The role of computer-assisted analysis in the evaluation of nuclear characteristics for the diagnosis of precancerous and cancerous lesions by contact laryngoscopy.

PURPOSE: Contact endoscopy (CE) through the direct contact with the surface of the mucosa enables in vivo visualization of upper epithelial layers. There is a broad spectrum of laryngeal pathologies, as has been confirmed by earlier CE reports. The aim of the study was to resolve some of the limitations of CE through the application of computer-assisted image analysis. Quantitative and qualitative evaluation of nuclei was applied in the diagnosis of precancerous and cancerous lesions. MATERIALS AND METHODS: Fifty four patients with various laryngeal pathologies were included in the study. Paraffin section histopathology showed 15 benign lesions, 12 precancerous lesions (5 mild and 7 severe dysplasias) and 27 invasive squamous cell cancers (SCC). After staining the mucous with 1% methylen blue, examination with contact endoscope (Karl Storz, Germany) connected to the C-7070 Wide Zoom Olympus high-resolution camera was performed. RESULTS: The most discriminative parameters were revealed to be as follows: nucleus area (p<0.001), nuclei density index (p<0.001), elongation coefficient (p<0.05), nucleus area to equivalent area ratio (p<0.05). Computer-assisted image analysis composed with data mining techniques is presented for nuclei categorization. CONCLUSIONS: We established that computer-aided image analysis can indicate, with a high level of reliability, cases of severe dysplasia and carcinoma. By implementing the technique described in this paper, we can substantially increase the sensitivity of CE.

Laryngeal manifestations of gastroesophageal reflux disease in children.

Although the association between gastroesophageal reflux disease (GERD) and laryngeal disorders in adults is well established there is still a lack of information concerning the true extent of the laryngeal complications of GERD in children. The aim of this study was to determine the laryngeal status of children with diagnosed GERD. We sought to identify the initial appearance of their larynges and then to determine the clinical response to antireflux therapy. GERD was recognized in 90/100 children examined. Using 24-h pH monitoring we found that most of the patients experienced episodes of gastroesophageal reflux during the daytime when they were in an upright position. The hallmark of GERD affecting the larynx in our group was posterior laryngitis, which is characterized by erythema of the mucous membrane overlying the arytenoid cartilages and the posterior mucosal wall of the glottis. The findings regarding the effectiveness of therapy were that, in children with severe laryngeal alterations, voice quality improved significantly after 12 weeks of antireflux treatment (p < 0.001) and laryngeal status was significantly better after 6 weeks of treatment (p < 0.001). This study provides evidence that gastroesophageal reflux in children is the underlying cause of inflammatory and morphological lesions, and that antireflux treatment is effective in reducing or eliminating these lesions.

Expression of type IV collagen and matrix metalloproteinase-2 (type IV collagenase) in relation to nodal status in laryngeal cancer.

Laryngeal carcinoma has a lower incidence of neck metastases than other malignant carcinomas of the head and neck region. However, some cases are very aggressive, showing neck metastases even in the early stages. In this study the expression of collagen IV and type IV collagenase (MMP-2) were examined immunohistologically in 50 patients with laryngeal carcinomas, and the results were compared with the incidence of neck metastases and other clinicopathological factors. The correlation between collagen IV expression and the existence of nodal metastases was statistically significant (P < 0.001). There was also significant correlation between collagen IV expression and the histological grading of the tumour. There was a tendency for samples with continuous collagen IV staining to have no matrix metalloproteinase-2 (MMP-2) immunoreactivity. No significant correlation was seen between MMP-2 protein expression and clinicopathological parameters although the correlation between MMP-2 and existence of nodal metastases was statistically borderline (P = 0.07). Multivariate analysis of the clinicopathological factors that may have an influence on the nodal status in laryngeal cancer revealed that, apart from T stage, collagen IV pattern in the basement membrane surrounding nests of carcinoma is an important prognostic factor.

[Androgens and laryngeal cancer]. / Androgeny a rak krtani.

The article concerns relations between larynx cancer and androgenic activity in men. Up till now the role of androgens in laryngeal carcinogenesis has not been established. Authors point out to andropenia (gonadal and supracortical) in elderly males and its influence on larynx cancer occurrence in the course of aging. Results of androgen receptor studies in unchanged and neoplastic tissue of the vocal organ are described. There is presented data on serum androgen concentrations in healthy men and patients with laryngeal neoplasms. The necessity of further studies of the larynx cancer's hormone-dependence is underlined.

Immunohistochemically stained markers (p53, PCNA, bcl-2) in dysplastic lesions of the larynx.

The percentage of malignant transformation of laryngeal dysplastic lesions is difficult to estimate. There is a need for new histological markers which could enable more objective assessment of the premalignant stages of the larynx and help in estimation of the potential of future neoplastic progression. We performed a retrospective study to determine whether immunohistochemical staining for the proliferating cell nuclear antigen (PCNA), tumour suppressor gene protein p53 and antiapoptotic protein bcl-2 may be prognostic factors in laryngeal epithelial lesions. Staining was performed on 57 paraffin-embedded biopsies from patients with clinically detected precancerous stages of the larynx. Histopathologic examination revealed normal epithelium in six cases, mild dysplasia in 20 cases, moderate dysplasia in 18 cases, severe dysplasia in seven cases, CA in situ in four cases, papilloma in one case and CA invasivum in one case. The p53 count in mild and moderate dysplasia was 26.8 and 38.6%, respectively. This difference was statistically significant. There was significant correlation between PCNA and p53 scores. There was also a relationship between the scores of these markers and bcl-2 expression. In ten out of 45 cases of dysplastic lesions the invasive cancer developed in 4 years of follow-up. The correlation between PCNA score and malignant progression of the dysplastic lesions was on the statistical borderline. There was significant relationship between malignant transformation and age of the patients.

Epidermal growth factor receptor (EGFR), proliferating cell nuclear antigen (PCNA) and Ki-67 antigen in laryngeal epithelial lesions.

The epidermal growth factor receptor (EGFR), proliferating cell nuclear antigen (PCNA) and Ki-67 immunostaining in paraffin sections from 154 cases of laryngeal squamous cell carcinoma, 25 specimens of normal and hyperplastic laryngeal epithelium, and 21 preneoplastic lesions was examined. The difference of EGFR expression and PCNA score between laryngeal cancer and dysplastic lesions vs normal and hyperplastic epithelium was significant. There was significant difference in Ki-67 score between malignant vs premalignant lesions and normal and hyperplastic epithelium. There was significant correlation between PCNA score and histopathological grading of the tumour. The highest PCNA expression was detected in stage G3. Our findings have shown that PCNA and Ki-67 staining can be used as a marker of cell proliferative activity in laryngeal epithelial lesions. EGFR, PCNA and Ki-67 expression correlate with severity of laryngeal lesions. PCNA immunostaining can aid in estimating the histological grade of malignant lesions.

C-erbB-2 immunostaining in laryngeal cancer.

Tumour progression is strongly associated with a series of specific genetic changes in protooncogenes and tumour suppressor genes. One of the potential factors involved in tumorogenesis of squamous cell carcinomas is protooncogene c-erbB-2 (also known as neu or HER2). The authors analysed the expression of c-erbB-2 oncoprotein in 154 cases of laryngeal squamous cell carcinomas and its relationship to the clinical outcome of the patients. The difference in c-erbB-2 oncoprotein expression between the control group and cancer patients was on the statistical borderline (p = 0.0470). There was no significant correlation between c-erbB-2 expression and sex and age of the patients. T stage, lymph node status, site and histopathological grading of the tumour and clinical outcome of the patients. Univariate analysis revealed no correlation between c-erbB-2 expression and survival rates. We conclude that immunohistological examination of c-erbB-2 on paraffin section is not a valuable prognostic factor in laryngeal carcinoma.

[Analysis of voice disorders in teachers treated in the Phoniatric Laboratory of the Otolaryngology Department AM in Wroclaw]. / Analiza schorzen narzadu glosu u nauczycieli leczonych w Pracowni Foniatrii Katedry i Kliniki Otolaryngologii AM we Wroclawiu.

Analysis of voice disorders in 898 teachers was performed. In all cases otolaryngologic, videostroboscopic and phoniatric examinations were completed. There was prevalence of women at the age ranged from 46 to 56 years. Majority of morphologic changes included Reinkes oedema (120 cases), chronic simple laryngitis (109 cases), vocal nodules (95 cases), chronic hypertrophic laryngitis (70 cases) and laryngeal polyps (35 cases). In 175 cases vocal insufficiency of glottis and in 57 cases functional disorders were diagnosed. In 131 cases no morphologic and functional changes were found. In the group of teachers the incidence of vocal insufficiency was higher than in control group. The analysis of the examined teachers revealed that professional disease was confirmed in 33% of cases. Majority of them included vocal nodules and chronic hypertrophic laryngitis.

Laryngeal cancer in Lower Silesia: descriptive analysis of 501 cases.

This paper presents a descriptive analysis of 501 cases of laryngeal cancer. The patients were classified according to their age, sex, primary tumour localisation and stage. There were 448 males and 53 females, with a male-to-female ratio of 8.5:1. The peak incidence of cancer was detected in the 6th and 7th decades of age. The most common primary tumour localisation was the glottis. Three-hundred-and-forty patients presented at advanced tumour stages (T3/T4). The proportion of patients presenting matastatic neck nodes was 29.3% and the incidence of metastatic lymph nodes increased with increasing T stage. Histopathological analysis revealed that 98% of tumours were squamous cell carcinomas. There were 125 well-differentiated, 235 moderately differentiated and 133 poorly differentiated carcinomas. Among other tumours, there was 1 adenoid squamous cell carcinoma, 1 giant cell carcinoma, 1 adenoma pleomorphicum, 1 adenoid cystic carcinoma (cylindroma), 1 haemangiopericytoma, 1 verrucous cell carcinoma, 1 lymphoepithelioma and 1 granular cell tumour.

Prognostic value of nucleolar organiser regions (AgNORs) in laryngeal cancer.

The argyrophilic nucleolar organizer regions (AgNORs) of 154 biopsy specimens of laryngeal squamous cell carcinoma were examined. The silver colloid staining technique was used. For the control, normal laryngeal epithelium obtained from 25 patients with benign lesions of the larynx was examined. There was significant difference in mean AgNORs count between control group and cancer patients. No significant correlation was found between AgNORs count and patients' age and sex, tumour site, T stage and lymph node metastasis. There was a significant correlation between AgNORs number per cell and tumour histological grading. The mean number of AgNORs per nucleus was 3.85 +/- 2.09 in patients with poor and 2.47 +/- 0.71 in patients with satisfactory clinical outcome after treatment. Significant correlation between the mean AgNORs number and survival in univariate and multivariate analysis was documented. Among clinical features the lymph node status and the T stage were important prognostic factors. We conclude that AgNORs may be a potential prognostic marker in laryngeal cancer.

Ki-67 immunostaining and prognosis in laryngeal cancer.

The expression of the antigen defined by the Ki-67 antibody in paraffin sections from 154 biopsies of laryngeal squamous cell carcinomas was examined. There was a significant difference in Ki-67 expression between the control group and the patients with cancer (P < 0.001). There was no significant difference in the Ki-67 score between the patients with recurrence and the patients with a satisfactory outcome after treatment. There was no significant correlation between the Ki-67 score and the patient's age and sex, T and N stage and site of the tumour. The survival time of patients with a Ki-67 score > 30 was shorter than patients with a Ki-67 score < or = 30 but the difference did not reach statistical significance (P = 0.055). Multivariate analysis indicated that the only important prognostic factor was the existence of lymph node metastases. We could not confirm the value of Ki-67 as a prognostic factor in laryngeal cancer. Ki-67 score may assist in differentiating malignant from benign laryngeal epithelium.

[A case of lymphoepithelioma of the larynx]. / Przypadek lymphoepithelioma krtani.

The very rare case of lymphoepithelioma of the larynx was presented. The opinions on the histogenesis of such tumors as well as histopathologic terminology were shown. The patient was successfully treated by radiotherapy.

[A case of neurilemmoma of the larynx]. / Przypadek nerwiaka oslonkowego krtani.

The rare case of neurilemmoma of the larynx was presented. The difficulties in histopathologic diagnosis of such tumors were emphasized. The tumor was removed by surgery from external approach.

[A case of frontal sinus osteoma with unusual clinical course]. / Przypadek kostniaka zatoki czolowej o nietypowym przebiegu klinicznym.

The case of frontal sinus osteoma causing exophtalmus and brain compression was presented. The osteoma was removed surgically. The information connected with histopathological and clinical features of the tumor were shown. The review of literature was presented.

[Difficulties in diagnosis of esophageal achalasia]. / Trudnosci diagnostyczne Kurczu wpustu.

The authors present the case of 36 years old patient with dysphagia. This symptom appeared three years ago and became more severe for six month. The endoscopic and radiologic examinations revealed achalasia of the cardia. The surgical treatment was performed. Two weeks after surgery all symptoms disappeared. We present this case because achalasia of the cardia is comparatively rare disease which diagnostic is not easy.

Acute bilateral vocal fold paresis as a symptom of benign thyroid disease.

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.

[Vocal folds paresis -- our experience in diagnostics and treatment]. / Porazenia faldów glosowych--doswiadczenia wlasne w diagnostyce i leczeniu.

In the years 1989-1992 we diagnosed 148 cases of recurrent nerve paresis. There were 78 cases of iatrogenic paresis, mainly caused by thyroid surgery and cardiosurgery. In 48 cases we found the diseases which caused paresis (mainly cancers and lesions of central nervous system). In 22 cases we have not found the cause of the paresis. We used videostroboscopy for diagnostic and monitoring therapy. This method seems to be very valuable because provides very good magnified image of the larynx and serves perfect documentation. The return of mucosal wave is the first sign of reinnervation of vocal cord. In the paper we analysed the voice quality of the patients by means of original acoustic method. The results of long term treatment were presented. We emphasizes the important role of voice rehabilitation in preventing of vocal muscle atrophy and degenerative changes in cricothyroid joint.

Clinical aspects of vocal cord nodules.

A clinical study of 251 patients with vocal nodules who underwent endolaryngeal microsurgery and speech therapy, was carried out. The postoperative results were evaluated. All patients were examined by videostroboscopy. An original acoustic method was applied for the estimation of the voice before and after therapy. Different patterns for vocal nodules were discussed.

An attempt at acoustic estimation of the results of phonosurgery.

The acoustic method of voice examination is presented. The method was verified in the group of 62 patients. The examination was performed before and after larynx microsurgery. All results were compared with traditional examination of voice. The method revealed a good sensitiveness as well as reliability and seems to be useful for monitoring of patients after phonosurgery.

[A clinical study of Reinke's edema]. / Obrzek reinkego--aspekty kliniczne.

Reinke's oedema is a benign disorder of the larynx. This pathological condition involving vocal cords is most often seen in middle-aged smokers, and has a female predilection. The results of videostroboscopic and acoustic examination of 160 persons with Reinke's edema were presented. The original method for voice analysis was used. The authors present their procedure and examine indications for surgery, surgical technique, postoperative follow-up and results obtained in different stages of diseases. The diagnosis and conservative as well as surgical treatment modalities are discussed. Important role of smoking cessation for long term treatment results was emphasized. This work indicates that by means of microsurgery we can obtain very good voice improvement in almost all cases of Reinke's edema.