Laryngeal Neuroendocrine Neoplasms: Analysis of 11 Cases in a Single-Center Study.

Objective: Laryngeal neuroendocrine neoplasms (LNEN) are rare, and there have been previous uncertainties regarding their classification and treatment modalities. This article aims to share our treatment experience, elucidate changes in LNEN classification, and discuss the treatment implications of different types and stages. Methods: A retrospective analysis was conducted on 11 cases of LNEN treated through surgical intervention at the Department of Otolaryngology, Qilu Hospital of Shandong University, Qingdao, from January 2014 to November 2023. Among the 11 cases, there were 9 males and 2 females, with ages ranging from 61 to 77 years. Pathological classifications included neuroendocrine tumors (NET) G1 (1 case), G2 (2 cases), G3 (5 cases), small-cell neuroendocrine carcinoma (2 cases), and large-cell neuroendocrine carcinoma (1 case). The follow-up period ranged from 1 to 115 months. Results: Treatment modalities varied among the cases: 5 patients underwent transoral laser microsurgery (TLM) without neck dissection, 1 patient underwent TLM with unilateral neck lymph node dissection, 1 patient underwent open partial supraglottic laryngectomy (OPSL) with ipsilateral neck lymph node dissection, and 4 patients underwent OPSL with bilateral neck lymph node dissection. Among the 11 patients, 4 died, with 2 succumbing to distant metastasis, 1 to local recurrence, and 1 to other diseases. Conclusion: The prognosis of LNEN is closely associated with the latest pathological classification and TNM staging. For a more detailed and specific clinical staging, further research involving multicenter large-scale data is needed.

Therapeutic effect on pyriform sinus carcinoma resection via paraglottic space approach.

Objective: To analyse the surgical indications, surgical efficacy and key influencing factors of prognosis of using a novel surgical approach for pyriform sinus carcinoma resection utilising the paraglottic space. Methods: From 2014 to 2017, 93 patients with squamous cell carcinoma originating in the pyriform sinus were resected through the paraglottic space approach. The postoperative laryngeal function preservation, complications, survival rate and prognostic factors were analysed. Results: All patients were followed up for more than 5 years. The 2, 3 and 5 year overall survival rates of the patients were 77.2%, 61.6% and 47.4%, respectively. The univariate analysis of survival rate showed that primary tumour T stage and N stage had a statistically significant effect on the survival rate of patients (P = 0.047 and P < 0.001, respectively). Multivariate analysis with the Cox regression model revealed that N stage is an independent risk factor for postoperative survival (P = 0.042). The preservation rate of laryngeal function was 65.6% (61/93). Pharyngeal fistula incidence was 4.3% (4/93). Systemic distant metastasis and second primary cancer were found to be the main causes of death. Conclusions: As a novel surgical approach for the resection of pyriform sinus carcinoma, the paraglottic space approach can better expose the tumour, effectively improve the retention rate of laryngeal function, reduce the incidence of pharyngeal fistula and result in the better recovery of postoperative swallowing function with satisfactory long-term survival. N stage is an independent risk factor for postoperative survival.

[Analysis of clinical characteristics of fungal ball in unilateral maxillary sinus].

Objective:The aim of this study is to investigate the pathological characteristics of unilateralmaxillary sinus fungus ball（UMFB） in order to improve the accuracy of clinical diagnosis. Methods:A total of 86 patients with unilateral maxillary sinus lesions who underwent nasal endoscopic surgery in Qilu Hospital of Shandong University（Qingdao） from January 2017 to June 2019 were included. Those patients were confirmed UMFB or unilateral chronic maxillary sinusitis（UCMS） by pathology. The characteristics including age, sex, diabetes mellitus or no, CT features of the diseased maxillary sinus and GOSS osteitis score of the posterolateral wall of the maxillary sinus were analyzed, and the differences between the two groups were compared. CT features include: ①intralesional hyperdensity（calcification）; ②maxillary sinus full haziness with or without mass effect; ③the irregular lobulated protruding lesion（fuzzy appearance） or smooth. Chi-square, independent sample t test and Mann-Whitney U test were performed. Logistic regression analysis and receiver operating Characteristic（ROC） curve analysis were used to find the best cutoff value for UMFB diagnosis. Results:Among the 86 cases of unilateral maxillary sinus lesions, 62 cases were UMFB, which accounted for 72.1%, and 24 cases were UCMS, which accounted for 27.9%. UMFB usually occurs in middle-aged and elderly patients, and there are more females than males. There was no statistical difference between the two groups with or without diabetes. In terms of CT characteristics of paranasal sinuses, intergroup comparison and binary Logistic regression analysis, intralesional hyperdensity, maxillary sinus full haziness with mass effect, the irregular lobulated protruding lesion（fuzzy appearance） were significant predictors of MFB（all P<0.05）. The score of osteitis in UMFB was significantly higher than that in UCMS（P<0.001）. ROC curve analysis showed that when the cutoff value was more than 3.5（the area under the curve was 0.824）, the corresponding sensitivity and specificity were 0.516 and 0.958, respectively. Conclusion:The age, gender, CT characteristics and maxillary sinus osteitis score can distinguish UMFB from unilateral maxillary sinus chronic inflammation, and improve the accuracy of clinical diagnosis.