ABSTRACT
We report on a rare complication of surgery in a 36-year-old man who had undergone removal of a hamartoma of the larynx. The patient had developed a submucosal lesion in the left ventricular fold, which was removed by surgical microlaryngoscopy. Following the excision, the patient began to experience an excessive amount of bleeding at the surgical site. Before hemostasis was achieved, the patient had lost almost 1,000 ml of blood. Although the occurrence of hemorrhage during surgical laryngoscopy is rare, surgeons should be aware of and prepared for this possibility.
Subject(s)
Blood Loss, Surgical , Endoscopy/adverse effects , Hamartoma/surgery , Laryngeal Diseases/surgery , Laryngoscopy/adverse effects , Adult , Biopsy, Needle , Endoscopy/methods , Follow-Up Studies , Hamartoma/diagnosis , Hamartoma/physiopathology , Hemostasis, Surgical/methods , Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/physiopathology , Male , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The nm23 gene, which encodes nucleoside diphosphate (NDP) kinase, is proposed as a metastatic suppressor gene and has been demonstrated to correlate inversely with metastatic potential in several tumours. To elucidate the role of nm23 in larynx carcinomas, we examined using immunohistochemistry the expression of the nm23 protein in matched sets of primary tumours and metastatic lymph nodes. nm23 Protein was expressed in all the carcinomas as well as in non-neoplastic larynx mucosa. Overexpression of nm23 protein was found in the majority of primary tumours compared with corresponding normal mucosa, while decreased expression was associated with poor differentiation and distant metastasis and/or recurrence. No significant difference in age, sex and stage was found between primary tumours with high and low nm23 protein expression. These results suggest that decreased nm23 protein expression may play a role in metastasis and/or recurrence in larynx cancer and therefore could be used as a prognostic factor.
Subject(s)
Antigens, Neoplasm/metabolism , Carcinoma, Squamous Cell/metabolism , Genes, Tumor Suppressor , Laryngeal Neoplasms/metabolism , Monomeric GTP-Binding Proteins , Nucleoside-Diphosphate Kinase , Transcription Factors/metabolism , Adult , Aged , Carcinoma, Squamous Cell/genetics , Female , Humans , Immunohistochemistry , Laryngeal Neoplasms/genetics , Lymphatic Metastasis , Male , Middle Aged , NM23 Nucleoside Diphosphate Kinases , Prognosis , Transcription Factors/geneticsABSTRACT
INTRODUCTION: Peristomal recurrence following laryngectomy is a very serious and fatal complication. To treat this complication, extensive surgical resection has been advocated. However, when peristomal recurrence develops, the prognosis is dismal and the mortality is nearly 100%. Therefore, attention should focus on prevention. METHODS: Treatment of patients with tumors of the subglottis should include attention to the paratracheal region and superior mediastinum. For this reason pretracheal, paratracheal, and retrosternal dissection has been performed in patients with subglottic lesions since 1968 in the Otolaryngology Department of the Hacettepe Faculty of Medicine. RESULTS: The incidence of peristomal recurrence was 11.5% before 1968 in patients without pretracheal, paratracheal, and retrosternal dissection. The incidence of peristomal recurrence dropped from 11.5% to 2.7% after routine application of pretracheal, paratracheal, and mediastinal dissection in patients with subglottic lesions (either primarily or secondarily). DISCUSSION: A total of 488 patients with total laryngectomy were studied. The importance of pretracheal, paratracheal, and retrosternal dissection in patients with subglottic carcinoma of larynx (primarily or secondarily) was emphasized.
Subject(s)
Glottis , Laryngeal Neoplasms/surgery , Neoplasms, Second Primary/surgery , Tracheal Neoplasms/surgery , Adult , Aged , Humans , Incidence , Laryngeal Neoplasms/pathology , Laryngectomy , Middle Aged , Neck Dissection , Neoplasms, Second Primary/epidemiology , Neoplasms, Second Primary/pathology , Preoperative Care , Thyroidectomy , Tracheal Neoplasms/epidemiology , Tracheal Neoplasms/pathology , TracheotomyABSTRACT
PURPOSE: Most patients with squamous cell carcinoma of the lower lip present with early disease and follow a rather indolent clinical course. Determinant 5-year survival rates range from 85% to 95%. This study was undertaken in an attempt to gain insight into the cause of failure in those few patients who develop recurrent disease. PATIENTS AND METHODS: A retrospective review was completed on patients treated between 1964 and 1990. Patients were staged according to the American Joint Committee. Patients with no palpable adenopathy had either a unilateral or bilateral suprahyoid dissection performed. Patients with palpable adenopathy underwent radical neck dissection. All patients were followed for evidence of recurrent disease. RESULTS: The records of 92 patients treated surgically for squamous cell carcinoma of the lower lip were available and complete. Palpable adenopathy was present in 38 patients; however, only 8 of these patients (21%) were histologically positive. Of the 54 patients judged to be free of disease, 3 (5.5%) had histologic evidence of metastasis. Overall, the incidence of cervical metastasis was 12%. CONCLUSION: The incidence of cervical metastasis in patients with squamous cell carcinoma of the lip is low; however, these data suggest that the size of the primary tumor does not correlate closely with predicting the incidence of regional lymph node metastases.
