[Laryngeal Papillomatosis: A Statistical Analysis of 60 Cases].

Laryngeal papillomatosis is the most common benign neoplasm of the larynx. Juvenile onset laryngeal papillomatosis tends to recur. In patients with adult onset laryngeal papillomatosis, laryngeal cancer rarely develops. This paper reports a clinical analysis of 60 patients with laryngeal papillomatosis who were treated at our clinic between January 1971 and September 2009. We analyzed the sex ratio, age at the onset of papilloma, type of developing papilloma (single or multiple type), site of developing papilloma, recurrence rate, and therapeutic modalities. Furthermore, the clinical characteristics of the patients with malignant transformation were examined. The patients were classified according to their age at the onset of the papilloma and the type of developing papilloma. The patients were grouped into a juvenile-onset group and an adult-onset group according to their age at the onset of the papilloma. They were also classified into single-type or multiple-type according to whether the initial papilloma appeared singly or multiply. The male to female sex ratios were 1.2 in the juvenile-onset group and 5.1 in the adult-onset group. Among the patients who developed papilloma at an age of under 10 years old, most of the juvenile cases had experienced onset by 4 years of age. Furthermore, the frequency of multiple-type papilloma was significantly higher in the juvenile-onset group, compared with the adult-onset group. The vocal fold was the most frequent site of the papilloma. The recurrence rate in the juvenile-onset group was significantly higher than that of the adult-onset group. A stratified analysis according to the type of papilloma occurrence, however, showed no significant difference in recurrences between the juvenile-onset and adult-onset groups. A stratified analysis according to the age at the onset of papilloma showed that the recurrence rate of multiple-type papilloma was significantly higher than that of single-type papilloma in the adult-onset group. Among multiple therapeutic modalities, vaporization by carbon dioxide laser was the most frequently used. Adjuvant therapy was performed in 6 cases who suffered from multiple relapses. The injection of interferon was performed in 5 cases, and the local injection of cidofovir was performed in 1 case. Malignant transformation of the papilloma was confirmed in 3 cases. The periods between the onset of papilloma and the malignant transformation were 40 years, 14 years, and 3 years. The present study indicates that patients with laryngeal papilloma developing at multiple sites have a significantly higher rate of relapse, even in the adult-onset group. There was no tendency in the period observed between the onset of papilloma and malignant transformation. From the standpoint of recurrence and malignant transformation, patients with papillomatosis should be carefully followed up for a long period of time.

[A clinical study on cervical tuberculous lymphadenitis: the position of a low invasive needle aspiration procedure for the diagnosis of cervical tuberculous lymphadenitis].

OBJECTIVE: The diagnosis of cervical tuberculous lymphadenitis has been performed by histological examination using excisional biopsy specimens. However a non-invasive diagnostic procedure alternative to invasive excisional biopsy has been required and fine needle aspiration cytology as well the polymerase chain reaction (PCR) technique have become useful modalities. The aim of this study was to clarify the effectiveness of needle aspiration as a less invasive and more rapid diagnostic procedure than excisional biopsy. MATERIAL AND METHODS: Twenty-one excisinal biopsy specimens and 20 needle aspiration specimens were collected from 29 patients who were diagnosed as having cervical tuberculous lymphadenitis. The detection of mycobacterium tuberculosis with a smear microscopy was performed in 20 specimens, with the culture method in 20 and with the PCR test in 14 specimens. The histopathological positive rates, the detection ratio of mycobacterium, the rupture rate of the local skin lesion and the period necessary for diagnosis were compared between the two percutaneous approaches. RESULTS: The diagnosis of tuberculous lymphadenitis was successful in all cases either by cytological examination in 8 of 21 (40%) or with the histological approach in the other 21 cases. The detection ratios of smear, culture and PCR were 20%, 40% and 64%, respectively. The rupture rate of the local skin after the excisional biopsy was higher than that of the needle aspiration procedure (p = 0.05). The period for diagnosis was significantly longer than that of the needle aspiration procedure (p < 0.001). CONCLUSION: As a less invasive method of diagnosis of cervical tuberculous lymphadenitis, cytology as well as the detection of mycobacterium using an aspiration procedure is highly recommended.

Histiocytic sarcoma of the parotid gland region.

Histiocytic sarcoma (HS) is a malignant neoplasm showing the morphological and immunophenotypic features of mature histiocytes. Reported herein is a case of HS of the parotid gland region. A 53-year-old woman noticed a swelling of the right preauricular area. Preoperative fine needle aspiration cytology showed an admixture of pleomorphic atypical cells and mature lymphocytes. She underwent total parotidectomy. Grossly, the tumor was located at the parotid gland to subcutaneous tissue, and showed infiltrative growth with massive necrosis and hemorrhage. Microscopically, the tumor was composed of marked pleomorphic cells with eosinophilic cytoplasm. Bizarre multinuclear giant cells were scattered and intermingled. Tumor cells were positive for CD68 (KP-1 and PG-M1), CD163, S-100 protein, CD1a, CD4 and CD31, but negative for CD3, CD20, CD21, CD79a, DEC205 and langerin, immunohistochemically. Monoclonal proliferation of B cells was not confirmed on polymerase chain reaction for IgH. The patient had recurrent lesions in the pelvis and stomach 5 months after parotidectomy and died of the disease 10 months after the operation.