lesions in the larynx and hypo pharynx but requires general anaesthesia and a dedicated operation theatre. While DL offers us the ability to map the lesion adequately and take a biopsy, it requires workup for anaesthesia well as rigid oesophagoscopy for assessing the oesophagus with its associated complications. Sixty-nine patients underwent TNE under topical anaesthesia. The lesions were mapped and biopsies taken. Those patients who had an inadequate evaluation on TNE or negative biopsy underwent direct laryngoscopy. Completeness of evaluation, adequacy of biopsy, presence of synchronous oesophageal lesions and the modified Gloucester Comfort Score for patient comfort was documented. Amongst 69 cases enrolled for TNE evaluation, 97% of cases had an adequate mapping of disease extent, and 100% adequacy of biopsy material. General anaesthesia could be avoided in 92.75% of patients. TNE took a median time of 8 min. Synchronous oesophageal tumours were seen in 5.8% of patients. There were no complications and 74% patients did not experience any discomfort. TNE appears to be simple, safe, efficient office based diagnostic procedure. TNE has the potential to be the new standard of care making DL obsolete.     

Hydrogen peroxide as ‘defogger’ in indirect laryngoscopy

Indirect laryngoscopy examination is a routine clinical procedure for visualizing larynx and hypopharynx. Many methods are described in literature to prevent fogging over the mirror during the examination. Authors have used hydrogen peroxide 0.75% w/v solution as a defogging agent during indirect laryngoscopy examination and found it safe and cost effective.     

Computed tomography in definitive radiotherapy of prostatic carcinoma

Pelvic computerized tomography (CT) scans were obtained in 35 patients with carcinoma of the prostate. Clinical findings were correlated with these scans. CT scanning was of limited efficacy in definition of tumor size and extent in carcinoma of the prostate, but has been quite useful in treatment planning. The information from the CT scans has prompted field adjustment in 23% and an increase in field size in 11% of the patients.     

A Study of Clinicopathological Profile of Patients of Hoarseness of Voice Presenting to Tertiary Care hospital

Hoarseness is subjective term used to describe abnormal voice quality which may occur due to many causes because it is just a symptom. Proper knowledge and clinicopathological profile is important to treat the underlying pathology. This prospective study was carried out in 100 patients presented in Department of ENT, Gandhi Medical College, Bhopal from April 2013 to September 2014 with complaint of hoarseness of voice for more than 15 days. Objective of this study is to study incidence, duration and sex predilection for hoarseness of voice. Also to study different etiological and predisposing factors for hoarseness of voice. After taking detailed history of the patient, complete examination of ear, nose and throat has been carried out. Indirect laryngoscopy, direct laryngoscopy, FOFE is done. Any suspicious tissue is sent for histopathological evaluation. X-ray soft tissue neck and if required CT SCAN larynx is done. Out of 100 patients maximum were from 50 to 70 years age group. 89% were males while only 11% were females. Labourers (37%) and farmers (32%) were the major groups affected. Smoking habit found in 60% of patients and tobacco chewing in 33% of patients and both, also having. Most common cause for hoarseness was found out to be laryngeal neoplasms of which supraglottic growth being commonest (37%) in our study. Hoarseness of voice may be present due to various underlying pathologies. So proper diagnosis, through detailed history, clinical examination and investigations is warranted to find out the cause and starting treatment.     

Computed tomography in the staging of small cell lung cancer: implications for combined modality therapy

Computed tomography of the thorax and abdomen, from the thoracic inlet to the renal hila, was performed as part of initial staging in 51 patients with small cell carcinoma of the lung (SCCL). The computed tomographic (CT) scans were repeated after completion of chemotherapy, as part of routine restaging and assessment of response to therapy. To identify the ways in which CT scanning uniquely benefited evaluation of initial disease extent in comparison to other diagnostic studies exclusive of CT scan, all diagnostic and clinical data were reviewed. CT scan identified more advanced intrathoracic disease than chest radiography in 82% of patients. Mediastinal node involvement not appreciated by chest radiography was seen in 61% of patients. Adrenal and retroperitoneal node involvement, not suspected by other studies, was identified by CT scan in 31% and 12% of patients, respectively. Thirty percent of the patients staged as limited disease (LD) were advanced to extensive disease (ED) by CT scan findings. While confirmation, by biopsy, of positive CT findings was not consistently accomplished, restaging CT scans provided indirect confirmation by displaying improvement or worsening that correlated with disease regression or progression. Thoraco-abdominal CT scanning more accurately identifies the extent of small cell carcinoma than other imaging procedures. This has important implications for reporting results by extent of disease. In addition, CT more accurately identifies the magnitude of intrathoracic primary and nodal tumors, which may influence the choice and conduct of local treatment--surgery and/or radiation therapy--in combination with systemic chemotherapy.     

原发性输尿管癌的螺旋CT表现与病理对照分析

Objective： To explore the characteristics of the primary ureteral carcinoma （PUC） and discuss the value of spiral CT （SCT）in the diagnosis of PUC. Methods： The SCT findings of the primary ureteral carcinoma in 16 cases were analyzed and compared with the histopathological diagnosis and staging. Results： The transverse diameters of the lesions were 1.0-2.1 cm, and the longitudinal lengths were 1.5-15.2 cm. There were no statistically significant differences （P〉0.1） in diameters and lengths among the low staging group （pT0-T2） and the high staging group （pT3-T4）. The average CT value of the lesions was 43 HU on plain scanning, and 73 HU on CE scanning. The increment was 30 HU. The lesions were clearer on CE scanning. Curved planar reconstruction （CPR） could show the entire course of the urinary tract. Among 6 cases of pT3 stage, CT gave a correct diagnosis in 1 case. For 2 cases of pT4 stage, CT gave correct diagnoses in both cases. Conclusion： The carcinomatous lesions spread along the ureter. The longitudinal length of each lesion is longer than its transverse diameter. Tumor cannot be staged merely according to its diameter and length. CT is difficult to differentiate stage T0-T3, while for stage T4, CT diagnosis is accurate. Contrast enhancement CT scanning has the confirming and differentiating roles. CPR offers direct and easy observing images for clinical doctors.     

Whole-breast volume perfusion images using 256-row multislice computed tomography: visualization of lesions with ductal spread

Background  The aim of this study was to apply perfusion techniques to breast tumors using a prototype 256-row multislice computed tomography (CT) scanner (which allows a wide range of 128 mm to be scanned and can provide whole-breast perfusion maps without any dead angles) to improve contrast and assess the possibility of precisely depicting the extent of breast cancer. Patients and methods  The study group included seven patients with breast cancer who were scheduled to undergo radical surgery and radiotherapy. Dynamic scanning was performed using a 256-row multislice CT scanner during normal respiration. Volume perfusion images of the entire breast were obtained using the maximum slope method. Perfusion map images and early-phase breast CT images at 54 s were compared by means of pathological examination. Results  All breast cancers could be distinguished from normal mammary glands based on the perfusion value. The extent of cancer depicted in perfusion images showed excellent agreement with the pathology findings for invasive ductal carcinoma and ductal carcinoma in situ. In three patients, all ductal spread, parts of which were not visualized by early-phase CT, were depicted in volume perfusion images. Simulation analysis suggested that perfusion maps could be generated with fewer scanning points. Conclusion  The results of the present study suggest that volume perfusion imaging may be useful for depicting the extent of breast cancer, with excellent sensitivity. Further research is needed to determine the clinical relevance of these findings.     

多层螺旋CT重建技术对咽喉部疾病的诊断价值

目的：探讨多层CT重建技术在咽喉部的临床应用,探讨其在疾病诊断方面的优越性。方法：对50例患者（其中正常组5例及病变组45例）行16层CT薄层容积扫描,应用多种重建方法进行后处理,正常组重点观察正常的解剖结构,病变组重点观察病变的位置大小、形态及与周围结构受侵犯的情况,并与手术病理或纤维喉镜结果进行对照。结果：所有病例结合各种重建方法均做出正确诊断。多层螺旋CT扫描多平面重建、三维透明化法重建以及仿真内镜技术可清晰显示病变的大小、形态、气道狭窄的范围与程度及与周围结构的关系,与手术及纤维喉镜显示的结果相符。结论：多层螺旋CT扫描速度快,可节省检查时间。采用薄层重建使三维重建图像分辨率提高。各种重建方法是常规轴位扫描的很好补充。仿真内镜技术可克服纤维喉镜的一些局限性,是纤维喉镜的辅助手段。     

喉癌及其周围组织三维结构特点扫描电镜观察

目的　了解形态学与喉癌生物学特性之间的关系。方法　深低温冰冻切割法扫描电镜观察来自 12例喉癌患者及 4例非喉源性疾病死亡患者的 12 6个喉标本。结果　 ( 1)正常喉室带和声带上皮表层细胞角化现象明显 ,可见大量细胞间桥。 ( 2 )癌周围组织表层鳞状上皮形态可辨 ,但排列紊乱 ,形态变异。 ( 3)癌组织周围结构可见两种类型。浸润型周边可见淋巴细胞浸润 ,表面有若干淋巴触手。结论　形态学与喉癌生物学特性之间有密切关系 ,深低温冰冻切割法扫描电镜技术是理想的观察手段。     

A clinico-pathological study of the role of allergy on larynx in children

Laryngeal manifestation of allergy though less common than rhinosinusitis, tubotympanitis and bronchopulmonary allergy is not that uncommon and is usually misdiagnosed and mistreated in children. Hence, the importance of larynx as the allergic shock organ in children with spasmodic croup and laryngotracheo hronchits. In the present study, children below five years, presenting with Stridor and/or hoarseness were evaluated regarding the history of allergy, direct laryngoscopic finding, measurement of serum IgE,. presence of eosinophilia and histopathological examination of laryngeal biopsy. Out of the 80 cases studied, 9 cases (11.2%) presented with associated allergic manifestation, 8 cases (10%) having family history of allergy. 4 cases (5%) having raised serum lgE, 12 cases (15%) with eosinophilia and 3 cases (3.75%) with eosinophilic infiltration on histopathological examination of the biopsy material taken during the direct laryngoscopy.     

Cancer de l’hypopharynx et du larynx : proposition de sélection et délimitation des volumes cibles microscopiques péri-tumoraux (aires ganglionnaires exclues)

This article reviews the concept of selectivity in peritumoral microscopic disease to be included in the Clinical Target Volume (CTV) for elective treatment for larynx and hypopharynx squamous cell carcinoma (50 Gy or 54–60 Gy for SIB-IMRT), using the local tumoral spread. The objective of the present article is to present the different delineations of the target volumes, required for an appropriate application of 3-DCRT and IMRT (supraglottic larynx, vocal cord, subglottic larynx, pyriform sinus, lateral and posterior pharyngeal wall and postcricoid pharynx). These propositions are for the delineation of microscopic peritumoral target volumes when external beam irradiation is required. CTVs are illustrated on CT sections.     

Lead article

Squamous cell carcinoma arising from upper aerodigestive tract carries with it a significant morbidity and mortality and, over the last few decades, its incidence has steadily increased. The management of patients requires thorough investigation to determine the local, regional, and distant extent of the disease, and treatment options include surgery, radiotherapy, chemotherapy, or combinations of these. Despite the large number of therapeutic and hsitopathologic studies in print, there is currently no morphologic or cytologic feature available which consistenly predicts outcome in patients with laryngeal carcinoma. The use of proliferating cell nuclear antigen (PCNA), a newly available marker of a cell’s proliferative activity ( S-phase fraction), was evaluated in 25 cases of squamous cell carcinoma of the larynx. PCNA scores differed, statistically significantly as far as the localization of the lesion, pathological grade, clinical stage, presence of lymph node metastases and prognosis of the patients were concerned. These data suggest that PCNA is an indicator of the malignant potential of the larynx. PCNA can be used in decision making for treatment and assessing prognosis in carcinoma of the larynx.