Intraoperative modification of a supracricoid laryngectomy to a subtotal laryngectomy with tracheohyoidoepiglottopexy.

In recent decades, with the widespread diffusion of the supracricoid laryngectomy in the treatment of selected advanced laryngeal neoplasm, the indications to non-conservative surgery are less frequent than in past. We report the case of a patient in whom a planned supracricoid laryngectomy was intraoperatively converted in an extended partial laryngectomy with tracheohyoidoepiglottopexy for a tumor involving the cricoid cartilage.

P27 and MIB-1 expression is related to malignancy recurrence in laryngeal carcinoma treated with partial laryngectomy: preliminary results.

OBJECTIVE: Considerable evidence has confirmed that p27 protein plays a negative role in cell-cycle progression from the G1 to the S phase and is considered a tumour suppressor. p27 down-regulation was demonstrated in several malignancies. Only a few studies investigated p27's potential prognostic role in laryngeal squamous cell carcinoma (SCC). The aim of the present study was to determine the prognostic relevance of p27 expression in a cohort of laryngeal SCCs that were very homogeneous from a treatment viewpoint to avoid possible influences of treatment modalities on results; all patients underwent only partial laryngectomy on the primary lesion. We simultaneously investigated monoclonal antibody against a proliferating cell associated epitope MIB-1 expression. DESIGN AND METHODS: Twenty-two cases of laryngeal SCC that had undergone exclusive supracricoid or supraglottic laryngectomies with or without neck dissection at the Department of Otolaryngology of Padova University were evaluated. Primary laryngeal SCC p27 reactivity and MIB-1 reactivity were immunohistochemically tested and evaluated by a workstation image analysis system. MAIN OUTCOME MEASURES: A lesion was considered p27 positive when more than 18.56% of the tumour cells showed diffuse strong staining. Samples with > 20.24% of stained cells were considered MIB-1 positive. RESULTS: The mean p27 expression was 17% and 22% in patients with and without disease recurrence, respectively. Low p27 expression was statistically associated with disease recurrence (p = .045); on the other hand, high MIB-1 values were associated with SCC recurrence after treatment (p = .045). CONCLUSIONS: The intervals of confidence analysis showed a stronger relationship of MIB-1 versus p27 in predicting disease recurrence in our cohort of patients treated only with partial laryngectomies.

Expression of the apoptosis inhibitor protein Survivin in primary laryngeal carcinoma and cervical lymph node metastasis.

BACKGROUND: Survivin is the smallest mammalian member of the inhibitor of apoptosis (IAP) proteins family. The aim of the present study was to determine survivin expression in laryngeal squamous cell carcinoma (SCC) and in neck lymph node metastases. The survivin value in predicting prognosis in laryngeal SCC was also investigated. PATIENTS AND METHODS: Survivin expression was investigated in 37 laryngeal SCCs and in 12 cervical lymph node metastases. RESULTS: A nuclear reaction predominated in laryngeal SCCs. Survivin expression was significantly higher in pN+ laryngeal SCCs than in pN0 (p = 0.017). Survivin expression was higher in cervical lymph node metastases than in correspondent primary laryngeal SCCs (p = 0.002). Survivin expression in laryngeal SCCs that developed loco-regional recurrence was significantly higher than in laryngeal SCCs without recurrence of disease (p = 0.039). CONCLUSION: Nuclear expression of survivin should be studied as a hallmark of higher risk laryngeal SCCs to develop loco-regional recurrences. Higher survivin expression in pN+ laryngeal SCC may suggest elective neck dissection in clinically N0 patients with high survivin expression in primary SCC. The extremely high survivin expression in lymph node metastases may support the use of survivin in the diagnosis of lymph node micro-metastases.

Maspin nuclear localization is related to reduced density of tumour-associated micro-vessels in laryngeal carcinoma.

BACKGROUND: MASPIN, a tumour suppressing serpin, is a potent inhibitor of angiogenesis. CD105 is a proliferation-associated protein acting in endothelial cells of angiogenic tissues. For the first time the relation between nuclear MASPIN expression and CD105-assessed micro-vessel density (MVD) in laryngeal carcinoma was investigated. PATIENTS AND METHODS: The sub-cellular distribution of MASPIN and nuclear MASPIN expression were immunohistochemically determined in 35 cases of laryngeal carcinoma. The percentage of the fields occupied by CDl05-assessed micro-vessels was also calculated. RESULTS: MVD was significantly lower in laryngeal carcinomas with MASPIN nuclear staining than in carcinomas with cytoplasmic staining (p=0.02). The mean nuclear MASPIN expression was higher in patients without carcinoma recurrence than in those with recurrence (p=0.06). The mean MVD was significantly higher in patients with recurrence of carcinoma (p=0.024). CONCLUSION: The crucial role of MASPIN nuclear localization in reducing the MVD has been demonstrated. Nuclear MASPIN re-expression should be investigated as a potential therapeutic option in the treatment of laryngeal carcinoma.

Distant muscular (gluteus maximus muscle) metastasis from laryngeal squamous cell carcinoma.

Clinical evidence of non-lymphatic distant metastasis has been reported in approximately 10% of cases of head and neck squamous cell carcinoma (HNSCC). The lungs are the commonest site of distant metastasis of HNSCC, followed by the bones, liver and skin. A 65-year-old male underwent supraglottic laryngectomy and left modified neck dissection for a carcinoma of the laryngeal surface of the epiglottis extending to both false cords. Eight months later the patient underwent right radical modified neck dissection for hypodermal metastatic disease involving the underlying (sternocleidomastoid) muscle. Thirty-two months later, surgical excision of a lesion in the right gluteus maximus muscle was performed. Histological study diagnosed a muscular metastasis with the same morphological aspect as the laryngeal carcinoma. The patient showed no evidence of cervical or distant recurrence at follow-up after 13 months. Although skeletal muscles represent approximately 50% of total body mass and receive a large proportion of total cardiac output, haematogenous metastases to skeletal muscle are extremely uncommon. Most skeletal muscle metastases are of pulmonary origin. Distant skeletal muscle metastasis from HNSCC is an extremely rare occurrence. Treatment options, depending upon the clinical setting, include observation, radiotherapy, chemotherapy and excision; these approaches rarely alter the patient outcome. The prognosis associated with skeletal muscle metastasis is thought to be poor, consistent with the fact that it generally occurs as a feature of systemic spread.