The role of contact endoscopy in screening for premalignant laryngeal lesions: a study of 141 patients.

At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients--51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified.

Primary laryngeal NK/T-cell non-Hodgkin lymphoma: a case report.

The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-term follow-up is advisable for the timely detection of possible local or distant recurrences, which are common.

Cigarette smoking and progression of laryngeal lesions.

The association between cigarette smoking and an increased risk of laryngeal carcinoma has been demonstrated in numerous studies. The aim of the present study was to assess the prevalence of smoking habit in patients with different laryngeal pathologies. The prevalence of cigarette smoking was compared between patients with laryngeal tumors and those with nonmalignant laryngeal lesions. Data on all patients with indications for direct microlaryngoscopy at the Clinic for Otorhinolaryngology of the University Hospital Center Split, during a five-year period were analyzed. The study included 562 patients with various laryngeal pathologies, divided into three groups as follows: group 1, benign lesions; group 2, precancerous lesions; and group 3, tumors. The majority of patients (82.92%) had a long history of smoking. The proportion of smokers was lowest in benign lesion group (72.13%), higher in precancerous lesion group (81.48%) and highest in malignant lesion group (97.14%). There was a statistically significant difference in the prevalence of cigarette smoking between patients with laryngeal tumors and those with benign or precancerous lesions (p < 0.001). The mean number of cigarettes per day was 20.54 +/- 14.80, and was lowest in benign lesion group (15.67 +/- 13.41) and highest in malignant lesion group (26.33 +/- 12.70). The mean length of smoking habit was 26.44 +/- 16.92 years, ranging from 19.57 +/- 16.03 years in benign lesion group to 35.20 +/- 12.12 years in malignant lesion group. Study results clearly pointed to the increased prevalence of laryngeal diseases in smokers, with a significant difference between patients with benign laryngeal lesions and those with laryngeal tumors.

High mega jugular bulb presenting with facial nerve palsy and severe headache.

We present a rare case of a 50-year-old female patient with symptomatic high mega jugular bulb requiring surgery. We review her medical file, preoperative and postoperative imaging, audiograms, and surgical report. High jugular bulb was diagnosed with computed tomography and magnetic resonance imaging. Symptoms of facial nerve palsy and headache were abolished after surgical procedure. Headache and facial nerve palsy can be caused by high mega jugular bulb. Surgery is indicated in such symptomatic cases and leads to relief of signs and symptoms of disease.

Cyclin D1 and p27 expression as prognostic factor in papillary carcinoma of thyroid: association with clinicopathological parameters.

AIM: To determine the prognostic value of cell cycle regulators cyclin D1 and p27 for papillary thyroid carcinomas. METHODS: Analysis included 180 patients with papillary thyroid carcinoma who underwent surgery at Split University Hospital Center between 1999 and 2001. Clinical data were obtained from clinical charts and histopathology reports. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by antibody p27 and cyclin D1. Quantification was based on the intensity and distribution of nuclear staining. RESULTS: Univariate analysis showed that sex (P=0.019) and capsular invasion (P=0.010) were significant predictors of lymph node metastases, whereas age (P=0.96), histopathological variant (P=0.075), size (P=0.556) and multifocality (P=0.131) were not. Univariate analysis also showed that overexpression of cyclin D1 (P<0.001) and underexpression of p27 (P<0.001) predicted lymph node metastases in papillary thyroid carcinomas. There was a significant correlation between cyclin D1 (P=0.024) and p27 (P=0.029) expression in two prognostic groups of low and high risk. Low risk group was cyclin D1 negative and p27 positive, while high risk group was cyclin D1 positive and p27 negative. Multivariate analysis confirmed that sex (P=0.041), capsular invasion (P=0.027), and p27 (P<0.001) were strong independent predictors of lymph node metastases in the high-risk group. CONCLUSIONS: Immunohistochemical analysis of p27 expression may be a valuable tool for identifying risk of lymph node metastases and more aggressive behavior of papillary thyroid carcinoma.

Role of exfoliative cytology in diagnosis of laryngeal tumors.

OBJECTIVE: To evaluate the value of cytologic examination in the diagnosis of laryngeal tumors. STUDY DESIGN: A series of 100 patients with suspected tumorous lesions of the larynx were included in the study. The material for cytologic analysis was obtained by use of a modified instrument, that is, a slightly concave discoid knife, during direct microlaryngoscopy, followed by biopsy for paraffin and frozen section histopathology. The findings obtained by cytology and frozen section histopathology were compared with the findings of paraffin section histopathology. RESULTS: Cytology showed an 83.9% sensitivity, 100% specificity and 90% accuracy compared with histopathologic findings (p < 0.05; chi2 = 7.7). Frozen section pathohistology vs. paraffin section histopathology showed an 80.6% sensitivity, 97.4% specificity and 87% accuracy (p < 0.05; chi2 = 8.1). CONCLUSION: Cytologic examination showed higher accuracy compared to frozen section histopathology, also giving an insight into the type of laryngeal pathology in the case of precancerous lesions. The use of cytology and frozen section histopathology during direct microlaryngoscopy improves clinical diagnostic accuracy.