Long-term disease-free survival in patient with laryngeal small cell neuroendocrine carcinoma: A case report and literature review / 吉林大学学报(医学版)

Objective: To analyze the clinical characteristics of patient with laryngeal small cell neuroendocrine carcinoma (LSCNC) with long-term disease-free survival, and to provide the basis for the diagnosis and treatment of LSCNC. Methods: The clinical materials of a patient with primary LSCNC were collected, and the clinical features, diagnosis and treatment of LSCNC and extrapulmonary small cell cancer (EPSCC) combined with the relative literatures were analyzed. Results: The patient was a 55-year-old man who had a long history of heavy smoking and drinking, and presented with neck mass. The laryngoscope revealed the uneven mass on the left side of epiglottic laryngeal surface. The subsequent biopsy of the neck mass indicated lymph node metastasis. The patient underwent laryngectomy and bilateral cervical lymph node dissection. The postoperative pathology indicated LSCNC; the immunohistochemistry results showed CD56 (NK-1) (+), CK-pan (+), CgA (-), Syn (-) and Ki-67 (+ 90%). The patient underwent radiotherapy to the tumor bed and lymph node drainage area and 6 courses of chemotherapy with EP regimen. No prophylactic cranial irradiation (PCI) was conducted. Regular follow-up with laryngoscope, crainial MRI and other examinations showed no recurrence and metastasis. The patient still alive with disease-free survival of 38 months now. Conclusion: LSCNC is highly malignant. The diagnosis mainly depends on the pathohistomorphology and immunohistochemistry examination. The combination of surgery, chemotherapy and radiotherapy is commonly used for LSCNC at present. PCI is not recommended routinely. Multimodality treatment can improve the prognosis.

Outcome analysis of 71 patients with laryngeal squamous cell carcinoma / 中国基层医药

Objective To investigate the prognosis relevant factors of laryngeal squamous cell carcinoma (LSCC).Methods From January 2013 to December 2013,the clinical data of 71 patients with LSCC who were initially treated in Zhejiang Cancer Hospital were retrospectively analyzed.Results Univariate analysis showed that there were statistically significant differences in survival rate between the group of supraglottic type and glottic type (60.0% vs.86.3% ,χ2 =6.284,P<0.05),the group of N0 and N+(41.7% vs.86.4% ,χ2 =16.803,P<0.01), the group of early and late stage(93.6% vs.50.0% ,χ2 =19.854,P<0.01).There were no statistically significant differences in survival rate between the group of age ≤50,>50-60,>60-70 and >70(88.9% vs.88.2% vs. 79.3% vs.62.5% ,χ2 =3.909,P>0.05),the group of T1+T2 and T3+T4(83.6% vs.62.5% ,χ2 =3.623,P>0.05),the group of high,medium,low differentiated and unsigned(75.0% vs.69.7% vs.83.3% vs.91.7% ,χ2 =3.780,P>0.05),the group of surgery,radiotherapy and surgery+radiotherapy (74.3% vs.90.9% vs.71.4% , χ2 =2.437,P>0.05).Multivariate analysis showed that age( P =0.003),treatment( P =0.048) had significant effect on the prognosis of patients,but tumor location(P=0.766),T stage(P=0.677),N stage(P=0.482),clinical stage(P=0.825),the degree of pathological differentiation(P=0.206) had no significant effect on the prognosis of patients.Conclusion More aggressive treatment should be supplied for patients with N+,advanced clinical stage and age whom the prognosis are usually poor. In addition, the proportion of tracheal tube extraction should be appreciated.

Amiloidosis laríngea: a propósito de un caso / Laryngeal amyloidosis: a case report

RESUMEN La amiloidosis es una enfermedad poco frecuente, de etiología desconocida, caracterizada por la presencia de depósitos extracelulares de proteínas fibrilares en diversos órganos y tejidos, teniendo una amplia gama de manifestaciones clínicas según localización y tamaño de los depósitos. En cabeza y cuello, el sitio de presentación más frecuente es la laringe. Suele presentarse con disfonía y/o disnea progresiva, cuyo tratamiento definitivo, sin estar estandarizado, suele ser la resección quirúrgica. Se presenta a continuación el caso de un paciente de 78 años, con historia de disnea en reposo y estridor laríngeo leve de 6 meses de evolución, cuya nasofibroscopía evidenció una masa subglótica, determinando lumen crítico de vía aérea superior. Biopsia reveló amiloidosis, siendo tratado de manera exitosa con exéresis tumoral vía laringoscopía directa.

ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.

A Case of Successful Use of C-MAC® Video Laryngoscope in ‘Cannot Ventilate’ Situation Due to Unexpected Severe Narrowing of Laryngeal Inlet

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using C-MAC® video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.

Analysis of 63 patients with laryngeal carcinoma / 实用医学杂志

Objective To investigate the survival rate and its prognostic factors of laryngeal carcinoma. Methods We retrospectively analyzed 63 cases of laryngeal carcinoma. A total of 7 clinicopathologic factors were studied by univariate analysis and Cox multivariate model. Results The overall cumulative survival rate was 69.8% at 3 years,54.0%at 5 years.In univariate analysis, the survival was related to location of the tumor(P 0.05). In Cox multivariate model, T status (P < 0.01) and N status (P < 0.01) were independent prognostic factors. Conclusions T and N status were independent prognostic factors for patients with laryngeal carcinoma. Early detection and treatment should be given to improve the survival of patients.

An abrupt supraglottic obstruction during the induction of general anesthesia due to a rapid growing laryngeal tumor: A case report

A 68-year-old woman with laryngeal tumor was scheduled for a biopsy under the general anesthesia. As dyspnea or stridor was not present and half of the laryngeal opening could be easily seen by preoperative bronchoscopy which took one month prior to the surgery, anesthesia was induced with sedatives and muscle relaxant in stepwise patterns. However, an impending total airway obstruction developed after muscle relaxant administration and emergency tracheostomy became unwanted necessity. Since a laryngeal tumor could grow large enough to make trouble in general anesthesia in a short period of time from diagnosis to operation, preoperative anticipation of airway compromise, reevaluation just before the anesthesia, communication with all operating team workers, and prompt management were needed to avoid dread complications.