Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings / Carcinoma de células não escamosas da laringe: achados clínicos e de imagem

Abstract Introduction Squamous 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. Objective The purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx. Methods This 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. Results There 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. Conclusion Imaging 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.

Resumo Introdução O carcinoma de células escamosas é a neoplasia laríngea mais comum, representa aproximadamente 95% de todas as neoplasias malignas da laringe. No entanto, vários outros tumores benignos e malignos, e doenças inflamatórias, podem afetar a laringe. Objetivo O objetivo deste estudo é analisar os achados clínicos e de imagem de neoplasias de células não-escamosas e de doenças inflamatórias da laringe. Método Este estudo retrospectivo foi feito com 18 pacientes diagnosticados com lesões de carcinoma de células não escamosas da laringe em nossa instituição, entre 2007-2017. Foram analisados os sintomas clínicos, achados dos exames, características de imagens, diagnóstico histopatológico e modalidades de tratamento. Resultados Foram identificados 9 casos com lesão maligna (2 condrossarcomas, 1 tumor carcinoide neuroendócrino atípico, 1 linfoma de células T/NK, 1 linfoma difuso de grandes células B, 3 plasmocitomas com envolvimento de mieloma múltiplo, 1 metástase de adenocarcinoma, 3 neoplasias benignas (condroma, paraganglioma, lipoma), 2 lesões tumor like (tumor de Brown e tumor miofibroblástico inflamatório), 3 lesões inflamatórias (granulomatose de Wegener, doença de Behçet e tuberculose) e 1 malformação vascular. O sintoma mais comum foi a rouquidão (66,6%). O paraganglioma foi visto como lesão hipervascular na tomografia computadorizada e na ressonância magnética e mostrou intensa captação do traçador na PET/TC com 68Gálio-DOTA. Calcificações de matriz condroide foram detectadas no condroma e condrossarcoma grau 1. Em pacientes com malformação vascular e lipoma, os achados típicos de imagem tornaram possível o diagnóstico. Conclusão Estudos de imagem podem fornecer pistas para o diagnóstico de lesões laríngeas de células não escamosas. Achados clínicos e de imagem e histórico clínico prévio devem ser avaliados em conjunto no manejo clínico das lesões laríngeas.

The evaluation of pretreatment neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms / Avaliação da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivadano pré-tratamento em pacientes com neoplasias laríngeas

Abstract Introduction: Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. Objective: The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. Methods: A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis. Results: The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p < 0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p ˂ 0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p < 0.001). Furthermore, neutrophil-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR = 2.396; 95% CI 1.408-4.077; p = 0.001), Disease free survival (HR = 2.246; 95% CI 1.322-3.816; p = 0.006) and locoregional recurrence free survival (HR = 2.210; 95% CI 1.301-3.753; p = 0.003). Conclusion: Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.

Resumo Introdução: Biomarcadores inflamatórios sistêmicos são fatores preditivos e prognósticos promissores para cânceres sólidos. A relação neutrófilo-linfócito e a relação neutrófilo-linfócito derivada são utilizadas para predizer a inflamação e como biomarcadores em várias malignidades. Objetivo: O objetivo deste estudo foi demonstrar o papel diagnóstico, preditivo e prognóstico da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada em pacientes com neoplasias laríngeas. Método: Foi realizado um estudo retrospectivo em prontuários médicos de 229 pacientes com neoplasias laríngeas benignas, pré-malignas e malignas entre 2002 e 2015. O papel diagnóstico, preditivo e prognóstico da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada foi avaliado por meio de análise uni- e multivariada. Resultados: A relação neutrófilo-linfócito e a relação neutrófilo-linfócito derivada não foram estatisticamente diferentes entre pacientes com neoplasias laríngeas benignas, pré-malignas e malignas. Ambas as relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada foram fatores preditivos para o estágio, metástase linfonodal e metástase a distância. Pacientes com valor alto da relação neutrófilo-linfócito (≥ 4) apresentaram pior prognóstico quando comparados com pacientes com valor mais baixo da relação neutrófilo-linfócito (5 anos, Sobrevida Global: 69,0% vs. 31,1%, p < 0,001; 5 anos, sobrevida livre de doença: 70,0% vs. 32,7%, p < 0,001; 5 anos, sobrevida livre de recorrência loco-regional: 69,7% vs. 32,0%, p < 0,001). Além disso, a relação neutrófilo-linfócito foi um fator prognóstico independente para 5 anos: Sobrevida global (HR = 2,396; IC95% 1,408-4,077; p = 0,001), sobrevida livre de doença (HR = 2,246; IC95%: 1,322-3,816; p = 0,006) e sobrevida livre de recorrência loco-regional (HR = 2,210; IC95%: 1,301-3,753; p = 0,003). Conclusão: A relação neutrófilo-linfócito no pré-tratamento é um biomarcador preditivo e de prognóstico útil e confiável para pacientes com carcinoma de laringe.

Effect of nutrition intake method with adaptive viscosity on nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy / 中华临床营养杂志

Objective To investigate the effect of nutrition intake method with adaptive viscosity on nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy (RT).Methods 77 laryngeal carcinoma patients with dysphagia after surgery and radiotherapy were divided randomly into two groups by a random number table as study group (SG,n=39) and control group (CG,n=38).The CG received routine diet instruction and swallowing training,while the SG received oral nutritional supplementation with adaptive viscosity in additon.The body weight,body mass index (BMI),hemoglobin,albumin,prealbumin and scores of nutritional status at the end and 3 months after RT were compared between the two groups.Results There were 34 patients (87.2％) and 32 patients (84.2％) with nutritional status scores more than or equal to 2 at the end of RT in the two groups.At 3 months after RT,the body weight,BMI,hemoglobin,albumin,prealbumin,daily intake and nutritional status scores in the study group were significantly higher than those at the end of RT and those in the control group [(61.28±11.16) vs.(51.82±7.36),(56.44±10.69) kg;(20.57±6.13)vs.(18.81±4.43),(19.47±5.36) kg/m2;(134.87±17.86)vs.(114.68±15.25),(123.58±19.34) g/L;(40.74±7.54) vs.(36.77±5.27),(37.94±8.47) g/L;(312.83±35.83) vs.(271.56±32.82),(290.73±41.38) g/L;(2 047±126) vs.(1 512±143),(1 589±138) kcal;(2.36±0.93) vs.(3.70±1.80),(3.14±1.26);P all＜0.05].The level of the body weight and hemoglobin in the control group at 3 months after RT were significantly higher than those at end of RT [(56.44±10.69) vs.(51.56±8.34) kg,P=0.025;(123.58±19.34) vs.(113.36±16.56) g/L,P=0.023].During 3 months,the rate of pulmonary infection was 1 (2.5％) in the study group and 6 (15.8％) in the control group and the difference was statistically significant (x2 =4.073,P =0.044).Conclusion Nutrition intake method with adaptive viscosity can effectively improve the nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy and reduce the infection rate of lung.

Incidence and mortality of laryngeal cancer in China, 2014 / 中华肿瘤杂志

Objective@#To estimate the incidence and mortality of laryngeal cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry (NCCR), and to provide support data for the control and prevention of laryngeal cancer.@*Methods@#The incident and death data of laryngeal cancer in 2014 from 339 cancer registries met the quality criteria of NCCR, and then adopted for analysis. The incident and death number, crude rate, age standardized rate, truncated rate and proportion which stratified by areas (urban/rural) and age were calculated. The nationwide incidence and mortality of laryngeal cancer in 2014 were estimated by combining with those data on national population in 2014. Chinese population census in 2000 and Segi′s population were used for age-standardized incidence/mortality rates.@*Results@#It was estimates that 23.4 thousand new cases of laryngeal cancer occurred in China in 2014. There were 20.8 thousand males and 2.6 thousand females. And 14.5 thousand occurred in urban areas, while 8.9 thousand in rural areas. The age standardized rates of incidence by world standard population (ASRs world) in male, female and both genders were 2.05/100, 000, 0.24/100, 000 and 1.14/100, 000, respectively, whereas those were 1.22/100, 000 and 1.03/100, 000 for urban and rural areas. The incidence was much higher in males than females, and slightly higher in urban areas than those in rural areas. Moreover, it was estimates that 13.2 thousand death cases of laryngeal cancer occurred in China in 2014. There were 11.5 thousand males and 1.7 thousand females. And 7.8 thousand occurred in urban areas, while 5.4 thousand in rural areas. The age standardized rates of mortality by ASRs world in male, female and both genders were 1.08/100, 000, 0.14/100, 000 and 0.60/100, 000, respectively, whereas those were 0.60/100, 000 and 0.59/100, 000 for urban and rural areas. The mortality was much higher in males than females, and slightly higher in urban areas than those in rural areas. In males, the age specific incidence and mortality of laryngeal cancer increased greatly from 40-44 and 45-44 years old, respectively, and peaked at age group of 75-79 and >85 years old. In females, the age specific incidence and mortality increased slowly from 50-54 and 60-64 years old, respectively, and peaked at age group of 80-84 and >85 years old. The trends remained similar in urban and rural areas, except for the different peak ages.@*Conclusions@#The incidence and mortality of laryngeal cancer in China are at middle-low levels worldwide, and there are obvious differences between urban and rural areas with distinct gender disparity. Comprehensive prevention and control strategies should be carried out according to local status and age groups.

Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer.@*Methods@#One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software.@*Results@#Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ2=6.78, P<0.05).@*Conclusion@#MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.

A Case of Neurilemmoma of the Larynx Excised via Trans-Cricothyroid Membrane Approach without Tracheostomy / 대한이비인후과학회지

Neurilemmoma of the head and neck is not rare in parapharynx, but rare in the larynx. The treatment of choice in neurilemmoma of the larynx is a complete surgical resection. A small size lesion can be removed via an endoscopic approach. For a large size lesion, an external approach, such as the median or lateral thyrotomy, or pharyngotomy, can be more useful. These surgical methods often require preliminary tracheostomy to secure the airway. Through a case of neurilemmoma of the larynx, we present this disease and the treatment course of a patient, who has been successfully treated by surgical excision via trans-cricothyroid membrane approach without tracheostomy. Furthermore, we discuss its symptoms, physical examinations, microscopic features and other options of treatment for laryngeal schwannoma through literature reviews.

Analysis of surgical methods and clinical analysis of its long-term effect of laryngeal carcinoma / 中国癌症杂志

Background and purpose:Surgical operation is the main method in the treatment of laryngeal carcinoma, but different patients have different impacts on the survival time and the quality of life with different type of operation. This study was to analyze the methods of surgical treatment and its long-term effect of laryngeal carcinoma, to increase survival rates, laryngeal function reservation and reconstruction and improve life quality.Methods:A total mumber of 424 patients of laryngeal carcinoma treated with surgical treatment during between Jan. 2002 and Dec. 2012 were researched by clinical follow-up and data analysis. Surgical method: CO2 laser-assisted laryngeal microsurgery for laryngeal tumors for 50 cases, frontal partial laryngectomy or modiifed thyroid cartilage window partial laryngectomy without tracheostomy for 42 cases, vertical frontolateral partial laryngectomy for 119 cases, horizontal partial laryngectomy and extended subtotal laryngectomy for 22cases, anastomosis of pharynx and trachea for 4 cases, supra cricoid partial laryngectomy for 129 cases (CHEP of them for 103 cases, CHP for 26 cases), total laryngectomy for 58 cases, cervical lymph node dissection at the same term for 121 cases.Results:Partial laryngectomy without tracheostomy for 92 cases (21.7%), total laryngectomy for 58 cases (13.7%); decannulation rate was 86.5%, vertical frontolateral partial laryngectomy of them for 93.2%, horizontal partial laryngectomy of them for 90.9%,supra cricoid partial laryngeal of them for 82.2%; laryngeal function reservation rate for 86.3%; all patients did outpatient review and telephone follow-up, 9 cases loss to follow-up, a total of tumor recurrence, cervical lymph node metastasis and distant metastasis were 41 cases, mostly occurred in 1 year after surgery; death for 57 cases, relapse of them for 8 cases, cervical metastasis for 13 cases, pulmonary metastasis for 5 cases, hepatic metastases for 2 cases, brain metastases for 1 case, esophagus metastases for 1 case, pulmonary infection for 6 cases, acute renal failure for 2 cases, unknown reason for 19 cases, according to Kaplan-Meier to count survival rate, 3-year and 5-year survival rate were 90.7% and 84.1%, relapse and metastasis were the main causes of death.Conclusion:Surgical treatment is the main therapy mode of laryngeal carcinoma. We choose individualized surgical methods for patients according to tumor staging, invasion site, age, occupation and education background of patient, health condition and so on. On the premise that tumor is completely cut off, we always advocate function surgery and minimally invasive surgery, and adopt comprehensive treatment at the same time, in order to increase survival rates, lesson suffering and improve life quality as far as possible.

Predicted value of cell Cycle-dependent protein kinase 1 (Cdk1/p34 cdc2) for local recur-rence of laryngeal cancer / 临床与实验病理学杂志

Purpose To study the expression of p53, p21 and Cdk1/p34cdc2 in the laryngeal cancer and its margin tissues and to ex-plore their relationship with local recurrence of laryngeal cancer. Methods A total of 85 patients with early laryngeal cancer were se-lected randomly during 2004 to 2010 in Tangshan Union Hospital, Hebei, China. SP immunohistochemical method was used to detect the expression of p53, p21 and Cdk1/p34cdc2 in the tumor and margin tissues. Pathological data were collected for follow-up. Results In more than 2 years of follow-up study, 14 of 85 patients with laryngeal cancer presented with recurrence (recurrent group), while 71 patients without recurrence (none recurrent group). The positive rate of p53 protein in laryngeal cancer and its margin tissues was 60. 0% and 36. 5%, respectively, the positive rate of p21 protein in laryngeal cancer and its margin tissues was 38. 8% and 21. 2%, respectively. The positive rate of Cdk1/ p34cdc2 in laryngeal cancer and its margin tissues was 70. 6% and 29. 4%, respectively. p53 protein in the surgical margin of the recurrent group and non recurrent group was 71. 4% and 29. 6% (P = 0. 003), that of p21 was 50. 0% and 15. 5%, (P =0. 004) and Cdk1/ p34cdc2 was 57. 1% and 23. 9% (P =0. 013), respectively. There was no correlation between expression of p53 with p21 protein and Cdk1/ p34cdc2 protein(P > 0. 05). Conclusion p53, p21 and Cdk1/ p34cdc2 may be involved in the occurrence, development and recurrence of laryngeal squamous cell carcinoma. Overexpression of p53, p21 and Cdk1/ p34Cdc2 in the surgical margin is closely related to local recurrence of laryngeal cancer.

Expressions of CD147 and MMP-9 in laryngeal squamous cell carcinoma and their significance / 西安交通大学学报(医学版)

Objective To investigate the expressions of CD147 and matrix metalloproteinases-9 (MMP-9)in laryngeal squamous cell carcinoma (LSCC)tissue and their clinical significance.Methods The expressions of CD147 and MMP-9 were analyzed semi-quantitatively by immunohistochemical staining in LSCC and control group tissues.Results ① The positive rate of CD147 was 83.3% (30/36)in LSCC,which was higher than that in laryngeal polyp (33.3%,5/15)and in adjacent normal tissue (16.7%,6/36);it was related to histological grade, clinical stage and lymph node metastasis status (P<0 .0 5 ).② The positive rate of MMP-9 was 7 2 .2% (2 6/3 6 )in LSCC,which was higher than that in laryngeal polyp (13.3%,2/15)and in adjacent normal tissue (5.6%,2/36);it was related to histological grade,T stage,clinical stage and lymph node metastasis status (P<0.05).③ There was a positive correlation between the expressions of CD147 and MMP-9 in LSCC tissue (r=0.721,P=0.000). Conclusion The over-expressions of CD147 and MMP-9 in LSCC may contribute to the development and metastasis of LSCC.

The expression of PTTG,VEGF-C and LMVD in laryngeal carcinoma and the relationship among them / 重庆医学

Objective To investigate the expression of PTTG and VEGF-C in laryngeal carcinoma and the effect of angiogene-sis .Methods Immunohistochemistry was used to detect the expression of PTTG 、VEGF-C and LMVD in 60 cases of laryngeal car-cinoma and 32 cases of para-carcinoma tissue .D2 40 positive products was used to locate lymphatic endothelial cell cytoplasm and cell membrane ,and count lymphatic microvessel density (LMVD) .Results The expression of PTTG and VEGF-C in laryngeal car-cinoma was significantly higher than that in para-carcinoma tissue(P0 .05) .The expression of LMVD in laryngeal carcinoma was significantly higher than that in para-carcinoma tissue(P0 .05) .A significantly positive relation was found between PTTG and VEGF-C(P<0 .05) .And there were positive relation between PTTG and LMVD、VEGF-C and LMVD(P<0 .05) .Conclusion PTTG and VEGF-C might play an important role in the carcino-genesis and development of laryngeal carcinoma .PTTG and VEGF-C could be a prognostic factor of colorectal cancer and a new tar-get of gene therapy .

The Treatment Outcomes of Primary Subglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Primary subglottic cancer is uncommon, so our understanding of primary subglottic cancer is limited. The purpose of this study is to review the clinical characteristics and treatment result of primary subglottic cancer from our experience. SUBJECTS AND METHOD: During the period from Nov. 1996 to Nov. 2010, patients with primary subglottic cancer were reviewed retrospectively. The mean follow up period was 46.1+/-40.9 months. We analyzed its clinical characteristics, stage, treatment results and survival rate. RESULTS: Of 824 patients with diagnosed laryngeal cancer, 8 (0.97%) had primary subglottic cancer and hoarseness (50.0%) is the most common initial presenting symptom. The symptom of dyspnea was found in 25.0% (2/8) of the patients and squamous cell carcinoma in 75% (6/8). At the time of diagnosis, the four clinical stages of TNM, T1, T2, T3 and T4, had 1 (12.5%), 2 (25.0%), 1 (12.5%) and 4 (50.0%) patients, respectively. There were two cases of cervical lymph node metastases, N1 and N2c. No distant metastasis was found. Two groups of patients comprising of two patients each received surgery alone or radiation alone as an initial treatment; another two groups of patients comprising of two patients each received concurrent chemoradiation or surgery plus radiation therapy alone. The overall 2-year survival rate was 80.0% and 2-year disease free survival rate was 51.7% in patients with squamous cell carcinoma. CONCLUSION: Despite the infrequency of primary subglottic cancer, it is important to understand its clinical characteristics and treatment results during the early diagnosis to make the prognosis better.

Can the lymph node reactivity pattern in the pN0 neck analysis provide any additional prognostic information in patients with laryngeal squamous cell carcinoma? / A análise do padrão de reatividade linfonodal no pescoço pN0 pode fornecer alguma informação prognóstica adicional em pacientes com carcinoma epidermoide de laringe?

Objective: To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma. Methods: Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival. Results: The total number of lymph nodes studied was 3,648, with an average of 34.7 lymph nodes/neck specimens. The most frequent lymph node reactivity patterns were sinusal histiocytosis (50 cases), paracortical hyperplasia (35 cases), and follicular hyperplasia (20 cases). There was no statistical association of these individual patterns with recurrence rate (p = 0.98) or mortality (p = 0.49). However, there was a statistically significant association between paracortical hyperplasia pattern (related to cellular lymph node immunity) and improved five-year survival (76 versus 60%; log-rank = 0.05). Conclusions: There was a positive correlation between stimulated cellular lymph node pattern and improved 5-year survival rate in patients with pN0 laryngeal squamous cell carcinoma, suggesting the indication of adjuvant treatment for those individuals with decreased immune response, even in the absence of pathologic metastases detected by the usual methods.

Objetivo: Avaliar a importância da reatividade linfonodal na recidiva e mortalidade em pacientes com carcinoma epidermoide de laringe estagiados como pT3 ou pT4 pN0 M0. Métodos: Entre 2002 e 2005, foram selecionados 105 pacientes matriculados na Seção de Cirurgia de Cabeça e Pescoço do Instituto Nacional de Câncer (INCA) com o diagnóstico de carcinoma epidermoide de laringe, com estágio III ou IV. A radioterapia foi indicada em 69 casos. Todos os pacientes foram estagiados como pT3 ou pT4 e pN0. Todos os linfonodos ressecados foram analisados e classificados conforme os quatro padrões de reatividade linfonodal: hiperplasia folicular associada à resposta imune humoral, hiperplasia paracortical associada à resposta imune celular, histiocitose sinusal sem relação com resposta imune específica, e linfonodo normal. Os dois primeiros padrões são definidos como linfonodos estimulados e os dois últimos como linfonodos não-estimulados. O padrão linfonodal mais frequente em cada paciente foi considerado para a análise da relação com a recidiva e mortalidade. Resultados: Foi analisado um total de 3.648 linfonodos, com média de 34,7 linfonodos por paciente. O padrão de reatividade mais frequente foi a histiocitose sinusal (50 casos), seguido da hiperplasia paracortical (35 casos) e da hiperplasia folicular (20 casos), sendo esses padrões sem relação com a recidiva (p = 0,98) ou mortalidade (p = 0,49). No entanto, o estímulo da imunidade celular relacionada à hiperplasia paracervical apresentou relação com significância estatística com melhor sobrevida global em cinco anos (76 versus 60%; log-rank = 0,05). Conclusões: houve correlação positiva entre o padrão de estímulo da imunidade celular e o aumento da sobrevida em cinco anos em paciente pN0 com carcinoma epidermoide de laringe sugerindo a indicação de tratamento adjuvante em casos que apresentarem diminuição da imunidade celular mesmo na ausência de metástases patológicas detectadas pelos métodos habituais.

Expression and clinical significance of NY-ESO-1 protein in human laryngeal squamous carcinoma / 肿瘤研究与临床

Objective To detect the expression of Cancer-Testis antigen NY-ESO-1 in human laryngeal squamous carcinoma (LSC) and to explore its significance in immunotherapeutic application. Methods The expressions of NY-ESO-1 protein in the LSC and in the pathologically positive lymph nodes were detected by PV-9000 Immunohistochemistry. Western blotting was also employed to measure the expressions of NY-ESO-1 in the tumor core region(TC), the tissues at the sites of 0.5cm, 1.0cm away from LSC periphery and the distant normal larynx tissues. Results NY-ESO-1 protein expression was positive in 30 out of 69 (43.48 %) cases of LSC. The expression level of NY-ESO-1 protein were found to significantly decrease by tums in TC and corresponding adjacent tissues (P ＜0.01). None of the nine normal larynx tissues expressed NY-ESO-1 protein.It did not display an obvious correlation between the expression of NY-ESO-1 with T staging, pathological grading and lymph node metastasis (P ＞0.05). Its positive expression was found in pathologically positive cervical lymph nodes, which were significantly lower than that in the primary site (P ＜0.05). Conclusion NY-ESO-1 protein express at high level in human laryngeal squamous carcinoma, and they may play a role in genesis and development of tumors, which suggests that NY-ESO-1 gene might be used as target antigens for immunotherapy of LSC and the further research is necessary.

The effect of the proteasome inhibitor combined with pshSTAT3 on proliferation and apoptosis in human laryngeal squamous cell carcinoma Hep-2 cell line / 中国癌症杂志

Background and purpose:Proteasome inhibitors constitute a novel class of antitumor agents that has a complex mechanism of action.Previous studies have confirmed that proteasome inhibitor MG-132 can significantly inhibit Hep-2 cell growth and induce cell apoptosis in a manner that is dependent on dosage and time.But it also induced p-STAT3 protein expression.The aim of this study was to explore whether the STAT3 gene can,by transfecting short hair pin RNA(shRNA),enhance the anti-tumor effect of MG-132 on human laryngeal carcinoma cells.Methods:Hep-2 cells were plated into 96-well and 6-well plates and incubated overnight.Then,they were treated with MG-132 alone and combined with pshSTAT3.Their cell growth was detected by MTT assay,and apoptosis was examined with flow cytometry.The protein expression of p-STAT3 was detected by Western blotting.Results:MTT assay showed that a combined group inhibited the proliferation of Hep-2 cells compared to the MG-132 group and pshSTAT3 group(P＜0.01).Flow cytometry showed that apoptosis of the combined group was significantly higher than the MG-132 group and pshSTAT3 group (P＜0.01).Western blotting showed that the p-STAT3 protein expression up-regulation was observed in the MG-132 group,whereas down-regulation was expressed in the combined group and pshSTAT3 group.Conclusion:The shRNA targeting STAT3 gene can prevent the up-regulation of p-STAT3 protein following a MG-132 treatment thereby significantly enhancing the anti-tunlor effect of the protease inhibitor,MG-132,on human laryngeal carcinoma cells.

Correlation of body and mind symptoms with social support and coping style in patients with laryngeal carcinoma / 中国实用护理杂志

Objective To explore the influence of social support and coping style on body and mind symptoms of patients with laryngeal carcinoma. Methods SCL-90, SSRS and MCMQ were used for the questionnaire survey of 168 patients with laryngeal carcinoma. Results The result of SCL-90 showed that all items were higher than those of norm in China, except the interpersonal relationship sensitivity and psychotic symptoms. The result of SSRS showed that the total score of social support was higher than that of norm, while the availability of support was obviously lower than that of norm. The result of MCMQ showed that avoidance and submissiveness were used frequently in patients, and avoidance was negatively correlat-ed with the factors of psychology. Conclusions Before the nursing plan and health consultation are set for patients with laryngeal carcinoma, the patients' social support should be used sufficiently, and the effect of coping style on patients' mental health should be evaluated.

To investigate the overexpression of Stat3 and Cyclin D1 in laryngeal neoplasm by immunohistochemistry / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the overexpression of Stat3 and Cyclin D1 in laryngeal neoplasm with immunohistochemistry method.Method:With immunohistochemistry method, we investigated the expression of Stat3 and Cyclin D1 in laryngeal neoplasm and analysis the relationship between Stat3 and clinical pathological factor.Result:Stat3 and Cyclin D1 overexpressed in laryngeal neoplasm tissue and they have positive relationship.Conclusion:Active Stat3 may promote the transcription of target gene Cyclin D1,which could accelerate carcinomatous change.

Laser Salvage Surgery for Recurrent Glottic Cancer after Radiotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salvage surgery for recurrent glottic cancer after radiation failure has been reported in the literature as a treatment for total laryngectomy and partial laryngectomy (vertical partial laryngectomy, supracriocoid partial laryngectomy) in selected cases. Also, CO2 laser cordectomy has also been reported as a successful primary treatment for early glottic cancer. However, salvage laser surgery for recurrent glottic cancer has been rarely reported. Our experience of transoral laser cordectomy on recurrent glottic cancer after radiotherapy is reported. SUBJECTS AND METHOD: Twelve patients with early recurrent glottic cancer after full-course radiotherapy (rT1a, n=4 ; rT1b, n=1 ; rT2, n=7) underwent laser cordectomy between October, 2002 and January, 2005. According to the European Laryngological Society Classification, they were found to have two type III, one type IV, and eight type V performed. One patient underwent type II at one side and type III at the other. Surgery in all the cases were performed at one stage with curative intent. RESULTS: The mean follow-up interval was 30 months (range 17-44 months) with five out of 12 cases (42%) having local recurrence. Four of the five cases with local recurrence underwent total laryngectomy. Three cases were salvaged while one had additional recurrence. The other one was under palliative treatment. The local control rate was 58%, overall survival and disease specific survival rate was 100%. The mean hospitalized period was 6.4 days (range 2-26 days) after surgery, and tracheotomy was performed in four cases (duration : 3-20 days). There was no postoperative aspiration pneumonia and nasogastric tube was not performed in any of the cases. CONCLUSION: Transoral laser microsurgery may be a feasible salvage method for recurrent glottic cancer to gain oncologic and functional results, and could be used as an organpreserving procedure with curative intent in selected cases.

Granular Cell Tumors of the Larynx: Report of Three Cases

Granular cell tumors are rare and usually benign neoplasms that can occur in various parts of the body. We recently encountered three cases of granular cell tumor of the larynx; here, we present their clinicopathologic features, along with a review of reported Korean cases.

Expression of E-cadherin and ?-catenin proteins and their significance in laryngeal squamous cell carcinoma / 中国耳鼻咽喉头颈外科

OBJECTIVE The purpose of this studywas to investigate the correlation of E-cadherin(E-cad) and ?-catenin(?-cat) expression with clinical factors and prognosis in laryngeal squamous cell carcinoma (LSCC) patients. METHODS The expression of E-cad and ?-cat in 79 cases of LSCC and 10 cases of adjacent normal laryngeal mucosal tissues were evaluated by SP immunohistochemical methods. RESULTS All 10 normal samples were positive for expression of E-cad and ?-cat , The positive expression of E-cad and ?-cat in LSCC were 34.18 % and 40.51 % respectively. There was a statistically significant difference in the positive expression of E-cad and ?-cat between normal samples and LSCC (P

Photodynamic Therapy(PDT) for Early Glottic Cancer which was Recurred after Initial Treatment Modality / 대한이비인후과학회지

Photodynamic therapy (PDT) is a method used to treat cancer early by irradiating laser with suitable wavelength after injection of a photosensitizer. We introduce the result of PDT for treating an early glottic cancer where initial treatment modality had failed. We tried PDT for 2 patients: one had recurrence after laser cordectomy (T1b) and the other after radiation therapy (T2). Photogem 2 mg/kg was injected intravenously and laser irradiation was performed after 48 hours. We irradiated the lesion site using diode laser (630 nm) delivered through 5 mm cylindrical fiber tip. The energy density, as determined by the depth and site of the lesion, were 138 J/cm and 204 J/cm, respectively. Patient with T1b is alive with no evidence of disease for 46 months post-PDT follow up. Patient with T2 developed chondritis at the subglottis but improved after hyperbaric oxygen therapy and several surgical debridement. After 4 months, tumor recurred at both vocal folds and was managed with total laryngectomy. PDT is a new treatment modality with advantages of good voice quality, short period of admission, and less rate of morbidity and may be another useful salvage option.