ABSTRACT
Cutaneous metastases from laryngeal and hypopharyngeal squamous carcinomas are extremely rare. A high index of clinical suspicion, supplemented with histopathologic evidence, aids in the diagnosis. The prognosis is extremely poor, and treatment is aimed only at palliation of symptoms and improving quality of life.
Subject(s)
Carcinoma, Squamous Cell/secondary , Hypopharyngeal Neoplasms/pathology , Skin Neoplasms/secondary , Carcinoma, Squamous Cell/pathology , Follow-Up Studies , Humans , Hyperpigmentation/pathology , Male , Middle Aged , Neoplasm Invasiveness , Palliative Care , Skin Neoplasms/pathologyABSTRACT
Although vascular malformations of the tongue comprise a significant portion of head and neck angiodysplastic lesions, hemangioma of base of tongue is rare. We report a case of hemangioma of base of tongue extending to the supraglottis, which necessitated an extended supraglottic laryngectomy. Patient had an uneventful recovery and at three year, follow-up has a normal speech and no difficulty in swallowing or aspiration. More importantly, there was no recurrence of hemangioma or bleeding. Although hemangiomas may be treated by various conservative methods, occasionally patient may require surgical excision as in the present case due to the repeated bleeding episode and difficult access. A high index of suspicion and radiological investigations should be performed if the clinical presentation is atypical for malignancy, as in our case.
Subject(s)
Hemangioma/pathology , Laryngeal Neoplasms/pathology , Tongue Neoplasms/pathology , Aged , Hemangioma/surgery , Humans , Laryngeal Neoplasms/surgery , Laryngectomy , Magnetic Resonance Angiography , Male , Tongue Neoplasms/surgeryABSTRACT
Laryngeal paragangliomas are rare neuroendocrine tumours. Most laryngeal paragangliomas are supraglottic in location, with only 3% reported to be glottic in location. We present a rare case of transventricular paraganglioma with fixation of the hemilarynx that presented a diagnostic and therapeutic challenge.
Subject(s)
Laryngeal Neoplasms/diagnosis , Larynx/pathology , Paraganglioma/diagnosis , Female , Humans , Laryngeal Neoplasms/pathology , Laryngoscopy , Larynx/diagnostic imaging , Middle Aged , Paraganglioma/pathology , Photomicrography , Tomography, X-Ray ComputedABSTRACT
Deregulation of oncogenes and tumor suppressor genes involved in apoptosis has been associated with tumor development and progression. To investigate the involvement of apoptosis regulating proteins in oral cancer in Indian patients, primarily associated with chewing tobacco habits, immunohistochemical expression of bcl-2 and bax was examined in 63 oral squamous cell carcinomas, and 31 putative premalignant lesions. Our studies revealed overexpression of tumor specific cytoplasmic bcl-2 in 56% and bax in 43% oral cancers. The oral cancers in the Indian patients are preceded by premalignant oral lesions; hence oral lesions were examined for bcl-2 and bax expression. We observed aberrant expression of bcl-2 in 16% oral lesions comprising leukoplakias and SMF and bax in 55% oral lesions. We have already reported, p53 expression in these oral cancers and lesions. It was noteworthy that 30% oral cancers demonstrated a p53+bcl2+ pattern, and 14% samples exhibited p53+bcl2+bax+ pattern. However, none of the oral lesions showed concurrent deregulation of p53 and bcl-2 or all the three genes. Interestingly 45% oral lesions were p53-bax+ as compared to 18% oral cancers; while 39% oral lesions were bcl2-bax+ as compared to 14% oral cancers, indicating overexpression of bax in oral lesions, in the absence of p53 and bcl-2 proteins. Significant correlation was observed between positive nodal status and bcl2+ (p=0.047) and p53+bcl-2+ (p=0.01) in oral cancers. Kaplan Meier survival analysis showed significantly (p=0.059) higher survival in patients with p53- oral tumors than with p53+ tumors. Our studies thus indicate frequent overexpression of apoptosis regulators bcl-2, bax and p53 proteins in oral cancers, and a subset of oral lesions, representing early events in oral car-cinogenesis. The aberrant bcl-2 expression and loss of p53 function observed, may play an important role in the tumorigenesis of oral cancers by allowing escape from apoptosis and enabling additional genetic alterations to accrue.
Subject(s)
Carcinoma, Squamous Cell/metabolism , Mouth Neoplasms/metabolism , Proto-Oncogene Proteins c-bcl-2/metabolism , Proto-Oncogene Proteins/metabolism , Tobacco, Smokeless/adverse effects , Adult , Aged , Carcinoma, Squamous Cell/etiology , Carcinoma, Squamous Cell/pathology , Disease Progression , Female , Gene Expression Regulation, Neoplastic , Humans , Immunoenzyme Techniques , India , Male , Middle Aged , Mouth Neoplasms/etiology , Mouth Neoplasms/pathology , Neoplasm Staging , Tumor Suppressor Protein p53/metabolism , bcl-2-Associated X ProteinABSTRACT
Hypopharyngeal squamous carcinoma is an aggressive disease with a high frequency of local and distant spread. Distant metastasis is seen more often now because of better loco-regional control due to more aggressive multimodal therapy. This article reports two cases of unusual metastatic disease from squamous carcinoma of pyriform sinus and reviews the metastatic disease in hypopharyngeal squamous cancers. The first was a case of metastatic pericardial effusion and the second was a metastasis to soft tissues of the scapular region and lung.
