Malignant salivary gland tumours of the larynx: a single institution review.

Malignant salivary gland tumours of the larynx are very rare, with limited reports of clinical outcomes. We present the decade-long experience of a single institution. A 10-year retrospective chart review of a tertiary head and neck cancer centre was performed. Index patients were identified from a review of a pathology database, and reviewed by a head and neck pathologist. Patient demographics, presenting signs and symptoms, treatment modalities and clinical outcomes were extracted from electronic medical records. Six patients were included, with an age range of 44 to 69. All six had malignant laryngeal salivary gland tumours. Pathologies included: three adenoid cystic carcinoma (2 supraglottic, 1 subglottic), one mucoepidermoid carcinoma (supraglottic), one epithelial-myoepithelial carcinoma (supraglottic) and one adenocarcinoma (transglottic). All were treated with surgery (2 endolaryngeal, 4 open) and five of six with the addition of adjuvant therapy (4 radiotherapy, 1 concurrent chemoradiation). One patient had smoking history; no patients had significant alcohol history. With 4.5 years of median follow-up, none of the patients has had recurrence or local/distant metastasis. Salivary gland tumours of the larynx present in mid to late-age, and can be successfully managed with a multi-modality approach, resulting in excellent local and regional control rates.

Non-epithelial tumors of the larynx: a single institution review.

AIM: Non-epithelial tumors of the larynx are rare and encompass a wide range of pathology. We present the decade-long experience of a single institution to define clinical presentations and outcomes. MATERIAL AND METHODS: This is a ten year retrospective chart review of a tertiary head and neck cancer center. Index patients were identified from a review of a pathology database, and patient demographics, presenting signs and symptoms, treatment modalities, and clinical outcomes were extracted from electronic medical records. Epithelial tumors (squamous cell carcinoma, spindle cell carcinoma, and salivary tumors), granulomas, sarcoidosis, papilloma, and amyloidosis were all excluded. RESULTS: Twenty-four patients with ages ranging from 2months-old to 84years were identified. Malignant lesions (11) included chondrosarcoma (6), Kaposi's sarcoma (2), metastatic melanoma, synovial cell sarcoma, and T cell neoplasm. Six were operated upon endolaryngeally, but four required either upfront or salvage total laryngectomy. Two received adjuvant therapy. Benign lesions (13) included hemangioma (4), granular cell tumor (3), myofibroblastic tumor (2), schwannoma (2), chondroma, and ossifying fibromyxoid tumor. Nine underwent endolaryngeal operations, and four were managed medically or with observation. None have required aggressive open resection or total laryngectomy. CONCLUSION: Treatment approach of non-epithelial tumors of the larynx depends on the site and extent of the tumor, histology, and sensitivity of adjuvant therapy. Benign tumors can be managed without need for aggressive resection thereby sparing laryngeal function.

The use of antibody to complement protein C5 for salvage treatment of severe antibody-mediated rejection.

Desensitized patients are at high risk of developing acute antibody-mediated rejection (AMR). In most cases, the rejection episodes are mild and respond to a short course of plasmapheresis (PP) / low-dose IVIg treatment. However, a subset of patients experience severe AMR associated with sudden onset oliguria. We previously described the utility of emergent splenectomy in rescuing allografts in patients with this type of severe AMR. However, not all patients are good candidates for splenectomy. Here we present a single case in which eculizumab, a complement protein C5 antibody that inhibits the formation of the membrane attack complex (MAC), was used combined with PP/IVIg to salvage a kidney undergoing severe AMR. We show a marked decrease in C5b-C9 (MAC) complex deposition in the kidney after the administration of eculizumab.