RESUMEN
Giant cell tumour is a growth predominantly found in long bones of the body. Giant cell tumour has a rare occurrence in the head and neck. A case of a 31 year old male with no known comorbidities at the ENT Department, Shifa International Hospital, Islamabad presented with anterior neck swelling and hoarseness of voice. Patient was diagnosed as having Giant Cell Tumour of Larynx (GTCL) proven on FNA cytology and post-operative biopsy. GCTL is an uncommon entity with only 45 reported cases in the world.
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Tumores de Células Gigantes , Cartílagos Laríngeos , Neoplasias Laríngeas , Humanos , Masculino , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/diagnóstico , Adulto , Tumores de Células Gigantes/cirugía , Tumores de Células Gigantes/patología , Tumores de Células Gigantes/diagnóstico , Cartílagos Laríngeos/patología , Ronquera/etiologíaRESUMEN
OBJECTIVES: Laryngeal Chondrosarcoma (LC) is a rare malignancy with limited studies documenting its clinicopathologic characteristics and treatment options. This study reports demographic and clinical determinants of outcomes for this rare tumor. METHODS: The National Cancer Database (NCDB) was queried for cases of LC reported from 2004-2016. 274 cases that met inclusion criteria were analyzed for demographic and clinicopathologic characteristics. Kaplan-Meier (KM) and Cox proportional hazard analyses were conducted to identify variables that impacted the overall survival of these patients. RESULTS: LC was found to be more common in males (74.8%). The mean age of patients was 61.8 years and 92.3% of the patients were white. 91.3% of patients were treated with only surgical resection, most commonly: partial laryngectomy (31.6%), total laryngectomy (25.7%), and local resection (22.4%). 98.8% of patients had no evidence of nodal disease and 99.6% of patients did not have distant metastasis at presentation. KM analysis revealed a 5-year overall survival (5YOS) of 89.0%. Age, insurance status, facility type, and surgery type were significant predictors of 5YOS (p<0.05). On Cox Proportional Hazard analysis, private insurance significantly improved survival (HR 0.21; p = 0.048) while increasing age was a poor prognostic indicator (HR 1.10; p = 0.004). CONCLUSION: The majority of LC patients present with no nodal involvement or distant metastasis at diagnosis, and overall this tumor has a favorable prognosis. Increasing age was found to be a poor prognostic factor while private insurance status was associated with improved survival.
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Neoplasias Óseas/epidemiología , Condrosarcoma/epidemiología , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/epidemiología , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Quimioradioterapia Adyuvante , Quimioterapia Adyuvante , Condrosarcoma/patología , Condrosarcoma/cirugía , Femenino , Humanos , Cartílagos Laríngeos/cirugía , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Laringectomía , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Distribución por SexoRESUMEN
Purpose of this review of medical literature is to present the immediate side effects of radiation therapy for head and neck cancer and their treatment. The likelihood and severity of these immediate side effects depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Early side effects include: inflammation of the oropharyngeal mucosa (mucositis), painful swallowing (odynophagia), difficulty swallowing (dysphagia), hoarseness, lack of saliva (xerostomia), orofacial pain, laryngeal radionecrosis, dermatitis, hair loss, nausea, vomiting, inadequate nutrition and hydration, and weight loss. These complications can interfere with, and delay treatment. Most of these side effects generally dissipate over time. In conclusion, radiation treatment for the head and neck cancer causes significant early side effects. Many of these side effects present difficult challenges to the patients. Their recognition and treatment can significantly improve the patients' health, long-term survival and quality of life. The review provides information that can assist head and cancer survivors deal with radiation side effects.
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Neoplasias de Cabeza y Cuello/radioterapia , Radioterapia/efectos adversos , Alopecia/etiología , Encéfalo/efectos de la radiación , Trastornos de Deglución/etiología , Trastornos de Deglución/prevención & control , Deshidratación/etiología , Deshidratación/prevención & control , Disgeusia/etiología , Disgeusia/prevención & control , Dolor Facial/etiología , Dolor Facial/terapia , Fatiga/etiología , Fatiga/prevención & control , Humanos , Cartílagos Laríngeos/patología , Mucosa Bucal/patología , Mucositis/etiología , Mucositis/prevención & control , Náusea/etiología , Náusea/prevención & control , Necrosis/etiología , Necrosis/terapia , Enfermedades Periodontales/etiología , Enfermedades Periodontales/prevención & control , Radiodermatitis/etiología , Radiodermatitis/prevención & control , Vómitos/etiología , Vómitos/prevención & control , Pérdida de Peso , Xerostomía/etiología , Xerostomía/prevención & controlRESUMEN
BACKGROUND: Myeloma of laryngeal cartilage (MLC) is a rare plasma cell neoplasm which has not been well characterized. However, it is an important differential diagnosis of laryngeal cartilage mass as it can indicate the presence of underlying systemic hematological diseases, such as multiple myeloma (MM), that is associated with poor prognosis. This article is the first of its kind and aims to educate clinicians on future diagnosis and management of similar cases. METHODS: Search of MLC was performed on the medical literature databases of Medline, PUBMED, and EMBASE. Additionally, institutional database at Gold Coast University Hospital Radiology Department was queried for relevant cases. Based on 16 cases that met the inclusion criteria, the etiology, epidemiology, clinical evaluation, investigations, management, and prognosis of MLC was summarized. RESULTS: Of all, 94% of MLC occur in males and 81% in those older than 60 years. It is more commonly a manifestation of systemic MM, rather than localized extramedullary plasmacytoma (EMP), 81% and 19% respectively. Additionally, 67% of laryngeal EMPs progress to MM within 3 years from initial diagnosis. Although treatments involving both local and systemic therapy were effective at relieving local symptoms, 39% of MLC patients died during the follow-up period-all of which were due to septicemia caused by secondary infections. CONCLUSION: Myeloma of laryngeal cartilage is a relatively rare condition that requires accurate diagnosis in order to promptly manage the potentially underlying systemic hematological disease. Currently, more case reports and analytical studies are required to provide evidence-based guidance on etiology, diagnosis, and management of this condition.
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Cartílagos Laríngeos/patología , Neoplasias Laríngeas/diagnóstico , Mieloma Múltiple/diagnóstico , Plasmacitoma/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
OBJECTIVE: Fibrosis and scar formation following laryngeal repairing is a major concern. This study evaluated the efficacy of applying amniotic membrane (AM) as a biologic dressing to reduce fibrosis and inflammation and promote cartilage repair. STUDY DESIGN: Experimental animal study. METHODS: Nine male white Dutch rabbits were selected. A standard defect (5 mm) was created in right and left thyroid lamina. In the right side, two layers of AM were applied while the left side was kept intact for future comparison. Histologic examination with criteria of inflammation, fibrosis, and cartilage regeneration was performed 2, 4, and 6 weeks following AM application. All procedures were done according to animal ethics rules. RESULTS: Histologic and gross examination showed that AM application was able to reduce inflammation and fibrosis and improve cartilage regeneration significantly. CONCLUSION: As a useful intervention, AM application can reduce inflammation and fibrosis and enhance cartilage regeneration, following laryngeal defect repair. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E527-E533, 2021.
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Apósitos Biológicos , Enfermedades de la Laringe/cirugía , Animales , Modelos Animales de Enfermedad , Cartílagos Laríngeos/patología , Cartílagos Laríngeos/cirugía , Enfermedades de la Laringe/patología , Laringe/patología , Laringe/cirugía , Masculino , Conejos , Herida Quirúrgica/patología , Herida Quirúrgica/terapia , Cicatrización de HeridasRESUMEN
OBJECTIVE: The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck. METHODS: A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded. RESULTS: Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, P < .00001). Patients with OM were more likely to develop distant metastasis (OR = 5.65, 95% CI = 3.36-9.51, P < .00001). CONCLUSIONS: Patients with advanced T-stage laryngeal SCC should undergo elective neck treatment. More aggressive treatment for patients with history of OM should be considered due to the risk of subsequent regional and distant metastasis. LEVEL OF EVIDENCE: II.
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Carcinoma de Células Escamosas/patología , Neoplasias Laríngeas/patología , Metástasis Linfática , Humanos , Cartílagos Laríngeos/patología , Disección del Cuello , Invasividad NeoplásicaRESUMEN
Finland has one of the highest homicide rates in Western Europe, and almost every tenth homicide is caused by asphyxiation. Reliable statistics, a strict legislation, and an exceptionally high medico-legal autopsy rate formed a base for a nationwide analysis of asphyxia homicides (n = 383) during 30 years. The cases were identified through multiple records, and all the forensic pathology case files were studied in detail. In more than one out of five cases, there were indications of staging, and the homicide was revealed first at autopsy in close to one in ten cases. The vast majority of the homicides took place in private locations and involved persons known to each other. Every third victim was an intimate partner, and every tenth a child. Almost half of the victims died from manual strangulation, one in three from ligature strangulation. Smothering, choking, neck compression with a firm object, and thoracic compression were more rare methods. Drownings were excluded from this study material. Of all the victims, 7% had no observable external injuries. Petechiae were recorded in approximately in 61%, laryngohyoid fractures in 47%, and vocal cord hemorrhages in 16% of the cases. Every tenth female victim had genital injuries. Toxicological analyses were performed in close to all of the cases, and almost three out of four victims tested positive for blood alcohol. The various aspects of the demographics and autopsy findings covered in this study contribute reliable and accurate data to further strengthen the spectrum of observable medico-legal characteristics of asphyxia homicides.
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Asfixia/mortalidad , Víctimas de Crimen/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Asfixia/patología , Nivel de Alcohol en Sangre , Niño , Preescolar , Femenino , Finlandia/epidemiología , Medicina Legal , Fracturas Óseas/patología , Fracturas del Cartílago/patología , Genitales Femeninos/lesiones , Genitales Femeninos/patología , Hemorragia/patología , Humanos , Hueso Hioides/lesiones , Hueso Hioides/patología , Lactante , Recién Nacido , Cartílagos Laríngeos/lesiones , Cartílagos Laríngeos/patología , Masculino , Persona de Mediana Edad , Motivación , Púrpura/patología , Estudios Retrospectivos , Distribución por Sexo , Detección de Abuso de Sustancias , Pliegues Vocales/patología , Adulto JovenAsunto(s)
Enfermedades de los Cartílagos/diagnóstico , Cartílagos Laríngeos/patología , Pliegues Vocales/patología , Trastornos de la Voz/etiología , Enfermedades de los Cartílagos/complicaciones , Condrocitos/patología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Voz/fisiología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatologíaAsunto(s)
Ciclofosfamida/administración & dosificación , Disnea , Cartílagos Laríngeos/patología , Laringoestenosis , Metotrexato/administración & dosificación , Policondritis Recurrente , Prednisolona/administración & dosificación , Ruidos Respiratorios , Antirreumáticos/administración & dosificación , Biopsia/métodos , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Femenino , Humanos , Laringoscopía/métodos , Laringoestenosis/etiología , Laringoestenosis/patología , Laringoestenosis/fisiopatología , Laringoestenosis/terapia , Policondritis Recurrente/diagnóstico , Policondritis Recurrente/fisiopatología , Policondritis Recurrente/terapia , Ruidos Respiratorios/diagnóstico , Ruidos Respiratorios/genética , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS: Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS: CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION: Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.
Asunto(s)
Cartílagos Laríngeos/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Cartílago Aritenoides/diagnóstico por imagen , Cartílago Aritenoides/patología , Medios de Contraste/administración & dosificación , Cartílago Cricoides/diagnóstico por imagen , Cartílago Cricoides/patología , Femenino , Humanos , Yohexol/administración & dosificación , Yohexol/análogos & derivados , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/patologíaRESUMEN
PURPOSE: The aim of this study was to evaluate magnetic resonance imaging (MRI) findings in cases of fatal manual or ligature strangulation. Verification of strangulation by computed tomography (CT), MRI, and at autopsy as well as its detectability in each modality was assessed. METHODS: We retrospectively analyzed 6 manual and ligature strangulation cases between 2013 and 2019 who all underwent a whole-body CT, head and neck MRI, and an autopsy. Two radiologists examined head and neck imaging data and compared the data to autopsy findings. RESULTS: Magnetic resonance imaging showed a high efficiency in verifying intramuscular hemorrhages, which were confirmed in autopsy. Moreover, in one case without a visible strangulation mark, soft tissue injuries associated with strangulation were detected. Fractures, especially thyroid cartilage fractures, were successfully diagnosed by CT. CONCLUSIONS: As MRI showed a successful detection of soft tissue lesions in relation to strangulation, it can serve as an alternative method or provide additional value to an autopsy. Intramuscular hemorrhages are a common finding in manual and ligature strangulation, providing a useful sign of applied pressure on the neck. However, to evaluate fractures, an additional CT or autopsy is recommended.
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Asfixia/diagnóstico por imagen , Asfixia/patología , Imagen por Resonancia Magnética , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/patología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Autopsia/métodos , Edema Encefálico/diagnóstico por imagen , Edema Encefálico/patología , Edema/diagnóstico por imagen , Edema/patología , Femenino , Patologia Forense , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/patología , Fracturas del Cartílago/diagnóstico por imagen , Fracturas del Cartílago/patología , Hemorragia/diagnóstico por imagen , Hemorragia/patología , Humanos , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/lesiones , Hueso Hioides/patología , Cartílagos Laríngeos/diagnóstico por imagen , Cartílagos Laríngeos/lesiones , Cartílagos Laríngeos/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Masculino , Músculos del Cuello/diagnóstico por imagen , Músculos del Cuello/patología , Enfisema Pulmonar/diagnóstico por imagen , Enfisema Pulmonar/patología , Estudios Retrospectivos , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/patología , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/patología , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/lesiones , Cartílago Tiroides/patología , Imagen de Cuerpo Entero , Adulto JovenRESUMEN
This study assessed the role of 18F-FDG PET-CT (PET/CT) to detect the cartilage and paraglottic infiltration in advanced glottic cancer comparing the results with those of conventional imaging (CI) (contrast-enhanced computed tomography and/or magnetic resonance). In addition, we assessed the prognostic value of quantitative parameters, measured on baseline PET/CT, in terms of event-free survival (EFS) and overall survival (OS). We retrospectively analyzed 27 patients with glottic squamous cell carcinoma stage III and IVA, treated in our institute between 2010 and 2016, comparing PET/CT, performed for staging and radiotherapy planning, and CI findings. Cohen's K was used to compare concordance between PET/CT and CI. Imaging findings were correlated with endoscopic evaluation and histological reports (gold standard (GS)). All lesions shown by CI were also detected by PET/CT imaging, and in 5 cases, a better definition of local infiltration was achieved with PET/CT than CI (5 CT). Sensitivity, specificity, and accuracy of PET/CT and CT were 95%, 86%, and 93% and 70%, 86%, and 74% for, respectively. MRI showed sensitivity and specificity of 100%. One false-negative (FN) cases and 1 false-positive (FP) case were observed with PET/CT with no difference compared to MRI (10 cases). Six FN cases and 1 FP case were observed with CT. Cohen's K was 0.60 (PET vs. CI) and 0.80 (PET vs. GS). Patients were followed-up for at least 24 months to calculate EFS and OS. 13 local recurrence and 7 deaths were recorded. Among quantitative PET parameters, baseline MTV was the most powerful predictor of outcome. Our data suggest a reliable sensitivity and accuracy of PET/CT in the evaluation of local extension, proving a useful method for initial local staging in addition to the well-established role in lymph-node and distant sites assessment. Furthermore, pretreatment MTV provides better prognostic information than other PET/CT parameters.
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Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Glotis/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Cartílagos Laríngeos/diagnóstico por imagen , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico por imagen , Supervivencia sin Progresión , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: The tissues of the laryngeal region only rarely harbor primary cartilaginous lesions, and squamous cell carcinoma remains the most frequently encountered malignant tumor in this area. MATERIALS AND METHODS: We reviewed the salient histological features of cartilaginous laryngeal lesions to provide differential diagnostics and guidelines for distinguishing the benign from the malignant ones. RESULTS: Cartilaginous neoplasms of the larynx include chondroma and chondrosarcoma. Among the overarching group of all forms of laryngeal sarcoma, chondrosarcoma forms the most common entity in the larynx, followed by rhabdomyosarcoma. Cartilaginous tumors comprise about 0.1%-1% of all laryngeal neoplasms with chondrosarcomas being more frequently encountered than chondromas. Several neoplasms earlier reported as giant-cell tumors of the larynx would most likely, using current terminology, be classified as cases of undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma, giant-cell variant) or aneurysmal bone cyst. CONCLUSION: When true laryngeal sarcomas do exist, they may prove to be challenging lesions both for the pathologist and the treating clinician. The diagnostic problems are mainly a result of the infrequent exposure of clinicians and diagnosticians to these lesions.
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Carcinoma de Células Escamosas/diagnóstico , Condroma , Condrosarcoma , Cartílagos Laríngeos/patología , Neoplasias Laríngeas , Neoplasias de los Tejidos Blandos , Biopsia/métodos , Neoplasias Óseas/diagnóstico , Condroma/diagnóstico , Condroma/patología , Condroma/terapia , Condrosarcoma/diagnóstico , Condrosarcoma/patología , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Laríngeas/clasificación , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Pronóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/terapiaRESUMEN
Hanging can be suicidal, accidental, or homicidal, and these backgrounds must be discriminated by police and forensic pathologists. We herein report a case involving a 33-year-old man who was found dead on the floor behind the entrance door of an apartment house. The man's brother declared that he had found him hanging in the gap between the stairs on the top floor. When his brother tried to cut him down, the victim fell three floors down through the gap between the stairs. Autopsy was performed to confirm suicidal hanging and a postmortem fall into the narrow gap. In this case, however, a homicide was suspected, and the version of events told by the victim's brother was initially doubted. Homicidal hanging may be uncommon, but intensive scene investigation and thorough autopsy are necessary in hanging cases to rule out homicide.
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Asfixia/patología , Homicidio , Traumatismos del Cuello/patología , Suicidio , Adulto , Acuaporinas/metabolismo , Epidermis/metabolismo , Medicina Legal/métodos , Fracturas del Cartílago/patología , Humanos , Cartílagos Laríngeos/lesiones , Cartílagos Laríngeos/patología , Masculino , Coloración y EtiquetadoRESUMEN
RATIONALE: Cartilaginous tumors of the larynx are rare. This report describes an atypical case with chondroma of laryngeal cartilage presenting as cervical mass, which was misdiagnosed as a thyroid tumor. PATIENT CONCERN: A 73-year-old Chinese man with a 1-month history of cervical mass. The neck color Doppler ultrasound and CT of thyroid showed a space-occupying lesion in the upper right pole of the thyroid gland. DIAGNOSES: Chondroma of laryngeal cartilage was confirmed at the time of surgery. INTERVENTIONS: After relevant examinations, subtotal thyroidectomy and excisional biopsy of the neck mass were performed under general anesthesia. However, the rapid pathology of the tumor (thyroid right lateral lobe) indicated chondroma, so the patient underwent laryngeal chondroma resection and tracheotomy under general anesthesia. OUTCOMES: After surgery, given the advanced age of the patient, long surgical duration and poor cardiorespiratory function, the patient suffered sudden cardiac death after the operation. LESSONS: Cartilaginous tumor of the larynx is rare, and approximately 250 cases have been reported till date. It is difficult to diagnose cartilaginous tumors of the larynx in the early stage, and they are easily misdiagnosed. Early diagnosis, radical surgery, and long-term follow-up are key to prolong survival.
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Condroma/diagnóstico , Cartílagos Laríngeos , Neoplasias Laríngeas/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Anciano , Condroma/patología , Diagnóstico Diferencial , Humanos , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/patología , MasculinoRESUMEN
Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described "gas bubble sign" may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this "vital sign" in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another "vital sign", gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman's fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking.
Asunto(s)
Asfixia/diagnóstico por imagen , Autopsia , Imagen por Resonancia Magnética , Traumatismos del Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Asfixia/patología , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/patología , Fracturas del Cartílago/diagnóstico por imagen , Fracturas del Cartílago/patología , Hemorragia/diagnóstico por imagen , Hemorragia/patología , Humanos , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/lesiones , Hueso Hioides/patología , Cartílagos Laríngeos/diagnóstico por imagen , Cartílagos Laríngeos/lesiones , Cartílagos Laríngeos/patología , Traumatismos del Cuello/patología , Cambios Post Mortem , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/patología , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/lesiones , Cartílago Tiroides/patologíaRESUMEN
Chondrosarcomas are rare primary malignant bone tumors that involve the head and neck region in 1% to 12% of cases. Central conventional chondrosarcoma is the most common subtype and is associated with isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) gene mutations in 50% to 60% of cases. We aimed to define the frequency of IDH1 and IDH2 gene mutations in a multicenter series of 88 cases of chondrosarcoma of the head and neck, including tumors involving the base of the skull (n = 30), the facial skeleton (n = 11), and the laryngeal and tracheal cartilages (n = 47). Petrous bone and cricoid cartilage were the most frequently involved sites for chondrosarcomas of the skull base and laryngotracheal tract (43.3% and 31.9%, respectively). Overall, 64.9% of craniofacial chondrosarcomas featured IDH mutations, with a high rate for skull base tumors (85.7%) but no IDH mutations in tumors of the facial skeleton. This different mutational profile could be related to the type of ossification, the bones of the base of the skull mainly resulting from endochondral ossification, and those of the face from intramembranous ossification. Conversely, mutation was infrequent in chondrosarcomas involving the laryngeal and tracheal cartilages (11.8% of 47 cases). Evaluation of IDH mutation status may be a useful diagnostic tool for bone tumors of the skull base, which are most often assessable with only small biopsy samples. The low rate of IDH mutations observed in laryngotracheal chondrosarcomas suggests a different mode of tumorigenesis needing further exploration.
Asunto(s)
Neoplasias Óseas/genética , Neoplasias Óseas/patología , Condrosarcoma/genética , Condrosarcoma/patología , Isocitrato Deshidrogenasa/genética , Adulto , Anciano , Anciano de 80 o más Años , Análisis Mutacional de ADN , Huesos Faciales/patología , Femenino , Humanos , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/genética , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Tráquea/genética , Neoplasias de la Tráquea/patologíaRESUMEN
Laryngohyoid fractures in hanging victims are one of the most studied and paradoxically contradictory topics in forensic pathology. According to literary sources, the incidence of laryngohyoid fractures in hanging varies significantly, from 0% to 100%. To verify the diagnostic significance of these injuries in hanging, we prospectively and consecutively analyzed the occurrence of laryngohyoid fractures in a group of 178 suicidal hanging victims (M/F=150/28, aged 14-94years, mean age=50, complete suspension=111 cases, partial suspension=67 cases) in relation to selected variables (age, sex, weight, the completeness of body suspension, and ligature knot location). Altogether, we identified the following types of laryngohyoid fractures in 129 of 178 cases (72.5%): isolated fracture(s) to the thyroid cartilage in 60 cases (33.7%), combined thyrohyoid fractures in 41 cases (23.0%), isolated fracture(s) to the hyoid bone in 28 cases (15.7%), and no fractures to the cricoid cartilage or the cervical vertebrae. The highest frequency of laryngohyoid fractures was found in lateral hangings (right lateral: 26/34, 76.5%; left lateral: 31/37, 83.8%), whereas the lowest rate was found in anterior hangings (4/11, 36.4%). In lateral hangings, fractures more often occurred contralaterally to the suspension point. Statistical analysis revealed significant associations of the occurrence of laryngohyoid fractures with the age of the victim (p=0.028), with the position of the ligature knot on the neck (p=0.019) and with the age-corrected weight of the victim (p=0.026). In addition, we performed a systematic updated review and critical appraisal of relevant literary sources to report the incidence, fracture patterns, and contributing variables of laryngohyoid injuries in hanging. Both the results of our study and the provided literary synthesis show that if evaluated properly, laryngohyoid fractures in hanging may diagnostically offer far more than just evidence that injury to the neck occurred and may also present research opportunities regarding several issues that should be further analyzed and explained.
Asunto(s)
Asfixia/patología , Fracturas Óseas/patología , Fracturas del Cartílago/patología , Hueso Hioides/lesiones , Cartílagos Laríngeos/lesiones , Traumatismos del Cuello/patología , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Peso Corporal , República Checa/epidemiología , Femenino , Patologia Forense , Humanos , Hueso Hioides/patología , Cartílagos Laríngeos/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Dual-energy CT can distinguish iodine-enhanced tumors from nonossified cartilage and has been investigated for evaluating cartilage invasion in patients with laryngeal and hypopharyngeal squamous cell carcinomas. In this study, we compared the diagnostic accuracy of MR imaging and of a combination of weighted-average and iodine overlay dual-energy CT images in detecting cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinomas, in particular thyroid cartilage invasion. MATERIALS AND METHODS: Fifty-five consecutive patients who underwent 3T MR imaging and 128-slice dual-energy CT for preoperative initial staging of laryngeal or hypopharyngeal squamous cell carcinomas were included. Two blinded observers evaluated laryngeal cartilage invasion on MR imaging and dual-energy CT using a combination of weighted-average and iodine-overlay images. Pathologic findings of surgically resected specimens were used as the reference standard for evaluating sensitivity, specificity, and the areas under the receiver operating characteristic curve of both modalities for cartilage invasion by each type of cartilage and for all cartilages together. Sensitivity and specificity were compared using the McNemar test and generalized linear mixed models. RESULTS: Dual-energy CT showed higher specificity than MR imaging for diagnosing all cartilage together (84% for MR imaging versus 98% for dual-energy CT, P < .004) and for thyroid cartilage (64% versus 100%, P < .001), with a similar average area under the curve (0.94 versus 0.95, P = .70). The sensitivity did not differ significantly for all cartilages together (97% versus 81%, P = .16) and for thyroid cartilage (100% versus 89%, P = .50), though there was a trend toward increased sensitivity with MR imaging. CONCLUSIONS: Dual-energy CT showed higher specificity and acceptable sensitivity in diagnosing laryngeal cartilage invasion compared with MR imaging.
Asunto(s)
Neoplasias Hipofaríngeas/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Metástasis de la Neoplasia/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Hipofaríngeas/patología , Cartílagos Laríngeos/diagnóstico por imagen , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Curva ROC , Sensibilidad y Especificidad , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/patologíaRESUMEN
OBJECTIVE: to study larynx chondroradionecrosis related to radiotherapy and chemotherapy treatment and provide a treatment flowchart. METHODS: retrospective study with clinical data analysis of all larynx cancer patients admitted in a two tertiary hospital in a five years period. RESULTS: from 131 patients treated for larynx cancer, 28 underwent chemoradiotherapy with curative intent and three of them presented chondroradionecrosis. They were treated with hiperbaric oxigen therapy and surgical debridment following our flowchart, preserving the larynx in all. CONCLUSIONS: the incidence of chondroradionecrosis as a complication of chemoradiotherapy in our series was 10,7% and the treatment with hiperbaric oxigen therapy, based in our flowchart, was effective to control this complication.
OBJETIVO: estudar a condroradionecrose de laringe por complicação de radio-quimioterapia para tratamento do câncer de laringe e propor um fluxograma de tratamento com a utilização de câmara hiperbárica. MÉTODOS: estudo retrospectivo de pacientes portadores de carcinoma de laringe admitidos em dois hospitais terciários num período de cinco anos. RESULTADOS: de 131 pacientes portadores de câncer de laringe, 28 foram submetidos à radio e quimioterapia exclusiva e destes, três evoluíram com condroradionecrose. O tratamento destes pacientes foi realizado com câmara hiperbárica e com desbridamento cirúrgico, conforme proposição do fluxograma. Todos os pacientes tiveram a laringe preservada. CONCLUSÃO: a incidência de condroradionecrose de laringe por complicação de radioterapia e quimioterapia em nossa casuística foi de 10,7% e o tratamento com oxigenoterapia hiperbárica, com base no nosso fluxograma, foi efetivo no controle desta complicação.