Office-based 532-nm KTP laser as a therapeutic modality for recurrent laryngeal papillomatosis: efficacy and relative factors.

This study aims to investigate the efficacy of office-based potassium-titanyl-phosphate (KTP) 532-nm laser in the management of recurrent laryngeal papillomatosis (RLP) following other treatments. A retrospective assessment was performed on 55 patients in 259 cases of RLP between 2012 and 2019. Derkay scores were obtained for all patients who underwent 532-nm KTP laser procedure (6 W of power with a continuous output mode) prior to treatment and after treatment. Analysis of parameters is based on the distribution characteristics of data. An ordinal logistic regression was also performed. Patients received a median of 3 (range 1-24) office-based KTP laser treatments. Among them, 96.36% (53 patients) were previously on cold steel equipment, CO2 laser, or microdebrider treatment under general anesthesia, and all previous treatments on them had failed. One patient progressed to invasive cancer, so he was excluded from the following analyses. After final KTP treatment, 36 patients (66.67%) received complete resolution with follow-up time ranging from 12.9 to 80.53 months (median 55.54 months). Results of subjective voice-quality indicators such as VHI-30 and GRBAS all improved greatly at the last follow-up. The initial Derkay scores and treatment intervals were found to be predictive of complete lesion remission. Arytenoid involvement may also correlate with lesion resolution. Serial office-based KTP treatment is an effective option for RLP patients, with ideal disease control and voice quality preservation. KTP laser therapy should be repeated with an interval of 1 month from the beginning of treatment until the lesion has been evaluated and subsided. Non-bulk or scattered laryngeal papilloma is an appropriate indication for KTP laser treatment.

Curing a Patient of Recurrent Tracheal Papillomatosis Using Laser Ablation and Adjuvant Radiotherapy.

We present a 28-year-old man with an early onset of recurrent respiratory papillomatosis at 1 year. The patient had undergone 31 operations over a period of 7 years. After the diagnosis of tracheal papillomatosis, he received a four-time treatment of T-tube insertion combined with laser fulguration. During the last operation, pathologic findings showed moderate dysplasia with malignancy potential. Conformal radiotherapy was then given at 5000 cGY, targeting the tracheal tumor bed. The patient experienced complete remission with no complications. His condition has lasted for 20 years, and has continued up through the time of this report.

The Role of Adjuvant Radiotherapy in the Treatment of Papillary Tumors of the Pineal Region: Some General Considerations and a Case Report.

BACKGROUND: Papillary tumor of the pineal region (PTPR) is a recently defined tumor entity. Its clinical course is characterized by frequent local recurrence, and patients may experience the burden of symptoms due to the anatomical location of the growing mass. Guidelines for treatment protocols, and the role of radiotherapy are still being investigated. CASE: We report the case of a 27-year old woman who was referred to our department after she was diagnosed with PTPR and had undergone multiple surgical interventions. We delivered adjuvant conformal radiotherapy on the gross residual tumor to a total dose of 59.4 Gy (33 × 1.8 Gy). DISCUSSION: After a follow-up period of 41 months, we obtained a complete response to the treatment, according to the Response evaluation criteria in solid tumors criteria (RECIST). Radiation treatment was well tolerated, and the patient did not develop acute and late side effects. The neurological symptoms, which were documented at the diagnosis and after the surgical procedure, have not been recorded at last follow-up. CONCLUSIONS: Formal consensus for managing patients with a diagnosis of PTPR are nonexistent. Despite surgery, this tumor has a tendency to recur. Radiotherapy could have a role in the adjuvant setting and needs to be investigated in a multicenter setting with a long follow-up.Key words: radiotherapy - neurosurgery - magnetic resonance - pineal region - brain tumor.

Oncocytic Schneiderian Papilloma of the Sinonasal Tract Treated With Radiotherapy.

A 66-year-old man visited the ophthalmology department due to epiphora and was subsequently diagnosed with oncocytic schneiderian papilloma. Surgical removal was recommended to the patient; however, he refused this option. Therefore, a radiation of 64 gray (Gy) was administered in 32 daily doses (2 Gy daily) over 45 days using intensity-modulated radiotherapy. Four months after radiotherapy, the tumor had disappeared. Two years postradiotherapy, the patient was healthy, without tumor recurrence or the development of orbital complications. The authors suggest that radiotherapy could be an adjuvant or definite treatment modality for patients of oncocytic schneiderian papilloma unsuitable for complete surgical removal, or those associated with a high risk of surgery-related complications.

Malignant transformation from benign papillomatosis of the external auditory canal.

OBJECTIVE: Report a case of malignant transformation of benign ear canal papillomatosis to malignant squamous cell carcinoma (SCC) of the temporal bone. PATIENTS: A 73-year-old with papillomata involving the posterior and inferior walls of the right external auditory canal (EAC), which subsequently transformed into SCC. INTERVENTIONS: Radical mastoidectomy and excision of the tumor and then radical radiotherapy. MAIN OUTCOME MEASURES: Loco-regional disease control. Recovery of facial nerve function. RESULTS: Approximately 20 months post-treatment, the patient remains disease free. No recovery of facial nerve function. CONCLUSION: Malignant transformation of a benign EAC papilloma to SCC of the temporal bone has not been reported previously. The association of human papillomavirus with temporal bone SCC has been reported in small number of studies with human papillomavirus subtypes 16 and 18 isolated in a high proportion of cases. With the increased availability in genotyping, the question over whether there should be further genetic analysis of benign lesions to assess their susceptibility to malignant transformation has merit.

Recurrent inverted papilloma with intracranial and temporal fossa involvement: A case report and review of the literature.

Inverted papilloma (IP) is a rare nasosinusal benign tumour, with epithelium surface inversion to inside the stroma. Extension to intracranial temporal fossa and middle ear has been reported in few cases in the literature. This involvement may be derived from either direct extension from sinonasal cavity via the Eustachian tube or primary middle ear involvement secondary to metaplastic changes of the middle ear mucosa. Here, we report a case of inverted papilloma in a male patient, with multiple recurrences, middle ear and intracranial involvement into the temporal fossa with posterior development of malignancy. This patient had received multiple surgeries and radiotherapy but despite of that, his disease recurred several times. As a conclusion, inverted papilloma is a benign tumour with an aggressive course, tendency to recurrence and progression to malignancy. Intracranial and temporal fossa involvements are rare and the treatment depends of the symptoms and the severity of the disease.

Laryngeal carcinoma in a non-smoker female patient with thyroid carcinoma: report of a case.

Laryngeal carcinoma is usually encountered in smoker men, and thyroid carcinoma is sometimes discovered incidentally during treatment for these patients. However, this coexistence of malignancies could occur in non-smoker female. We report an unusual case of multiple primary malignancies in the larynx and the thyroid gland. The laryngeal carcinoma was suspected to be related to the malignant transformation of the papillomas. The case suggests the importance of meticulous examination in the head and neck region for treatment of cervical metastatic lymph nodes with negative cytology in non-smoker female.

[Treating papillomatous intradermal nevi: lasers - yes or no? A prospective study]. / Management papillomatöser intradermaler Nävi: Laser ja oder nein? Eine Prospektivstudie.

BACKGROUND: Papillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be - especially on the face - cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. MATERIAL AND METHODS: In a prospective study with 90 (female symbol=77, male symbol=13) patients aged between 13 and 67 years, 130 intradermal nevi (female symbol=114, male symbol=16) were removed using a combined therapy with CO(2), erbium: YAG and ruby lasers. RESULTS: After therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. CONCLUSION: The combined laser method (CO(2), erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.

Papillary tumor of the pineal region--a new pathological entity.

Papillary tumor of the pineal region has recently been proposed as a new, distinct clinicopathological entity. On the basis of the immunophenotypic and ultrastructural properties of these lesions, origin from specialized ependymocytes of the subcommissural organ was postulated. We present the third publication on a papillary pineal tumor and describe the morphological, immunohistochemical and ultrastructural features of this neoplasm. The patient was a young woman who presented with signs of raised intracranial pressure and Parinaud syndrome. Magnetic resonance imaging revealed a neoplastic lesion in the pineal region. She underwent surgical resection of the tumor through a midline infratentorial-supracerebellar approach. Papillary tumor of the pineal region represents a new, distinct clinicopathological entity. The differential diagnosis, possible histogenesis and management of these lesions are discussed.

[Radiowave surgery for epibulbar tumor and nontumor masses].

The paper analyzes the results of removal of epibulbar tumor and nontumor masses, by using the radiowave surgical technique. The authors used two basic modes: fulguration and completely rectified and/ or completely filtered wave. Postoperative healing was aseptic and areactive. The duration of reparation depended on the working conditions, the volume of excised tissues, and the individual pattern of reparative processes. No intraoperative and postoperative complications were found. There were no cases of relapses and on-going growth during 9-12-month follow-ups. The authors have concluded that a radiowave knife may be used in surgery for epibulbar tumor and nontumor masses.

585-nm pulsed dye laser treatment of glottal papillomatosis.

Treatment of recurrent respiratory papillomatosis of the glottis is often challenging. The surgeon and patient must cooperatively balance decisions regarding airway safety, effects of multiple general anesthesias, employment disturbance, and vocal dysfunction. A pilot study was done in 41 adult cases (23 patients; 78 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-micros pulse width; fluence of 38 to 255 J/cm2; 1- to 2-mm spot size) in the treatment of this disorder. Thirty-seven of the 41 cases (90%) were bilateral disease. Twenty-six of the 41 cases (63%; including 20 cases with involvement of the anterior commissure) were treated by bilateral photocoagulation of the lesions' microcirculation without microflap resection of tissue. Clinical observation revealed that irradiated but unresected disease involuted without development of an anterior commissure web. In the initial 13 of the 41 cases (32%), PDL treatment was followed by cold instrument microflap resection. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. The PDL at 585 nm was less effective in the management of exophytic lesions because of its limited depth of penetration (approximately 2 mm). In this initial trial, the PDL was a relatively safe and efficacious treatment for glottal recurrent respiratory papillomatosis. Since the lesions involute without complete resection of the diseased epithelium, the anterior commissure can be treated to minimize the number of procedures. To study patterns of recurrence will require longer follow-up.

Evaluación citológica de la papilomatosis incipiente del paladar tratada con láser en portadores de prótesis / Cytological evaluation of incipient papillomatosis of the palate treated with laser in patients wearing dentures

Se realizó un estudio prospectivo y longitudinal, consistente en la descripción citológica (tipo celular, porcentaje y variaciones del núcleo, citoplasma y fondo de lámina) de las muestras obtenidas en 20 pacientes con papilomatosis incipiente del paladar duro, diagnosticados y atendidos en la consulta de Detección Precoz del Cáncer Bucal de la Clínica Estomatológica Provincial Docente de Santiago de Cuba, que reunieron criterios de inclusión para dicha entidad. Las muestras obtenidas por raspado a ambos lados de la mucosa fueron leídas al inicio del tratamiento a los 3, 6, 9, 12, 15 y 18 días para evaluar la recuperación epitelial bajo los efectos del láser infrarrojo de arsenurio de galio y aluminio, con dosis de 6 J/cm2 durante 12 a 15 sesiones. Las células intermedias de la mucosa mostraron el mayor nivel de multiplicación, la recuperación epitelial, según promedio de cambio celular, resultó más rápida en los casos de menos números de sesiones y el tiempo medio de recuperación fue indicado en esta muestra a partir del tercer día de evaluación citológica(AU)

A prospective longitudinal study consisiting in the cytological description (cellular type, percentage and variations of the nucleus, citoplasma and laminar fundus) of the samples obtained from 20 patients with incipient papillomatosis of the hard palate that were diagnosed and treated at the Consulting Room of Early Detection of Oral Cancer of the Provincial Teaching Dental Clinic, in Santiago de Cuba, was conducted. Inclusion criteria were gathered for this entity. The samples obtained by curettage on both sides of the mucosa were read at the beginning of the treatment at 3,6, 9, 12, 15 and 18 days to evaluate the epithelial recovery under the effects of the infrared laser of gallium and alluminum arsenid at doses of 6 J/cm3 during 12 to 15 sessions. The intermediate cells of the mucosa showed the highest level of multiplication. The epithelial recovery according to the average of cellular change proved to be faster in the cases that received less sessions. The mean recovery time was indicated in this sample from the third day of cytologic evaluation on(AU)

Evaluación citológica de la papilomatosis incipiente del paladar tratada con láser / en portadores de prótesis / Cytological evaluation of incipient papillomatosis of the palate treated with laser in patients wearing dentures

Se realizó un estudio prospectivo y longitudinal, consistente en la descripción citológica (tipo celular, porcentaje y variaciones del núcleo, citoplasma y fondo de lámina) de las muestras obtenidas en 20 pacientes con papilomatosis incipiente del paladar duro, diagnosticados y atendidos en la consulta de Detección Precoz del Cáncer Bucal de la Clínica Estomatológica Provincial Docente de Santiago de Cuba, que reunieron criterios de inclusión para dicha entidad. Las muestras obtenidas por raspado a ambos lados de la mucosa fueron leídas al inicio del tratamiento a los 3, 6, 9, 12, 15 y 18 días para evaluar la recuperación epitelial bajo los efectos del láser infrarrojo de arsenurio de galio y aluminio, con dosis de 6 J/cm2 durante 12 a 15 sesiones. Las células intermedias de la mucosa mostraron el mayor nivel de multiplicación, la recuperación epitelial, según promedio de cambio celular, resultó más rápida en los casos de menos números de sesiones y el tiempo medio de recuperación fue indicado en esta muestra a partir del tercer día de evaluación citológica(AU)

Six-year recurrence free survival after intraluminal iridium-192 therapy of human bilobar biliary papillomatosis. A case report.

BACKGROUND: Biliary papillomatosis is rare and often fatal. Liver resection or transplantation is recommended but may be impossible due to tumor or patient factors; furthermore, it appears to the authors of this study that no follow-up results after transplantation have been reported in previous studies. METHODS: Bilobar but limited biliary papillomatosis in a man age 54 years was mapped by cholangiopancreatography, cholecystectomy, and operative cholangioscopy. After cholangioscopic electrocoagulation, iridium-192 wires were temporarily inserted into the affected bile ducts, giving a dose of 60 grays at a 3-mm distance. Another percutaneous cholangioscopic electrocoagulation was performed 3 weeks later. RESULTS: The patient has been free of tumor and in good health for 80 months, but he has a long term stenting of a nonneoplastic stricture at the confluence of the bile ducts. CONCLUSIONS: Mechanical tumor reduction and intraluminal brachytherapy could possibly replace transplantation (which up to now has been suggested but not reported) when this life-threatening disease is bilobar, and also possibly replace liver resection for limited tumors in patients who are too frail for surgery.