Primary Site Influences the Ability of Magnetic Resonance Imaging to Assess Cartilage Invasion in Advanced Laryngeal Cancer.

OBJECTIVE: Accurate staging of advanced laryngeal cancer is important, as treatment can vary significantly between larynx preservation and total laryngectomy. The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in assessing features of T4a disease in locally advanced laryngeal cancer and determine if primary site played a role in the accuracy of MRI in this setting. METHODS: A retrospective cohort study of patients undergoing a total laryngectomy in a tertiary referral center for head and neck cancer over a 10-year time period was carried out. Patients met inclusion criteria if they underwent a primary total laryngectomy for squamous cell carcinoma (SCC) of the larynx during the study period. Data collected included basic demographic data, primary tumor subsite, and clinical and pathological staging. The predictive ability of MRI on outer thyroid cortex invasion, extralaryngeal extension, and overall T4a stage was analyzed with receiver operating characteristics analysis. Analysis was compared to histological data on outer thyroid cortex invasion, extralaryngeal extension, and histological T4a stage. RESULTS: A total of 112 patients met inclusion criteria. The mean age of the cohort was 65.1. Glottic primary subsite was associated with a statistically significant elevated risk for histological outer cortex erosion (p = 0.006), but MRI demonstrated worse sensitivity in detecting this outer cortex invasion in glottic primaries(p = 0.002). CONCLUSION: Glottic primaries tumors display an increased likelihood of thyroid cartilage invasion, however, MRI demonstrates a poorer sensitivity for detecting these features. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.

Spindle cell carcinoma of larynx: A case report.

INTRODUCTION AND IMPORTANCE: Laryngeal Spindle Cell Carcinoma (SpCC), a rare subtype constituting only 0.5% of cases, poses diagnostic challenges due to its biphasic nature and histological resemblance to other neoplasms. Our study explores unique observations, including monoclonal epithelial origin and an unusually large tumor triggering respiratory distress. CASE REPORT: In this comprehensive case report, a 62-year-old male with a history of tuberculosis and extensive smoking presented with respiratory distress and a white vocal cord mass, diagnosed as spindle cell carcinoma (SpCC). Laryngoscopic and imaging evaluations revealed an ill-defined mass originating from the right supraglottic larynx. Histopathological examination and immunohistochemistry confirmed confirming the diagnosis. The management included immediate tracheostomy, surgical resection, adjuvant radiation therapy, and chemotherapy. Regular follow-ups and a multidisciplinary approach contributed to a successful three-year outcome without recurrence. CLINICAL DISCUSSION: Spindle Cell Carcinomas (SpCCs) of the larynx, historically termed carcinosarcoma and sarcomatoid carcinoma, are rare and predominantly affect middle-aged to elderly males. These biphasic tumors arise from both epithelial and spindle cell elements and present with symptoms like hoarseness and dysphagia. Risk factors include tobacco use, alcohol, and viral infections. Accurate diagnosis relies on histological and immunohistochemical analysis. Early detection facilitates favorable outcomes, with five-year survival rates ranging from 65 to 95%. CONCLUSION: Spindle Cell Carcinoma (SpCC) of the larynx, originating from epithelial and spindle cell elements, requires early detection through histological and immunohistochemical analysis. Early diagnosis leads to a notably optimistic five-year survival prognosis.

Surgical Implications of Superior Thyroid Cornu Agenesis in Laryngeal Malignancy.

The most commonly reported superior thyroid cornu (STC) anatomical variation is in STC syndrome, where the cornu is enlarged or medially displaced. STC agenesis is a rare laryngeal variation that can be unilateral or bilateral. Previous studies have reported STC agenesis in cadaveric or forensic studies in patients with an otherwise normal larynx. We report a case of unilateral STC agenesis in the context of a stage III glottic laryngeal squamous cell carcinoma. The variation was discovered intra-operatively during a total laryngectomy and was clinically unknown beforehand. There were no clinical or histological signs of bony erosion by the tumor. To our knowledge, this is the first report of unilateral STC agenesis in a patient with laryngeal malignancy. This article draws attention to a rare anatomical variant of the larynx and highlights the surgical implications including potential diagnostic challenges and operative considerations.

Lymphepithelial carcinoma - a rare tumor of the larynx. Case Report.

Lymphoepithelioma was described in 1921 separately by Regaud and Schmincke as nests of non-keratinizing squamous cells embedded in a lymphoid stroma (Regaud) and isolated transitional cells scattered in lymphoid tissue resembling sarcoma (Schmincke). Lymphoepithelial tumors are the most common lesions of the nasopharynx, although they have also been reported in other localizations, such as the nasal cavity, maxillary sinus, the base of the tongue, parapharyngeal area, tonsils and thymus. Lymphoepithelioma of the larynx is extremely rare. We present a case of a 55-year-old patient treated due to this type of lesion to share our experience in the management of this type of malignancy and contribute to the field of rare laryngeal tumors diagnosis and treatment.

Is Laryngeal Squamous Cell Carcinoma Related to Helicobacter pylori?

BACKGROUND: Laryngeal carcinoma is a primary malignant tumor originating from the laryngeal mucosa. In recent years, an increasing number of studies have confirmed that Helicobacter pylori may play a role in the occurrence and development of laryngeal cancer. We conducted a systematic review and meta-analysis to identify and emphasize the relationship between laryngeal cancer and Helicobacter pylori infection. METHODS: We actively searched for systematic reviews of PubMed, Embase, Web of Science, and Cochrane libraries to select studies that met the recommended guidelines. A total of 1756 patients with laryngeal cancer were included in this study to assess the association of Helicobacter pylori in the larynx with laryngeal cancer. A subassessment of the risk of bias for each study that met the inclusion criteria was carried out. To illustrate the reasons for heterogeneity, we performed a subgroup analysis to determine the type of study, the quality of the article, the diagnostic method, and the impact of exposure factors. RESULTS: The meta-analysis included a total of 17 case-control studies on the association between Helicobacter pylori in the larynx and laryngeal cancer. Our meta-analysis showed that Helicobacter pylori infection in the larynx significantly increased the risk of malignant tumors in the larynx (odds ratio, 2.96; 95% CI, 1.83-4.78; P<0.00001; I2 = 86%). They still existed when we controlled for patients' exposure to smoking factors (odds ratio, 3.86; 95% CI, 1.89-7.88). CONCLUSION: This systematic review and meta-analysis showed an association between Helicobacter pylori and laryngeal cancer. These findings are consistent with the understanding that chronic inflammatory tissue insult may lead to the development of malignancy. Controlling risk factors will help us identify patients with an increased risk of laryngeal cancer.

Clinicopathologic characteristics of laryngeal chondrosarcoma: An analysis of the National Cancer Database.

OBJECTIVES: Laryngeal Chondrosarcoma (LC) is a rare malignancy with limited studies documenting its clinicopathologic characteristics and treatment options. This study reports demographic and clinical determinants of outcomes for this rare tumor. METHODS: The National Cancer Database (NCDB) was queried for cases of LC reported from 2004-2016. 274 cases that met inclusion criteria were analyzed for demographic and clinicopathologic characteristics. Kaplan-Meier (KM) and Cox proportional hazard analyses were conducted to identify variables that impacted the overall survival of these patients. RESULTS: LC was found to be more common in males (74.8%). The mean age of patients was 61.8 years and 92.3% of the patients were white. 91.3% of patients were treated with only surgical resection, most commonly: partial laryngectomy (31.6%), total laryngectomy (25.7%), and local resection (22.4%). 98.8% of patients had no evidence of nodal disease and 99.6% of patients did not have distant metastasis at presentation. KM analysis revealed a 5-year overall survival (5YOS) of 89.0%. Age, insurance status, facility type, and surgery type were significant predictors of 5YOS (p<0.05). On Cox Proportional Hazard analysis, private insurance significantly improved survival (HR 0.21; p = 0.048) while increasing age was a poor prognostic indicator (HR 1.10; p = 0.004). CONCLUSION: The majority of LC patients present with no nodal involvement or distant metastasis at diagnosis, and overall this tumor has a favorable prognosis. Increasing age was found to be a poor prognostic factor while private insurance status was associated with improved survival.

ELS live surgery: a developing story.

INTRODUCTION: Since 2015, the European Laryngological Society (ELS) has organized on a yearly basis the European Laryngological Live Surgery Broadcast. The goal of this paper is to demonstrate the increasing worldwide audience. MATERIAL AND METHODS: The number of individual computers logged in, number of estimated audience, and number of countries with an active audience were calculated and compared to the numbers in 2015. RESULTS: In 2018, 19 live interventions were performed in three parallel sessions. The surgeons worked in 10 departments in 8 different countries. The number of individual computers logged in increased from 1000 in 2015 to 16000 in 2018. The estimated audience increased from 3000 to 32000 visitors. The number of countries with an active audience increased from 52 to 91. DISCUSSION: The amount of computers logged in is increasing year by year. The audience was presenting despite inconvenient broadcasting times, highlighting the educational importance. The teaching aspect remains visible on videos of this year's and previous year's interventions. They can be seen on website http://els.livesurgery.net/home.php . The organization of the European Laryngological Live Surgery Broadcast concurs to the idea that live broadcast of laryngologic surgery is feasible and attractive. Therefore, the ELS is going to continue to organize additional European Laryngological Live Surgery Broadcasts in the future.

Survival Outcomes in Patients with T2N0M0 (Stage II) Squamous Cell Carcinoma of the Larynx.

Objective Emerging data have demonstrated suboptimal outcomes among patients with stage II larynx cancer. Our objective is to report survival outcomes for T2N0M0 larynx cancer and to determine the cause-specific survival. Study Design Case series with planned data collection. Setting Tertiary academic center. Subjects Adults with T2N0M0 squamous cell carcinoma of the larynx treated with curative intent. Methods A head and neck cancer epidemiology database was queried for eligible subjects from 2003 to 2014. Data were extracted from the electronic medical record and research database, and survival analyses were performed. Results Thirty-four patients with previously untreated stage II larynx cancer were identified (median follow-up 48 months). Patients included 27 males and 7 females with a mean age of 59 years. The majority of tumors arose from the glottis (59%). Of the cohort, 12% were treated with surgery, 65% radiation therapy, and 24% chemoradiation therapy. The estimated 2-year overall survival was 81%, (95% confidence interval [CI], 59%-92%), disease-specific survival was 91% (95% CI, 69%-98%), and recurrence-free survival was 84% (95% CI, 65%-93%). Four of 5 patients with persistent or recurrent disease posttreatment were successfully salvaged with total laryngectomy with 100% locoregional control. There were 11 mortalities (2 disease related, 2 due to metachronous primaries, 3 treatment related, and 4 from other/unknown causes). Conclusion Stage II laryngeal cancer has suboptimal survival outcomes. This appears to be a reflection of medical comorbidities, propensity for metachronous primaries, and the sequelae of late treatment effects rather than poor locoregional control.

Laryngeal Verrucous Carcinoma.

Objective Laryngeal verrucous carcinoma (LVC) is a rare, locally invasive neoplasm comprising 1% to 3.4% of laryngeal carcinomas. Management strategies are a topic of ongoing conversation, and no definitive treatment protocol based on T stage and presentation exists. This review examines characteristics, treatment modalities, and patient outcomes of LVC. Data Sources PubMed, MEDLINE, EMBASE, and Web of Science. Methods Databases were searched through October 29, 2015, for literature detailing individual patient cases of LVC. Variables analyzed included patient demographics, tumor characteristics, tumor size, treatment, and outcomes. Results Thirty-seven articles with 369 cases were included. LVC was found more commonly in males (13.8:1), at an average age of 58.7 years, and located in the glottis (74.0%). Most patients had local disease at presentation (94.9%). The most common presenting symptom was hoarseness (92.3%). The most common primary treatment was surgery alone (72.3%), with local excision as the most common technique (56.8%). In patients with data available on both surgical modality and T stage, most patients who presented as T1 and were managed surgically underwent local excision (79.2%). Surgical treatment alone led to high rates of disease-free survival at follow-up (86.8%). A large number of patients presenting with T1 disease were disease free at follow-up (88.6%). Overall survival was 80.3%. Conclusion LVC is most often managed surgically. The extent of surgical resection may be guided by T stage, with smaller tumors resected via local excision and larger tumors via partial or total laryngectomy. Regardless of T stage or therapy, LVC has a good posttreatment prognosis.

Laryngeal chondrosarcoma: A systematic review of 592 cases.

OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare entities that arise from the cartilaginous structures of the larynx, including the cricoid, thyroid cartilage, epiglottis, and arytenoid cartilages. These tumors represent a minority of malignancies involving the larynx and can be mistaken for benign pathologies. The treatment has historically been surgical excision, often by total laryngectomy. This review investigates treatment modalities and patient outcomes. STUDY DESIGN: Systematic review using PubMed/MEDLINE and EMBASE database. METHODS: The databases were used to identify articles reporting cases of chondrosarcomas occurring exclusively in the larynx. Variables analyzed included patient demographics, presenting symptoms, grade, therapeutic approach, patient outcomes, and follow-up. RESULTS: Five hundred and ninety-two cases were identified. The average age reported was 62.5 years. There was a 3:1 male to female ratio. The most common surgical approach was local excision in 178 cases, followed by total laryngectomy in 174 cases. Nonsurgical treatment such as radiotherapy and chemotherapy was only used in 0.8% and 0.2%, respectively. Disease-specific survival rates for 1, 5, 10, and 20 years were 97.7%, 91.4%, 81.8%, and 68.0%, respectively, with no differences when comparing 5-year survival rates for location, grade, and therapy. CONCLUSION: Laryngeal chondrosarcomas are rare with a good prognosis. Various surgical approaches exist, with no difference noted in 5-year survival outcomes. Nonsurgical approaches were rarely used for these lesions. LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016 127:430-439, 2017.

Laryngeal Adenoid Cystic Carcinoma: A Systematic Review.

OBJECTIVE: Adenoid cystic carcinoma is a malignant minor salivary gland tumor that represents <1% of all laryngeal tumors. The submucosal location of laryngeal adenoid cystic carcinoma (LACC) results in delayed presentation. Here, we present the first systematic review of reported cases of LACC to determine trends in presentation, diagnostic and treatment modalities, and patient outcome. DATA SOURCES: PubMed, Web of Science, MEDLINE, and EMBASE databases. METHODS: A search of the above databases was done to identify articles reporting cases of LACC. The variables included in the analysis were patient demographics, presenting symptoms, tumor location, imaging, treatment, follow-up time, recurrence, and outcome. RESULTS: A total of 50 articles and 120 cases were included in the review. The most common presenting symptom was dyspnea (48.8%), followed by hoarseness (43.9%). LACC arose most frequently from the subglottis (56.7%). At presentation, 14.6% (13 of 89) of patients had regional disease. The average follow-up time was 54.0 months. At follow-up, distant metastasis was reported in 30 cases (33.3%). Surgery alone (43.3%) and surgery with radiotherapy (43.3%) were used most frequently and resulted in 57.1% and 55.3% of patients alive with no evidence disease at follow-up, respectively. CONCLUSION: LACC was most often located in the subglottis. Patients commonly presented with dyspnea and hoarseness. In this systematic review, surgery with radiotherapy and surgery alone were the most commonly employed treatment modalities, and both resulted in slightly more than 50% of patients alive with no evidence of disease at follow-up.

Laryngeal Neuroendocrine Carcinoma: A Population-Based Analysis of Incidence and Survival.

OBJECTIVE: Laryngeal neuroendocrine carcinoma (LNEC) is a rare malignancy with various subtypes, each with different characteristics. Classification of these subtypes is used to delineate treatment and management, as most are clinically aggressive with poor prognosis. This study analyzes the characteristics and survival outcomes of LNEC using population-based data. STUDY DESIGN: Analysis of a population-based tumor registry. SETTING: Academic medical center. SUBJECTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1973-2011) was queried for LNEC cases. Data analyzed included patient demographics, incidence, treatment modality, and survival. RESULTS: In total, 257 LNEC cases were extracted from the SEER database. Sixty-three percent were male, and the mean age of diagnosis was 61.9 years. Most cases were located in the supraglottis (62.6%), were of the small cell carcinoma (52.9%) histologic subtype, and were grade IV (40.9%) and American Joint Committee on Cancer (AJCC) stage IV (59.4%). Surgery and radiotherapy were used as treatment modalities in 38.3% and 59.8% of patients, respectively. Overall 5-year disease-specific survival (DSS) for all LNEC was 30.2%, with lower grade, lower AJCC stage, and treatment with surgery having higher 5-year DSS. CONCLUSIONS: LNEC often presents as an aggressive tumor at an advanced stage and has poor survival outcomes. Poor prognostic factors include high histologic grade, advanced stage disease, and not undergoing surgical resection. LNEC may be best treated depending on its histologic differentiation, with surgery being beneficial for early grade tumors while radiotherapy is inconclusive in its benefit for late-stage disease.