Caracterización de pacientes con papiloma laríngeo / Characteristics of patients with lagyngeal papillomatosis

La papilomatosis laríngea es la neoplasia laríngea benigna más común y está causada por el virus de papiloma humano. Se considera que la papilomatosis laríngea tiene un papel independiente como factor de riesgo de cáncer; se clasifica dentro de tres grupos de acuerdo con sus características clínicas: juvenil, adulto y recurrente. Su incidencia asociada a neoplasia maligna es del 4%. Objetivos: Determinar si existen factores de riesgo asociados al tipo de papilomatosis laríngea; y si existe relación con el tipo de papilomatosis y neoplasias asociadas. Metodología: Estudio observacional descriptivo de pacientes que acuden al servicio de Otorrinolaringología del Hospital General San juan de Dios y su caracterización. Resultados: De los 33 pacientes evaluados con papilomatosis laríngea, 51 % fueron del género masculino, la edad promedio sin incluir pacientes pediátricos fue de 23 años. La mediana de reintervenciones es de 4 veces, y la mayoría tiene pérdida del seguimiento. La papilomatosis tipo infantil es la más común con pacientes de 7 a 14 años de edad. Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil y recurrente, p=0.01. Los pacientes presentan ronquera, disfonía y dificultad respiratoria. El diagnóstico se realiza por clínica con laringoscopía sin biopsia en la mitad de los pacientes. El 9% de los pacientes estudiados presentaron neoplasia asociada. El número de reintervenciones está asociado a un mayor riesgo de progresión a neoplasia. Conclusión: Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil, y el 9% de los pacientes presentan una neoplasia asociada, más alta de la reportada en la literatura.(AU)

Laryngeal papillomatosis is the most common benign neoplasm and is caused by the human papilloma virus. Laryngeal papillomatosis is considered to have an independent role as risk factor. Laryngeal papillomas are classified into three groups, according to their clinical characteristics: juvenile, adult and recurrent. 4% is associated with neoplasia. Objectives: Determine if there are risk factors associated with the type of laryngeal papillomatosis and if there is a relationship with the type of papillomatosis and associated neoplasms. Methodology: Descriptive observational study of patients attending the Otolaryngology service of the General Hospital San Juan de Dios de Guatemala and their characterization. Results: Of the 33 patients evaluated with laryngeal papillomatosis, 51% were male, with an average age of 23 years. The median number of reoperations is 4, and most do not return to follow-up. Infantile type papillomatosis is the most common, with patients 7 to 14 years of age. Patients with adult papillomatosis had more risk factors than patients with infantile and recurrent papillomatosis, p= 0.01. Patients present hoarseness, dysphonia and respiratory distress upon admission. Diagnosis is made clinically with laryngoscopy without biopsy in half of the patients. 9% of the patients studied had associated neoplasia. The number of reoperations is associated with an increased risk of developing a neoplasm. Conclusion: Patients with adult papillomatosis presented more risk factors than patients with infantile papillomatosis. And 9% of the patients present associated neoplasia, higher than reported in the literature

Lipoma obstructivo de laringe / Obstructive laryngeal lipoma

Los lipomas de laringe son tumores benignos de crecimiento lento, pero pueden producir síntomas graves como disnea inspiratoria, apneas del sueño y disfagia. Se describe el caso clínico de un paciente con un lipoma extenso de laringe e hipofaringe que consultó por disfagia y disnea inspiratoria intermitente, y que fue tratado con éxito mediante un abordaje transoral con microscopio asistido con cauterio y láser de CO2. (AU)

Laryngeal lipomas are benign, slow-growing tumors, but they can produce severe symptoms such as inspiratory dyspnea, sleep apnea, and dysphagia. We describe the clinical case of a patient with an extensive lipoma of the larynx and hypopharynx who consulted for dysphagia and intermittent inspiratory dyspnea, and who was successfully treated by a transoral approach with microscope and assisted with cautery and CO2 laser. (AU)

Sarcoma miofibroblástico posradioterapia / Radiation-induced myofibroblastic sarcoma

Paciente de 51 años, varón, fumador y alcohólico moderado, con síntomas de disfonía intermitente que debuta con una adenopatía cervical metastásica de carcinoma epidermoide, sin hallazgos del tumor primario. Es intervenido quirúrgicamente siéndole realizada una disección cervical unilateral y posteriormente es tratado con quimiorradioterapia concomitante. A los 4 años del final del tratamiento oncológico, sin recidiva local ni aparición del tumor primario, el paciente debuta con disnea de presentación subaguda. Tras la exploración física y pruebas diagnósticas, se constata una nueva tumoración en laringe que resulta ser un "sarcoma miofibroblástico de bajo grado". Según los criterios de Cahan, este tumor, de estirpe histológica poco frecuente en laringe, hace pensar que probablemente podría ser inducido por la radiación. Se discuten los criterios de causalidad entre radiación y oncogenesis y se resumen las características de los tumores radioinducidos.

We report a clinical case about a male patient, smoker and alcoholic, that debuts with a neck metastasis of an epidermoid carcinoma of unknown origin. He was submitted to a cervical dissection and treated with adjuvant combined chemo and radio therapy. Four years after finishing the oncologic treatment without tumor recurrence or appearence of the primary tumor, he begins with sub acute dyspnea. After physical examination and imaging, a new larynx tumor was found, "low grade myofibroblastic sarcoma". Under Cahan criteria, this tumoral kind, rare in larynx, was probably induced by the local radiotherapy. We discuss briefly the causality between radiation and oncogenesis and the characteristics of the radio induced tumors.

Nicotine dependence and smoking habits in patients with head and neck cancer / Dependência nicotínica e perfil tabágico em pacientes com câncer de cabeça e pescoço

Objective: To assess smoking habits and nicotine dependence (ND) in patients with head and neck cancer Methods: This study involved 71 smokers or former smokers with squamous cell carcinoma in the oral cavity, pharynx, or larynx who were treated at a university hospital in the city of São Paulo between January and May of 2010. We used the Fagerström Test for Nicotine Dependence to evaluate smoking habits and ND in the sample. Data regarding cancer treatment were collected from medical records. Depending on the variables studied, we used the chi-square test, Fisher's exact test, Student's t-test, or Spearman's correlation test. Results: Of the 71 patients, 47 (66.2%) presented with high or very high ND, 40 (56.3%) smoked more than 20 cigarettes/day, and 32 (45.1%) smoked their first cigarette within 5 min of awakening. Advanced disease stage correlated significantly with the number of cigarettes smoked per day (p = 0.011) and with smoking history (p = 0.047). We found that ND did not correlate significantly with gender, disease stage, smoking cessation, or number of smoking cessation attempts, nor did the number of cigarettes smoked per day correlate with smoking cessation or gender. Treatment for smoking cessation was not routinely offered. Conclusions: In most of the patients studied, the level of ND was high or very high. The prevalence of heavy smoking for long periods was high in our sample. A diagnosis of cancer is a motivating factor for smoking cessation. However, intensive smoking cessation treatment is not routinely offered to smoking patients diagnosed with cancer. .

Objetivo: Avaliar o perfil tabágico (PT) e a dependência nicotínica (DN) em pacientes com câncer de cabeça e pescoço. Métodos: Estudo realizado com 71 pacientes portadores de carcinoma epidermoide de cavidade oral, faringe e laringe, tabagistas ou ex-tabagistas, atendidos em um hospital universitário da cidade de São Paulo entre janeiro e maio de 2010. Utilizou-se o Teste de Fagerström para Dependência de Nicotina para avaliar PT e DN na amostra. Informações sobre o tratamento oncológico foram coletadas dos prontuários. Foram utilizados os testes do qui-quadrado, exato de Fisher ou t de Student, assim como o teste de correlação de Spearman conforme as variáveis estudadas. Resultados: Dos 71 pacientes, 47 (66,2%) apresentavam DN elevada ou muito elevada, 40 (56,3%) fumavam mais de 20 cigarros/dia, e 32 (45,1%) fumavam seu primeiro cigarro até 5 min após acordar. Houve associações significativas do estádio avançado da doença com a quantidade de cigarros fumados por dia (p = 0,011) e a carga tabágica (p = 0,047). Não houve diferenças significativas da DN em relação a sexo, estádio da doença, cessação tabágica ou tentativas anteriores de cessação, nem como do número de cigarros fumados ao dia em relação a cessação ou sexo. O tratamento do tabagismo não foi rotineiramente oferecido. Conclusões: A DN foi elevada ou muito elevada na maioria dos pacientes estudados. A prevalência de grandes fumantes por longos períodos foi alta em nossa amostra. O diagnóstico de câncer é um fator motivador para a cessação tabágica; entretanto, o tratamento intensivo do tabagismo ainda não é rotineiramente oferecido a fumantes diagnosticados com câncer. .

Carcinome epidermoide du larynx chez la femme

Le cancer du larynx est assez rare chez la femme. Cependant; il risque d'etre en recrudescence a cause de l'augmentation du tabagisme feminin. Peu de travaux se sont consacres a rechercher les specificites du cancer du larynx chez la femme. But: Analyser le profil epidemiologique et clinique des femmes porteuses d'un carcinome epidermoide du larynx et degager les caracteristiques therapeutiques; evolutives et les facteurs pronostiques chez cette population. Methodes: etude retrospective portant sur 50 femmes prises en charge pour un carcinome epidermoide du larynx sur une periode de treize ans (1994-2006). Resultats : L'age moyen de nos patientes etait de 63;5 ans. L'intoxication tabagique etait retrouvee chez 32;6 des patientes. Chez 30 de nos patientes aucun facteur de risque n'a ete retrouve. Les signes cliniques etaient domines par la dysphonie suivie de la dyspnee et la dysphagie. Les tumeurs prenaient naissanceau depend de l'etage glottique dans 55;8 des cas. Nous avons releve que 60;4 des tumeurs etaient vus a un stade evolue T3-T4 et que 95;3des tumeurs etaient initialement classees N0. La chirurgie a ete pratiquee chez 47;5 des patientes tandis que 16;2 ont recu une radio-chimiotherapie. La survie globale cumulee etait de 78;8 a 3 ans et de 73;5 a 5 ans. Conclusion : L'absence des facteurs de risque classiques chez un grand nombre de nos patientes laisse supposer le role d'autres facteurs etiopathogeniques dans la genese du cancer du larynx chez la femme. Toute dysphonie chez la femme doit etre exploree meme en l'absence de facteurs de risque. La prise en charge et le pronostic semblent superposables a celui de l'homme

Papilomatosis laríngea / Laryngeal papillomatosis

La papilomatosis respiratoria recidivante es una enfermedad de la vía aérea que afecta a las personas de todas las edades y que se caracteriza por la aparición de masas epiteliales recidivantes y benignas. Su evolución es multiforme y va desde su desaparición luego de un período de tratamiento relativamente corto y sencillo hasta su progresión por toda la vía aérea, llegando a sitios inaccesibles para el cirujano, obstruyéndola y a veces transformándose en un carcinoma pavimentosos que puede llevar al paciente a la muerte.

Assessment of awareness level on tobacco and smoking habits as risk factors for cancer among lung and laryngeal cancer patients in Kolkata--a case control study.

The burden of tobacco related cancers is increasing alarmingly throughout the world; therefore tobacco control merits the highest priority in the fight against cancer worldwide. The present report concerns a case control study of males with cancers of lung and larynx, to assess tobacco use, level of exposure and the awareness of risk of tobacco as a main cause of cancer. A total of 217 new patients with cancer of lung and larynx registered at Chittaranjan National Cancer Institute were recruited for the study, along with 200 healthy male (age, religion and residential status matched ) visiting controls. Information on socio-demographic parameters, details of the disease, tobacco use, and awareness about effects of tobacco were obtained through a standardized questionnaire. Smokers were at a higher risk of disease than nonsmokers, with a direct correlation between duration and number of smoking, monthly income, family size and education level. Adjusted ORs observed for smokers for duration more than 40 years of smoking and smoking more than 40 beedi/cigarettes per day were 4.3 and 3.9, respectively. Awareness level towards tobacco chewing, active and passive smoking revealed poor response among the subjects. Thus improved health education for antismoking and awareness generation of tobacco hazards should be strongly recommended as a preventive measure.

Rastreamento da neoplasia laríngea na população da vila Ipê 1, da cidade de Porto Alegre / An in-depth study of neoplasia of the larynx in population of Vila Ipê 1 in Porto Alegre city

A proposta do presente estudo foi realizar um rastreamento de neoplasia laríngea, bem como pesquisar a prevalência desta doença e sua relação com fatores de risco (fumo, álcool e chimarrão), dentro de uma comunidade delimitada na cidade de Porto Alegre, Rio Grande do Sul, Brasil. Este estudo teve como objetivo avaliar a relação custo-benefício do rastreamento do câncer da laringe na população de risco para esta doença; verificar a prevalência de neoplasia da laringe na população da vila IPE 1, na cidade de Porto Alegre, possibilitando seu diagnóstico precoce nessa comunidade. Tal investigação foi realizada no período de junho a dezembro de 2001. A coleta dos dados ocorreu no Ambulatório do Departamento de Cirurgia de Cabeça e Pescoço da Universidade Luterana do Brasil ­ ULBRA, da qual participaram 324 indivíduos inseridos em grupo de risco para câncer da laringe. Para a seleção da amostra, foram considerados indivíduos maiores de 30 anos, com hábito de fumar e/ou ingerir bebidas alcoólicas há mais de 10 anos e moradores da vila IPE 1, de Porto Alegre/RS. A coleta de dados foi realizada por meio de entrevista direta, com o preenchimento de um questionário, seguido de um exame otorrinolaringológico e fibrolaringoscópico. Os dados foram tabulados e analisados utilizando o programa EPI-INFO versão 6.01. Foram observadas altera- ções ao exame em 89 pacientes (27,5%), não sendo encontrado casos de câncer laríngeo. Dos indivíduos examinados, a maioria apresentava exame normal (72%). Em contrapartida, foram diagnosticados em 47 pacientes (14,5%) edema de Reinke, em 20 (6,2%) hiperemia das pregas vocais e em 22 indivíduos (6,8%), espessamento da parede posterior da laringe. Em relação ao diagnóstico precoce (rastreamento) do câncer da laringe, não obtivemos a efetividade esperada nesta amostra estudada, provavelmente devido à faixa etária jovem e ao pouco tempo de exposição aos fatores de risco (tabaco e álcool). Isso nos faz pensar que, além desses fatores, existem outros que são de particular importância no desenvolvimento de uma neoplasia maligna laríngea, como a imunodepressão, os fatores hereditários, além de outras doenças associadas, tipo refluxo gastroesofágico. A prevalência do câncer laríngeo, por sua vez, não pôde ser avaliada pela ausência de lesão maligna ou pré-maligna nos indivíduos investigados (AU)

The aim of this present work was to carry out an in-depth study of neoplasia of the larynx, as also to investigate the prevelance of this illness and its relation to risk factors such as smoking, consumption of alcohol and the drinking of "mate" (a herbal tea made with almost boiling water and drunk from gourd via a metal tube). This study was carried out in a delinated community in the city of Porto Alegre, Rio Grande do Sul ­ Brazil. It also red as its objective the evaluation of the relation cost/benefit of an in-depth study of laryngeal cancer in a population at risk of this illness and for this reason a study of the prevalance of laryngeal neoplasia was carried out in the area of IPE 1, in Porto Alegre, to do early diagnosis of the illness. This investigation was carried out during the period of June to December 2001. The material for the study was collected in the Out Patients of Head and Neck Surgery Department of Lutheran University of Brasil (ULBRA). The group consisted of 324 subjects considered at risk of laryngeal cancer and, the people living in IPE 1, in Porto Alegre, over the age of 30 who had been smoking and / or drinking for over 10 year, were selected as samples. The collection of the data was carried out by means of a direct interview, the filling in of a questionaire, followed by an examination of the ear, nose and throat and a fibrolrigalscopic exam. The data was tabulated and analysed, using the 6.01 version of the EPI-INFO. In 89 subjects (27,5%) examined by the above method, some alterations were found but no cases of laryngeal cancer. The majority of the cases studied were normal (72%); in 47 subjects (14,5%) Reinke's edema was found; in 20 subjects (6,2%) hiperema of the vocal chords was found and in 22 subjects (6,8%) thickening of the posterior wall of the larynx was found. With regard to early diagnosis of laryngeal cancer, using in-depth studies we did not obtain the results we expected from the subjects studied. This may have been due to the fact that they were all young people who had not been exposed for too long to the risk factors (tabacco, alcohol and "mate"), which leads us to think that, apart from these factors, others exist which ar important in the development of malignant neoplasia of the larynx, such as auto immune depression, heriditare factors and other associated illnesses, e.g. gastroesophageal reflux disease. Therefore the conclusion reached is that cancer of the larynx cannot be evaluated by the absence of malign or pre-malign lesions in people under investigation (AU)

The epidemiology of laryngeal cancer in Brazil

A cidade de São Paulo apresenta uma das mais altas incidências de câncer de laringe no mundo e o Brasil uma ocorrência expressiva quando comparada com outros países da América Latina. Em torno de 8.000 casos novos e 3.000 mortes pela doença atingem anualmente a população brasileira. Na cidade de São Paulo, as taxas de incidência por câncer de laringe mostram-se decrescentes desde o final da década de 1980, porém, entre as mulheres as taxas revelam-se estáveis. Estas tendências, possivelmente, expressam as mudanças no comportamento de homens e mulheres em relação ao consumo de cigarros. Vários fatores de risco são relacionados ao câncer de laringe. Os mais importantes são tabagismo e consumo bebidas alcoólicas, porém exposições a cancerígenos ocupacionais também são associadas à doença, como o amianto, os ácidos inorgânicos fortes, a poeira de cimento e a sílica cristalina livre. O consumo de carne salgada e gorduras está relacionado com excesso de risco de câncer de laringe. Por outro lado, vários estudos têm confirmado que frutas, vegetais crus e legumes protegem contra este câncer. Há referências da possível associação entre carcinoma espinocelular de laringe e o papiloma vírus humano (HPV), mas este fato não está comprovado. O refluxo gastro-intestinal relaciona-se de forma tênue, porém consistente com o câncer de laringe. Aglomeração de câncer na família, particularmente de tumores de cabeça e pescoço, aumenta o risco de câncer da laringe. Polimorfismos genéticos, especialmente de genes envolvidos na ação de enzimas responsáveis pela metabolização de cancerígenos, apresentam associação com o câncer de laringe de acordo com estudos recentes. Políticas de controle do tabagismo e consumo excessivo de álcool, bem como a vigilância de exposições a cancerígenos ocupacionais, terão benéficas repercussões no câncer de laringe. Não há recomendação para o rastreamento de câncer da laringe, todavia uma vez realizado o diagnóstico o tratamento médico imediato influenciará na sobrevida do paciente.

Carcinoma larynx--topographical distribution.

One hundred and sixty subjects were included in our study, collected from four hospitals in Dhaka City. The mean age (+/- SD) of study subjects were 54.67 +/- 11.27 years. Out of 160 subjects 155 was males and 5 were females, and male to female ratio was 31:1. The highest number of study subjects was related to cultivation (40.62%). The majority of study subjects were from the low socio-economic status (68.72%). Carcinoma larynx is a multifactorial disease. Smoking and chewing habit are the most important factors associated with carcinoma larynx. Most of the male (93.12%) subjects were smoker. One hundred and fifteen (71.87%) subjects were found chewing habit of betel leaves with other ingredients. Hoarseness of voice was the commonest symptom 65.62%. Regional distribution of tumour showed supraglottic carcinoma topping the list (69.38%) followed by glottic carcinoma (30.62%) and there was no subglottic carcinoma. Site involvement in supraglottic carcinoma was found in combined location topping the list (89.20%). In glottic carcinoma majority was found glottic with supraglottic extension (65.31%). In majority cases growth were exophytic 52.50%. Palpable lymph mode was found in 48.75% of cases. All the carcinoma of larynx was found histologically of squamous cell type.

Papilomatose de laringe / Laryngeal papillomatosis

A papilomatose de laringe é a neoplasia benigna que mais frequentemente acomete a laringe, tanto em crianças quanto em adultos, causada pelo papiloma virus humano, em especial pelos tipos 6 e 11. A apresentação clínica é variável e a evolução praticamente imprevisível, devido especialmente ao alto grau de recorrência típico desta entidade...

Laryngeal squamous carcinoma associated with longstanding localised amyloidosis. A case report.

An unusual case of squamous carcinoma arising in the background of longstanding localised tracheolaryngeal amyloidosis is reported and the relevant literature is briefly reviewed.

Laryngeal pathology

This study was conducted to assess the incidence and clinical presentation in patients with laryngeal symptoms of more than six weeks duration. It includes 81 patients. Every patient was admitted and had direct laryngoscopy and biopsy under G.A. Out of 81 patients, 16% had inflammatory lesions, 9% had pseudotumours, 15% had benign tumours and 60% had malignant tumours. Smoking, Pan and Alcohol were found to be main etiological factors for malignant disease and male to female ratio was higher for males in malignant tumour. Patients who had surgery, showed better long term survival. Early presentation to the surgeon is of paramount importance in long term survival of patients

Recent concepts in human papillomavirus

The human papillomavirus (HPV) belongs to a small group of viruses which are known to cause tumors in humans. not only do they cause benign papillomas, but they are also implicated in the pathogenesis of some malignancies. For this reason, it is important for both the practicing physicians and students to know about recent advances in the study of these viruses. The following is a review of the etiologic role HPV in non-genital and genital warts, laryngeal papillomas, and their possible roles in several malignancies