Laryngeal tuberculosis: A report of 17 cases.

OBJECTIVE: The aim of this study was to reduce misdiagnosis and inappropriate treatment of laryngeal tuberculosis. METHODS: Between April 2009 and March 2013, 1660 inpatients with tuberculosis were treated at the Osaka Prefectural Medical Center for Respiratory and Allergic Diseases. Seventeen of these patients were diagnosed with laryngeal tuberculosis. Criteria used for diagnosis were findings of histologic examination of biopsy specimens (2 patients) or clinical response of granuloma to antituberculosis therapy (15 patients). Medical records were used for this retrospective study. RESULTS: Patients' age ranged from 30 to 84 years with an average of 51.4±14.0 years (mean±SE); nine were men and eight were women. The most frequent chief complaint was hoarseness (n=15). Thirteen patients had persistent cough before they showed otolaryngologic symptoms. Endoscopic findings were categorized into five types of lesions: perichondritic (n=6), ulcerative (n=6), granulomatous (n=6), polypoid (n=1) and nonspecific inflammatory (n=1). Laryngeal tuberculosis showed as a single lesion in one patient and as multiple lesions in the other patients. The most commonly involved site was the true vocal cord (n=16, 94.1%), while 16 patients showed radiographic evidence of active pulmonary tuberculosis. These results indicate that deterioration of the lesions tended to result in the occurrence of multiple lesions. CONCLUSION: While morbidity in tuberculosis has been decreasing in Japan, a significant number of patients still has laryngeal tuberculosis in association with advanced pulmonary tuberculosis. If a patient has a protracted cough, laryngeal tuberculosis should be taken into consideration for differential diagnosis. Pulmonary imaging study should be performed for early diagnosis and to prevent the infection from spreading.

Clinicopathological factors related to cervical lymph node metastasis in a patient with carcinoma of the oral floor.

CONCLUSION: Tumors developing into the muscle layer and tumor thickness > or =5 mm are the most important risk factors associated with nodal metastasis. OBJECTIVE: It is necessary to identify the risk factors associated with cervical metastasis in patients with oral floor cancer to reveal the role of elective neck dissection for oral floor cancer. PATIENTS AND METHODS: Forty-eight patients with oral floor cancer were retrospectively analyzed for a correlation between clinicopathologic factors and cervical lymph node metastasis using Fisher's exact test and a logistic regression test. RESULTS: Univariate analysis showed significantly positive correlations for growth type, mitosis, perineural invasion, vascular invasion, lymphatic invasion, depth, thickness, and infiltration growth ratio. Multivariate analysis had a significantly positive correlation with nest formation and depth in all patients, and with thickness in patients with T1 or T2. In patients with bilateral cervical lymph node metastasis, lymph node metastasis was significantly positively correlated with perineural invasion.