The latest medical research on Laryngeal Cancer
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Request AccessSinonasal Neuroendocrine Carcinoma in Adult Proteus Syndrome.
Laryngeal CancerProteus syndrome (PS) is a rare genetic disorder usually caused by mutations in AKT1 or PTEN genes, characterized by multiple, asymmetric tissue overgrowth with high clinical variability. Sinonasal neuroendocrine carcinomas (SNEC) are exceptionally rare tumors encountered in the ethmoid sinus, nasal cavity, or maxillary sinus.
We report a 35-year-old patient with PS, who underwent successful surgical removal of a well-differentiated SNEC obstructing his nasal cavity and highlight the role of the otolaryngologist for safe airway management, minimal surgical intervention and coordination of the multidisciplinary care. Histologically, focally hyperplastic mucosal epithelium of respiratory type of the nasal chamber was noticed along with seromucinous glands and capillary congestion of the subepithelial fibrovascular tissue. The limited presence of neoplastic tissue with histomorphological and immunophenotypic features of a neuroendocrine neoplasm was focally observed. Tumor cells grow in the form of islets within a vascular stroma; these neoplastic cells are immunohistochemically positive for synaptophysin, CD56, EMA, Ki67 (low expression, cell proliferation rate: 2%), CD31, chromogranin and pancytokeratin AE1 / AE3 as well as for S-100 protein (weak intensity).
This first description of a SNEC in a PS patient, might hint towards a common basis between the two conditions, due to the mosaic AKT1 variant and an activated AKT/PIK3CA/PTEN pathway.
A Rare Case of Solitary Fibrosus Tumor (SFT) of the Nasal Septum.
Laryngeal CancerSolitary fibrous tumor (SFT) is a rare mesenchymal tumor that usually arises from the pleura but can also occur in extrapleural sites, such as the sinonasal region. It causes aspecific symptoms, including nasal obstruction and discharge, postnasal drip, anosmia, epistaxis, and headache. It may be difficult to distinguish these symptoms from those caused by other mesenchymal lesions that usually occur in this site, especially when the tissues undergo iatrogenic damage following surgical removal.
This case report shows a rare right nasal septal solitary fibrous tumor, which was surgically removed using a trans-nasal endoscopic technique. For the first time, the mass was decomposed by a plasma blade, and the implant site was treated by performing a subperiosteal removal of septal mucosa and cartilage. Histopathological examination confirmed the diagnosis of solitary fibrous tumor. Follow-up at three, six, and twelve months showed no signs of relapse.
Sinonasal SFT is unusual, and it may be difficult to distinguish it from other mesenchymal lesions in this site. In the literature, cases treated with CO2 laser are usually described; however, due to the high cutting temperatures, this can cause thermal damage of the tissues, making histopathological diagnosis difficult. The plasma blade uses pulsed radiofrequency, creating an effective cutting edge while the blade stays near body temperature. Therefore, this device results in atraumatic, scalpel-like cutting sensitivity and electrosurgical-like hemostasis, with minimal bleeding and tissue injury. Its use could, therefore, help both the surgeon in obtaining surgical radicality and the pathologist in the correct histologic classification.
A Comparative Immunohistochemical Expression of TRAP in Odontogenic Cysts.
Laryngeal CancerTartrate-resistant acid phosphatase (TRAP) is an acid phosphatase metalloprotein enzyme expressed in osteoclasts and is related to bone resorption. The molecular mechanisms involved in the different behavior of odontogenic keratocysts have not yet been fully elucidated. The purpose of this study was to compare TRAP expression in odontogenic keratocysts, radicular cysts, and dentigerous cysts.
In this cross-sectional study, we selected 60 samples, including 20 cases of each one of the odontogenic keratocysts (OKC), radicular cysts (RC) and dentigerous cysts (DC). The samples were stained with TRAP monoclonal antibodies using immunohistochemistry. The data were analyzed using the Chi-Square and Kruskal-Wallis tests.
In this study, TRAP expression was observed in the lining epithelium of 50% of OKC cases and 5% of RC cases, while it was negative in the lining epithelium of DC. This difference was statistically significant (p<0.001). Moreover, the TRAP staining intensity in the lining epithelium had a significant difference between the groups (P<0.001). TRAP expression in the connective tissue of OKC, RC, and DC was positive in 35%, 30%, and 20% of the cases, respectively. This difference was not statistically significant (P=0.788). Also, staining intensity of TRAP-positive cells in the connective tissue of the lesions was not significant (P=0.634).
In this study, we found a higher expression of TRAP in the lining epithelium of OKC, which may be one of the reasons for the aggressive behavior of OKC compared to other cysts. This finding supports the classification of OKC as an odontogenic tumor.
Omega-3 Adjunctive Therapy in Idiopathic SSNHL: A Randomised, Triple-Blind, Placebo-Controlled Trial.
Laryngeal CancerIdiopathic Sudden Sensorineural Hearing Loss as a subset of sensorineural hearing loss will be confirmed by a progressive hearing loss of at least 30 dB at three contiguous frequencies over 72 hours or less. A sudden or abrupt hearing loss correlates with the time course, and a vascular event is presumptive aetiology. There is an inverse association between Omega-3 consumption and hearing loss. This study aimed to evaluate the efficacy of Omega-3 adjunctive therapy in Idiopathic Sudden Sensorineural Hearing Loss by audiometric assessments.
In this randomised, triple-blind, placebo-controlled trial, all participants aged 18-70 with a history of sudden deafness (within 12 hours and ≤ 30 days) were eligible for enrollment. They were included if audiology diagnostic tests confirmed the SSNHL. Ultimately, they were randomised to the Omega-3 group and the placebo group.
Thirty-three patients were randomly allocated to the Omega-3 group and thirty-two to the placebo group. Vertigo (32.3% of all patients) and underlying conditions had significant relationships with complete response (C.R.)-final hearing level ≤of 25 dB in pure-tone average (P < 0.05). There was no significant difference between both groups before and after treatment. Although it was not statistically significant, patients in the Omega-3 group had faster recovery than placebo.
Omega-3 adjunctive therapy did not have a therapeutic effect on SSNHL patients. Moreover, C.R. happened in half the patients. Vertigo and underlying conditions considerably worsen the recovery from SSNHL.
Identifying Affecting Factors on Acceptance with CPAP on the First Night of PAP Titration in Sleep Clinic on Patients with Obstructive Sleep Apnea.
Laryngeal CancerThis research examined the causes of low acceptance with Continuous Positive Airway Pressure Continuous Positive Airway Pressure (CPAP) especially anatomical causes and if eliminating them would result in increasing its adherence.
This cross sectional study was performed on patients with moderate to severe Obstructive Sleep Apnea Obstructive Sleep Apnea (OSA) undergoing PAP titration in the sleep clinic. CPAP acceptance was evaluated by visual analog scale (VAS) about mask and sleep satisfaction and the possibility of using CPAP in the future, mask complications, physical examination of the upper airway and polysomnographic (PSG) results before and after titration.
participants were divided into three groups of non-acceptant, semi-acceptant and acceptant with CPAP based on the satisfaction of the mask and sleep. There were no significant differences between groups based on age, gender, education, BMI and polysomnographic variables. With a study of mask complication, there were significant differences among groups for dry mouth, mask leakage and cold air. (p<0.05) The severity of septal deviation, high arch palate, mallampati, retrognathia and maxillary hypoplasia in the acceptant group was less than the other two groups, but it was not statistically significant.
Satisfaction with the sleep and the mask on the first night of titration will significantly increase the likelihood of using CPAP in the future. A number of the pathological physical examinations were lower in the acceptant group than two other groups, but were not significant.
Serum Level of Vitamin D in Patients with Salivary Gland Tumors.
Laryngeal CancerThe active vitamin D metabolites have anticancer effects on many human neoplasms. The vitamin D receptors have been detected in salivary glands tissue. This study aimed to evaluate the serum level of vitamin D in patients with malignant and benign salivary gland tumors.
In this retrospective and cross-sectional study, 151 participants, including 42 patients with benign, 42 malignant salivary gland tumors, and 67 healthy subjects, participated. The serum level of vitamin D was measured using an enzyme-linked immunosorbent assay (ELISA).
The mean serum level of vitamin D was 42.7 ng/mL in patients with benign tumors, 40 ng/mL in malignant tumors, and 36.7 ng/mL in the control group. There was no significant difference between the mean vitamin D level and vitamin D status in patients with salivary gland tumors and normal controls (P=0.2). There was a significant positive correlation between vitamin D level and age in the control group (P=0.04).
The results showed a high prevalence rate of vitamin D deficiency/insufficiency in salivary gland tumors and normal subjects, with no significant difference. Therefore, the serum level of vitamin D might not play a significant role in the pathogenesis of these tumors, similar to many human cancers. However, further prospective studies are recommended focusing on specific tumors and considering other interventional factors.
Nasopharyngeal Branchial Cyst and Thornwaldt Cyst in a Patient with Hearing Loss after Coronavirus Infection.
Laryngeal CancerThe majority of nasopharyngeal cysts are asymptomatic and rare. Nevertheless, these lesions are rarely discovered during regular endoscopies and imaging tests. An upper nasopharyngeal Thornwaldt cyst is a benign, mucosal congenital cyst. Even less frequently, they can cause unexplained sinonasal symptoms such as rhinorrhea, vision problems, and nasal blockage.
Here, we report a case with new-onset hearing loss after the coronavirus infection, in which his imaging investigation showed a nasopharyngeal mass.
After covid-19 infection we should consider branchial Cyst and Thornwaldt Cyst in a high-risk patients. On the other hand, the progressive hearing loss after covid-19 can occur due to activation of this kind of cysts.
Comparing the Patients with or without Inner Ear Malformations in Terms of Intra and Postoperative Complications of Cochlear Implantation.
Laryngeal CancerSince 20% of the patients with sensorineural hearing loss have confirmed radiographically inner ear malformation, this study aimed to compare the incidence rate of intra and postoperative complications of cochlear implantation amongst the patients with or without inner ear malformations.
In this retrospective study, we evaluated the medical record of 954 patients who had undergone cochlear implantation. Seventeen patients had inner ear malformations and were selected as the case group, and 25 patients with normal inner ear were selected as the control group. Patient's information; including intraoperative complications, post-operative complications and neural response telemetry (NRT) immediately after the surgery were recorded. Finally, the collected data were analyzed, using the SPSS software, version 21.
According to the CT-scan findings, the most observed internal ear abnormality was the temporal bone Mondini in 8 patients (47%), and the next inline was the common cavity at a frequency of (23.52%). Cerebrospinal fluid (CSF) gusher was detected in 11 patients (64.7%) of the case group, which was significantly higher than the other group. This includes mild CSF gusher in 7 cases (41.17%) and severe CSF gusher in 5 cases (29.41%). Interestingly, no significant post-operative complications were observed in either group, minor side effects were limited and not significantly different.
In conclusion, despite the limitations of cochlear implantation surgery amongst patients with inner ear malformation with potential risk of early or late complications, it can still be recommended as an appropriate procedure to acquire hearing as well as auditory and speech perception.
Necrosis of the Tongue as a Late Complication of Radiotherapy.
Laryngeal CancerIrradiation to treat head and neck cancer, causing chronic tissue damage, is associated with the development of vascular disease. Interest has risen over the effects of radiotherapy on major vessels, due to its high morbidity and mortality rate. However, small-vessel disease has been poorly studied and described.
We present a case of a patient with bilateral necrosis of the anterior third of the tongue, occurring 3 years after chemoradiotherapy treatment for squamous cell carcinoma of the floor of the mouth. Contrast-enhanced CT scan showed multiple areas of stenosis concerning both external carotid arteries and their branches, and total opacification of lingual arteries. Conservative management was performed, with auto-amputation on the fifth day, which allowed healing by secondary intention.
Necrosis of the tongue appears as a rare late complication of radiotherapy, possibly due to its acceleration effect on the atherosclerosis process. Following small-vessel disease, one can assume a higher potential risk of major-vessel disease, highlighting the importance of a routine assessment and prophylaxis of thrombotic events.
Frequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy.
Laryngeal CancerThe aim of this study was to investigate hearing outcome of stapes surgery, considering the post-operative air and bone conduction (AC&BC) changes, in a frequency specific approach.
This was a retrospective cohort study. A total of 245 ears (231 patients), who underwent Stapedotomy at our tertiary referral center in a period of 5 years were enrolled in the study. Pure tone audiometry (PTA) was evaluated preoperatively and one month postoperatively. AC, BC, and Air-bone gap (ABG) were documented. Moreover, one-year post-op PTA was also recorded for more than a quarter of the cases.
Overall, significant improvements were observed in AC thresholds with a mean AC gain of 20.44±13.64 dB. At higher frequencies the results were poorer (AC gain of 27 dB at 250 Hz vs 7 dB at 8000 Hz). ABG significantly improved at all frequencies after one month. BC thresholds were typically better after surgery. However, there appears to be a worsening trend in BC thresholds at frequencies higher than 2000 Hz. In 68 patients with 1-year follow-up, BC thresholds were slightly worse (but not statistically significant) at most frequencies, in comparison to the one-month results.
Stapes surgery significantly improves air and bone conduction hearing, particularly at lower frequencies. Nonetheless, there exists a potential for sensorineural hearing loss (SNHL) at high frequencies. However, the changes are insignificant and not within the speech frequencies. Therefore, patients are typically satisfied with the hearing outcome of the surgery.
Rhinosporidiosis- Epidemiological, Clinicoradiological, Immunological Profile.
Laryngeal CancerRhinosporidiosis is an enigmatic disease with many unsolved queries right from taxonomy to treatment. This study has been done to understand the disease characteristics with a peek into the lesser known immunological aspects of it by studying the changes in levels of certain primarily cell-mediated immunity (CMI)-specific cytokines in rhinosporidiosis patients.
A prospective observational study was performed. Detailed epidemiological and clinicoradiological assessment was done along with selected inflammatory and immunological markers. The tests for immunological parameters were done by ELISA and CLIA and data were compiled and analyzed using appropriate statistics.
Disease showed male predominance and all patients gave a universal pond bathing history. Majority patients had O+ve blood group. Right side was affected most with nasal obstruction being commonest symptom. Nasal cavity was involved in majority of cases with inferior turbinate and meatus being sites of maximum occurrence and attachment. Nasopharynx, oropharynx were other involved sites. Extra-nasal sites included skin and parotid gland. Endoscopic and CECT findings were similar and confirmed intraoperatively. Tests for inflammatory markers showed no significant change in patients. Immunological markers -IL-6, TNF-beta- levels showed significant increase though no such increase was found with IFN-gamma levels.
Rhinosporidiosis has a definite epidemiological and clinical-radiological profile. A clear association with exposure to contaminated water is present which could not be further associated with disease duration or recurrence. The immunological profile needs to be further investigated upon since it remains quite elusive.
The Effect of Corticosteroids on Post-Covid-19 Smell Loss: A Meta-Analysis.
Laryngeal CancerThe rate of olfactory loss related to COVID-19 was reported between 4-89 percent. There is no approved treatment for patients who experience anosmia after the mentioned infection. This systematic review aimed to assess the therapeutic effects of corticosteroids on anosmia in COVID-19 patients.
Databases including PubMed, ISI Web of Sciences, Scopus, and Cochrane Library. Databases were searched up to September 2022 to find out randomized controlled trials that assessed the effect of corticosteroids on post-COVID anosmia/hyposmia. Only studies published in the English language were entered in this review.
Among the six relevant trials with a total population of 712, one study administered the combination therapy of both systemic and nasal corticosteroids, while others used intranasal corticosteroids. No significant difference was observed between the intervention (IG) and control (CG) groups in terms of duration of improvement from anosmia (mean difference:-1.799). The pooled effect of self-rating olfactory scores was assessed at 2 weeks and at the end point of the studies which revealed no significant effect in favor of the IG (pooled effect in 2 weeks: 0.739; in the endpoint: 1.32). The objective evaluation with different tools indicated that IG obtained higher scores at the endpoint of treatment. The pooled results showed that the number of patients who recovered from anosmia is higher in IG compared to CG (Odds Ratio: 1.719).
It appears that the duration of corticosteroid therapy more than two weeks may be a considerable effect on the recovery of smell dysfunction in COVID-19 patients.
