The rising rate of nonsmokers among laryngeal carcinoma patients: Are we facing a new disease?

OBJECTIVES/HYPOTHESIS: Laryngeal squamous cell carcinoma (SCC) is strongly associated with tobacco smoking. With the rising awareness of tobacco's adverse health effects, we have witnessed a global decrease in tobacco use. Nevertheless, laryngeal SCC remains prevalent and includes a subset of patients lacking the traditional risk factors. STUDY DESIGN: A two-center retrospective cohort. METHODS: Medical records of patients diagnosed with laryngeal SCC between 2009 and 2016 were reviewed. Data collected included demographics, smoking status, and tumor site. Patients who have never smoked were designated as nonsmokers. RESULTS: The study included 330 patients with laryngeal SCC, of whom 75 (22.7%) were nonsmokers; this rate was relatively similar for each of the two institutions independently (21.9% and 25%). There were 285 patients with glottic SCC and 45 with supraglottic SCC. All nonsmoking patients in this cohort had glottic SCC, representing 26.3% (75/285) of the glottic SCC cases. The rate of female patients was significantly higher among nonsmokers. Of the patients with glottic SCC, females represented 25.3% (19/75) of the nonsmokers compared with 12.4% (26/210) of the smokers (P = .008). Mean age at diagnosis was 60.2 ± 17.5 years for nonsmoking glottic SCC patients and 63.6 ± 12.4 years for smokers (P = .280). However, nonsmokers demonstrated a distinct age distribution pattern. Nonsmoking females with glottic SCC demonstrated a bimodal age distribution pattern; 73.7% (14/19) were age <40 years or >75 years at diagnosis. CONCLUSIONS: The rate of laryngeal SCC in nonsmokers is higher than what has previously been reported, representing a growing proportion, and may suggest a shift in etiology. Knowing that laryngeal SCC in nonsmokers predominantly affects the glottis, and that females and age extremities are more vulnerable, the traditional screening paradigm should be revised. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E108-E115, 2020.

Mini-dose of thalidomide for treatment of primary myelofibrosis. Report of a case with complete reversal of bone marrow fibrosis and splenomegaly.

We report a patient with very advanced myelofibrosis and huge splenomegaly who showed a complete hematological response to low dose thalidomide with reversal of splenomegaly and bone narrow fibrosis after 30 months of the treatment.

Invasive tracheal aspergillosis treated successfully with voriconazole: clinical report and review of the literature.

OBJECTIVES: Invasive tracheal aspergillosis is a rare and highly fatal fungal infection that manifests as a progressive airway obstruction in immunocompromised patients. Otolaryngologists should be familiar with the entity of invasive necrotizing tracheal aspergillosis. METHODS: In this report we describe a young patient with acute myeloid leukemia who was affected by invasive tracheal aspergillosis. This entity and the relevant literature are reviewed. RESULTS: On the basis of the presented clinical report, we discuss the clinical and pathologic characteristics of invasive tracheal aspergillosis as an opportunistic infection. The classic symptoms are of progressive dyspnea in an immunosuppressed patient. Diagnosis is via pathological evidence of fungal hyphae invading the endoluminal upper respiratory tree. The present patient was successfully treated with an azole antifungal agent, combined with tracheostomy for airway control. CONCLUSIONS: Invasive tracheal aspergillosis is a life-threatening fungal infection that affects immunosuppressed patients. Because the mortality rate is high, awareness of this entity is essential for early diagnosis and treatment. A favorable outcome in this type of invasive aspergillosis correlates with resolution of the bone marrow suppression and early antifungal medical therapy combined with aggressive surgical intervention for airway control, if needed.

Lesions of the posterior glottis: clinical and pathologic considerations and treatment outcome.

OBJECTIVE: To assess the clinical profile, presentation, prognosis, and response to treatment of patients with posterior glottic lesions and the prevalence of malignancy in this group. STUDY DESIGN: Retrospective cohort. METHODS: Studying medical records, videostroboscopic examinations, and pathologic reports of patients diagnosed and treated between 2008 and 2011. RESULTS: Forty-six patients had lesions limited to the posterior glottis. Forty-one of the cases were diagnosed clinically or pathologically as inflammatory granulation tissue; three were cysts; one carcinoma in situ; and one invasive squamous cell carcinoma. Of the inflammatory granulation patients, 71% had lesions defined as spontaneous and 29% were considered iatrogenic. Reflux symptoms and reflux signs, as well as psychological stress were significantly more prevalent in the spontaneous group. Fifty percent of the patients with spontaneous lesions had psychological stress, compared with 8% in the iatrogenic group (P value = 0.009). Smoking was a significant risk factor in the iatrogenic group (54% vs 21% P value = 0.03). Nine percent of the lesions were treated with primary surgery. Ninety-one percent were treated with primary conservative management, of whom 31% were eventually referred to surgery. Overall, 91% of the patients were treated successfully. All cases of iatrogenic lesions responded to conservative management or a single surgical intervention. All patients that required multiple interventions were spontaneous. CONCLUSIONS: The results of this study suggest that only a small percent of posterior glottic lesions are malignant, thus the decision about biopsy should be based on clinical judgment. Also, spontaneous granulomas are more refractory to treatment, which can be explained by the repetitive exposure to the etiologic factors.

Case report: metastatic small-cell lung carcinoma of the external auditory canal.

We report the case of a 73-year-old man who developed metastatic small-cell lung cancer to the bony external auditory canal (EAC). The patient had only recently been diagnosed with his primary carcinoma. The metastasis presented as a bulky, fleshy, bleeding mass in the right EAC. Biopsy of the metastasis revealed that its histologic characteristics were identical to those of the primary. This case is of interest because this was a unique type of metastasis to the EAC. Although there are reports in the literature of lung cancer and even small-cell cancer metastasizing to the temporal bone, we could find no previously published report of a small-cell lung carcinoma metastasizing to the EAC.

Cutaneous B-cell neoplasms mimicking granulomatous rosacea or rhinophyma.

BACKGROUND: Unlike T-cell neoplasms, B-cell lymphoproliferative disorders have a limited clinical spectrum of skin involvement. Cutaneous B-cell neoplasms mimicking rosacea or rhinophyma are rare. OBSERVATIONS: We described 12 patients with B-cell lymphoproliferative neoplasms presenting with a facial eruption clinically mimicking rosacea or rhinophyma. Eleven patients were women; ages ranged from 36 to 81 years. The clinical presentation included small papules on the nose and cheeks and around the eyes mimicking granulomatous rosacea; nodules on the nose, cheeks, chin, or forehead mimicking phymatous rosacea; or a combination of both. Three patients had preexisting erythematotelangiectatic rosacea and 1 had rhinophyma. Based on a clinicopathologic correlation and B-cell clonality analysis, the diagnosis was primary cutaneous follicular center B-cell lymphoma in 4 cases, primary cutaneous marginal zone lymphoma in 6, and skin involvement of chronic lymphocytic leukemia in 2. All patients had an indolent course as expected for their disease. CONCLUSIONS: Cutaneous involvement of B-cell neoplasms may mimic granulomatous rosacea or rhinophyma. This unusual clinical presentation is more common in women and appears in the setting of preexisting rosacea or as a new eruption. Proliferative B-cell disorders should be added to the differential diagnosis of symmetric papular or papulonodular eruptions of the face.