Rare case of angiomyolipoma of the larynx.

We report a rare case of angiomyolipoma (AML) of the larynx. AML belongs to the family of perivascular epithelioid cell tumors (PEComas). We review the literature on PEComas and describe differences in immunohistochemical findings between renal AML and AML in the head and neck region.

The role of frozen section biopsy for submandibular gland tumors.

BACKGROUND: Although there have been several reports of the diagnostic accuracy of frozen section biopsy (FSB) for parotid gland tumors, few studies have focused on its diagnostic accuracy for submandibular gland tumors. AIM/OBJECTIVES: This study aimed to investigate the necessity of FSB with regard to its diagnostic accuracy for submandibular gland tumors (SGTs). MATERIALS AND METHODS: About 42 SGT patients underwent both fine-needle aspiration cytology (FNAC) and FSB between 2005 and 2020. The results of FNAC and FSB were analyzed and compared with the final histological diagnoses. RESULTS: The respective sensitivity and specificity in detecting malignant tumors in 38 cases, excluding the four indeterminate FNAC cases, they were 0 and 97% for FNAC, and 100 and 97% for FSB. Considering the four indeterminate FNAC cases to be malignant, the respective sensitivity and specificity in detecting malignant tumors in the 42 cases were 50 and 92% for FNAC, and 100 and 95% for FSB. CONCLUSIONS AND SIGNIFICANCE: FSB may be useful for malignancy detection as a final histological diagnosis in cases that are diagnosed as benign or indeterminate by FNAC in SGTs.

Regenerative potential of basic fibroblast growth factor contained in biodegradable gelatin hydrogel microspheres applied following vocal fold injury: Early effect on tissue repair in a rabbit model / Potencial regenerativo do fator básico de crescimento de fibroblastos contido em microesferas biodegradáveis de hidrogel de gelatina aplicadas após lesão de prega vocal: efeito inicial no reparo tecidual em modelo de coelho

Abstract Introduction Postoperative dysphonia is mostly caused by vocal fold scarring, and careful management of vocal fold surgery has been reported to reduce the risk of scar formation. However, depending on the vocal fold injury, treatment of postoperative dysphonia can be challenging. Objective The goal of the current study was to develop a novel prophylactic regenerative approach for the treatment of injured vocal folds after surgery, using biodegradable gelatin hydrogel microspheres as a drug delivery system for basic fibroblast growth factor. Methods Videoendoscopic laryngeal surgery was performed to create vocal fold injury in 14 rabbits. Immediately following this procedure, biodegradable gelatin hydrogel microspheres with basic fibroblast growth factor were injected in the vocal fold. Two weeks after injection, larynges were excised for evaluation of vocal fold histology and mucosal movement. Results The presence of poor vibratory function was confirmed in the injured vocal folds. Histology and digital image analysis demonstrated that the injured vocal folds injected with gelatin hydrogel microspheres with basic fibroblast growth factor showed less scar formation, compared to the injured vocal folds injected with gelatin hydrogel microspheres only, or those without any injection. Conclusion A prophylactic injection of basic fibroblast growth factor -containing biodegradable gelatin hydrogel microspheres demonstrates a regenerative potential for injured vocal folds in a rabbit model.

Resumo Introdução A disfonia pós-operatória é causada principalmente por cicatrizes nas pregas vocais. Tem sido relatado que o manejo cuidadoso da cirurgia das pregas vocais reduz o risco de formação de cicatriz. No entanto, a depender da lesão da prega vocal, o tratamento da disfonia pós-operatória pode ser desafiador. Objetivo Desenvolver uma nova abordagem regenerativa profilática para o tratamento de pregas vocais lesionadas após a cirurgia, com microesferas biodegradáveis de hidrogel de gelatina como sistema de administração de medicamentos para o Fator Básico de Crescimento de Fibroblastos (bFGF). Método A cirurgia laríngea videoendoscópica foi feita para criar lesão nas pregas vocais em 14 coelhos. Imediatamente após esse procedimento, microesferas biodegradáveis de hidrogel de gelatina com bFGF foram injetadas na prega vocal. Duas semanas após a injeção, as laringes foram excisadas para avaliação da histologia das pregas vocais e do movimento da mucosa. Resultados A presença de função vibratória deficiente foi confirmada nas pregas vocais lesionadas. A histologia e a análise de imagem digital demonstraram que as pregas vocais lesionadas injetadas com microesferas de hidrogel de gelatina com bFGF apresentaram menor formação de cicatriz, em comparação com as pregas vocais lesionadas injetadas apenas com microesferas de hidrogel de gelatina ou aquelas sem injeção. Conclusão Uma injeção profilática de microesferas biodegradáveis de hidrogel de gelatina com bFGF demonstra um potencial regenerativo para pregas vocais lesionadas em um modelo de coelho.

Regenerative potential of basic fibroblast growth factor contained in biodegradable gelatin hydrogel microspheres applied following vocal fold injury: Early effect on tissue repair in a rabbit model.

INTRODUCTION: Postoperative dysphonia is mostly caused by vocal fold scarring, and careful management of vocal fold surgery has been reported to reduce the risk of scar formation. However, depending on the vocal fold injury, treatment of postoperative dysphonia can be challenging. OBJECTIVE: The goal of the current study was to develop a novel prophylactic regenerative approach for the treatment of injured vocal folds after surgery, using biodegradable gelatin hydrogel microspheres as a drug delivery system for basic fibroblast growth factor. METHODS: Videoendoscopic laryngeal surgery was performed to create vocal fold injury in 14 rabbits. Immediately following this procedure, biodegradable gelatin hydrogel microspheres with basic fibroblast growth factor were injected in the vocal fold. Two weeks after injection, larynges were excised for evaluation of vocal fold histology and mucosal movement. RESULTS: The presence of poor vibratory function was confirmed in the injured vocal folds. Histology and digital image analysis demonstrated that the injured vocal folds injected with gelatin hydrogel microspheres with basic fibroblast growth factor showed less scar formation, compared to the injured vocal folds injected with gelatin hydrogel microspheres only, or those without any injection. CONCLUSION: A prophylactic injection of basic fibroblast growth factor -containing biodegradable gelatin hydrogel microspheres demonstrates a regenerative potential for injured vocal folds in a rabbit model.

Indications for partial superficial parotidectomy for benign parotid gland tumors using the retrograde approach.

A recent systematic review and meta-analysis suggest that retrograde parotidectomy is a safe procedure with no significant difference in facial nerve paralysis rates when compared to anterograde parotidectomy. The aim of the current study was to establish indications for partial superficial parotidectomy using the retrograde approach. To this end, the two surgical techniques were compared in terms of postoperative facial nerve paralysis, tumor size, location of the tumor, and surgical time. For tumor diameters of 30 mm or less, mean surgical time in the retrograde parotidectomy group was significantly shorter than in the anterograde parotidectomy group (p < 0.05). Our study indicates that retrograde parotidectomy may be more effective than anterograde parotidectomy for partial superficial parotidectomy for benign parotid tumors of 30 mm or less.

Spontaneous regression of chemotherapy-resistant metastases from a scalp angiosarcoma.

Angiosarcomas are rare malignant tumors derived from endothelial cells and occur most commonly in the scalp and the face. The prognosis is poor. Therefore, spontaneous regression of angiosarcoma is a rare phenomenon.We describe a case of a 73-year-old man with multiple metastatic angiosarcoma.In the present case, weekly paclitaxel therapy had an effect, but could not be continued because of interstitial pneumonia (IP). Weekly docetaxel therapy did not have an effect, but further chemotherapy was not carried out because aggravation of the IP was a concern.The primary lesion and other metastatic lesions were inconspicuous on the positron emission tomography/computed tomography scan performed in one year and two months after best supportive care.We reported an extremely rare case of spontaneous regression of therapy-resistant metastases of angiosarcoma that has remained controlled for 40 months since the initial diagnosis.

Effects of artificial tracheal fixation on tracheal epithelial regeneration and prevention of tracheal stenosis.

CONCLUSION: Tight fixation of the artificial trachea is important for epithelialization and tracheal stenosis. OBJECTIVE: The authors have developed an artificial trachea and have used it for tracheal reconstruction. Although various studies on tracheal reconstruction have been conducted, no studies have examined the effect of artificial tracheal fixation on tracheal stenosis and regeneration. Therefore, the purpose of the present study was to evaluate the effect of artificial tracheal fixation. STUDY DESIGN: Preliminary animal experiment. METHODS: Artificial tracheae were implanted into rabbits with partial tracheal defects. Tracheal stenosis and regeneration of the tracheal epithelium on the artificial tracheae were evaluated by endoscopic examination, scanning electron microscopic analysis, and histological examination. The artificial tracheae fixed to the tracheal defects were classified into three groups (0-point, 4-point, and 8-point) by the number of fixation points. RESULTS: At 14 and 28 days post-implantation, the luminal surface of the implantation area was mostly covered with epithelium in all fixation groups. However, a small amount of granulation tissue was observed in the 0-point fixation group at 14 days post-implantation. Moreover, tracheal stenosis did not occur in the 8-point fixation group, but stenosis was detected in the other groups.

Optimal bovine collagen concentration to achieve tracheal epithelial coverage of collagen sponges.

OBJECTIVES/HYPOTHESIS: Artificial tracheas prepared using a collagen sponge and polypropylene mesh have been implanted in patients who received tracheal resections, but epithelialization in the reconstructed area is slow. We determined the optimal bovine atelocollagen concentration necessary for the rapid and complete tracheal epithelial coverage of collagen sponge implants. STUDY DESIGN: Preliminary animal experiment. METHODS: Collagen sponges were prepared using lyophilizing 0.5%, 0.7%, and 1.0% atelocollagen solutions (0.5%, 0.7%, and 1.0% sponges) and were analyzed using scanning electron microscopy. Partial tracheal defects were prepared in rabbits and reconstructed using sponges. Epithelial regeneration in the reconstructed area was evaluated by endoscopic, histological, and scanning electron microscope analyses. RESULTS: All sponges had a membranous structural framework, and numerous fibrous structures filled the spaces within the framework in the 0.5% sponges. The membranous structure in the 0.7% sponges branched at many points, and intermembrane spaces were frequently observed. Conversely, the membranous structure in the 1.0% sponges was relatively continuous, thick, and closely arranged. Two weeks after implantation, tracheal defects were entirely covered with epithelium in two of the four and three of the four of the 0.5% and 0.7% sponge-implanted rabbits, respectively. The collagen sponges remained exposed to the tracheal lumen in four of the four rabbits in the 1.0% sponge group. Ciliogenesis in the center of the epithelialized region was detected only in the 0.7% sponge group. CONCLUSION: Collagen sponges prepared from various concentrations of bovine atelocollagen have different structures. Complete epithelial coverage was achieved in more rabbits implanted with sponges prepared using the 0.7% bovine atelocollagen solution than in those implanted with sponges prepared from the 0.5% and 1.0% solutions. LEVEL OF EVIDENCE: NA Laryngoscope, 126:E396-E403, 2016.

Effect of Structural Differences in Collagen Sponge Scaffolds on Tracheal Epithelium Regeneration.

OBJECTIVE: We developed an in situ regeneration-inducible artificial trachea composed of a porcine collagen sponge and polypropylene framework and used it for tracheal reconstruction. In the present study, collagen sponges with different structures were prepared from various concentrations of collagen solutions, and their effect on the regeneration of tracheal epithelium was examined. METHODS: Collagen sponges were prepared from type I and III collagen solutions. The structures of the sponges were analyzed using scanning electron microscopy (SEM). Artificial tracheae, which were formed using the collagen sponges with different structures, were implanted into rabbits, and regeneration of the tracheal epithelium on the artificial tracheae was evaluated by SEM analysis and histological examination. RESULTS: The SEM analysis showed that collagen sponges prepared from 0.5% and 1.0% collagen solutions had a porous structure. However, the sponges prepared from a 1.5% collagen solution had a nonporous structure. After implantation of artificial tracheae prepared from 0.5% and 1.0% collagen solutions, their luminal surfaces were mostly covered with epithelium within 14 days. However, epithelial reorganization occurred later on artificial tracheae prepared from the 1.5% collagen solution. CONCLUSION: Collagen sponges with a porous structure are suitable for regeneration of the tracheal epithelium in our artificial trachea.

Chemoselection combined with alternating chemoradiotherapy or surgery for hypopharyngeal cancer.

OBJECTIVES/HYPOTHESIS: In order to make possible organ preservation, since 2007 our hospital has performed induction chemotherapy (ICT) with cisplatin and 5-fluorouracil (PF) for hypopharyngeal cancer as chemoselection, followed by alternating chemoradiotherapy (ACRT) with docetaxel, cisplatin, and 5-fluorouracil in (TPF) good responders and curative surgery was used in poor responders. METHODS: Twenty-six patients with stage III to stage IVB hypopharyngeal cancer received ICT. Eleven of the patients were classified as poor responders and received curative surgery. The remaining 15 patients were classified as good responders. Three of these patients underwent curative surgery, and the remaining 12 underwent ACRT. RESULTS: The primary lesions in the 12 ACRT patients responded completely to treatment without severe late toxicities. The estimated 3-year laryngectomy-free rate for all 26 patients was 23%. The estimated 3-year overall survival rates for all 26 patients, 12 patients treated with ACRT, and 14 patients who underwent curative surgery, were 79%, 75%, and 84%, respectively. CONCLUSION: The patients who underwent ACRT showed no significant difference in overall survival compared with the patients who underwent curative surgery. All the patients were able to proceed with this series of therapy, indicating that ICT with PF could be a feasible tool for choosing good responders. Because ACRT with TPF had a high response rate and fewer severe toxicities, this treatment could be safe and have enough impact to control hypopharyngeal cancer in good responders. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1349-1353, 2016.