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Twenty cases of laryngeal neoplasms are presented. We analyse tumor extent, invasion of the laryngeal cartilages and cervical metastasis and findings histopathologic with computed tomography in preoperative evaluation and surgical strategy.
Based on their 40 years' clinical experience in treating patients with laryngeal and cervical tracheal stenoses of various etiology, the authors consider that circular trachectomy, by anastomosing laryngeal cartilages, may be performed by highly skilled specialists only at specialized and well-equipped institutions. In cases of chondroperichondritis of cartilages of the larynx or trachea in the presence of paralysis of the vocal folds, it is necessary to make stepwise reparative and plastic operations that can be performed at the ENT clinics having experience in laryngeal surgery.
The laryngeal cartilage radionecrosis is an infrequent treatment complication with radiotherapy of head and neck tumoral lesions and it can present since a few months to many years later its application. We present the different evolution of two patients with laryngeal carcinoma treated with radiotherapy who developed laryngeal radionecrosis. The differential diagnosis with the recidiva and the primitive tumoral lesion are very important, as well as the diagnosis difficulty and its treatment.
Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.
Metalloproteinases (MMPs) are a class of enzymes largely involved in tumour progression and metastasis. At least twenty different enzymes are recognized that are also present under normal state of tissues. Their activity is regulated by their presence as proenzymes and by the concomitant presence of the respective tissue inhibitors (TIMPs). The present study describes the alterations of MMPs observed in human laryngeal carcinoma with respect to tumour classification and compares their activity in normal and cancerous tissues and biopsy specimens. Samples from five patients who underwent laryngectomy, from five biopsies and three from autopsies were used. The MMPs of normal and malignant human laryngeal cartilage and of biopsy specimens were identified immunochemically and by zymography using gelatin or casein as substrates. Healthy cartilage from autopsies was found to contain almost exclusively MMP-1, proMMP-2 and proMMP-9. Normal parts from laryngectomies contained, in addition, significant amounts of active MMP-2. The respective malignant parts contained both MMP-2 and -9 in increased amounts in their latent and active forms. Similar profile of MMPs was also identified in tissues surrounding affected cartilage. These alterations were found to be in good accordance with tumour stage and were also observed in biopsy samples. Thus, analysis of MMPs in biopsies can be used together with the clinicopathological parameters for the classification or early diagnosis of laryngeal tumours.
Primary infection of the laryngeal cartilages has become rare in the antibiotic era. However, trauma, irradiation, a foreign body, or cancer may initiate the infection, particularly in the immunocompromised patient. We encountered three cases of perichondritis and abscess associated with airway intubation, nasogastric intubation, and external beam radiotherapy. Laryngeal perichondritis and abscess remain serious potential causes of laryngeal deformity and dysfunction.
We report the results of a prospective controlled trial of the effect of hyperbaric oxygen as an adjuvant in radiotherapy of head and neck cancer. Patients were allocated randomly to treatment in oxygen or air. The radiotherapy in both groups was identical in planning, dose, and fractionation--i.e., 3500 rads in 10 fractions in 3 weeks. There was no difference in the survival rate between the two groups. However, significantly better local tumour control was seen in the hyperbaric-oxygen group, particularly in smaller lesions; there was significantly greater need for salvage surgery in the air group. Radiation effects on normal tissue appeared somewhat greater in the oxygen series, especially on laryngeal cartilage.
Malignant tumour of the upper hypopharynx is the most often the continuation of the supraglottic cancer of the larynx or it develops from the beginning between the lingual site of the epiglottis and the base of the tongue. The enlarged supraglottic laryngectomy has the best results. The large defect between the partial resected base of the tongue and the border of the resected laryngeal cartilage was covered by the fascia of the sternohyoid muscle. From 22 cases operated from 1979 on this way one local relapse was found.
A sensitive and accurate quantitative assay for the measurement of minor amounts of chondroitin/dermatan sulfate and heparan sulfate that does not require specific apparatus or reagents is described. The assay involves labeling of chondroitin sulfate A following reaction of carboxyl groups with biotin hydrazide in the presence of carbodiimide. ELISA plate wells were coated with glutaraldehyde and then spermine was coupled to it via a Schiff's base bond. In such activated wells, the biotinylated molecules were readily bound and detected after the interaction with avidin-peroxidase conjugates and the subsequent enzymic assay. Chondroitin/dermatan sulfate and heparan sulfate competed this interaction in a linear manner. Disaccharides derived from chondroitin sulfate A did not act as competitors, while heparan sulfate disaccharides showed significant competition. From the competition, before and after digestion with either chondroitinase ABC or heparitinases, the amounts of chondroitin sulfate and heparan sulfate in a sample could be calculated. The assay was applied for the determination of sulfated glycosaminoglycans in normal and cancerous human laryngeal cartilage samples. By using this procedure, the accurate determination, especially, of heparan sulfate in a mixture of glycosaminoglycans was achieved, which otherwise would require the use of very expensive technology.
A series of 76 cases of laryngeal carcinoma was examined in transverse slices using a motorized slicing machine. Eleven cases of ventriculosaccular carcinoma were detected by this method and the topography and gross appearances of the tumours in the larynges are described. Microscopy of the tumour indicates a keratinizing squamous cell carcinoma the mode of growth of which seems to be by concentric expansion through the whole margin rather than by invading tongues of tumour. In no case was there invasion of laryngeal cartilages or extension to the surgical cut surface of the specimen. The clinical, radiological and biopsy features in 10 of the 11 patients are described. In follow-up studies, which were 12 years or longer in five patients, none had lymph node metastases or recurrences of the laryngeal carcinoma of any sort. The following features may suggest the diagnosis of ventriculosaccular carcinoma before laryngectomy: (1) a ventricular tumour, (2) a supraglottic bulge above it, (3) a paraglottic swelling on CT scan radiology covered by a smooth laryngeal lining and (4) biopsy appearances of a well differentiated 'folded carcinoma'.
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Specific chemical modifications of amino acid residues were performed on purified, native link protein from bovine articular cartilage. The effects of these on link protein's interactions with hyaluronate and bovine articular cartilage proteoglycan were assayed by gel chromatography. Interaction with hyaluronate was significantly perturbed by modification of lysine, arginine, tyrosine and aspartic/glutamic acid residues, but not histidine and tryptophan residues. No free, accessible sulphydryl group was found on native link protein. The requirement for unmodified lysine and arginine residues resembles that of the hyaluronate-binding site of pig laryngeal cartilage proteoglycan (Hardingham, T.E., Ewins, R.J.F. and Muir, H. (1976) Biochem. J. 157, 127-143). In contrast, proteoglycan binding was only significantly perturbed by the loss of arginine residues. This resistance may reflect hydrophobicity of the binding site or masking of the site from chemical modification by link protein self-association. Amidation of carboxyl groups, which destroyed hyaluronate binding but left proteoglycan binding intact, provides a means of generating a monofunctional link protein molecule of potential use in proteoglycan aggregation studies.
The use of specialized surface coils has made it possible to obtain high-signal, high-resolution magnetic resonance (MR) images of the neck. We describe the normal anatomy of the larynx imaged with surface coils and a technique adapted from respiratory gating to reduce motion from swallowing and coughing. Compared with computed tomography, MR has superior discrimination of tissues that on computed tomography appear to be of similar density. The intrinsic laryngeal muscles and carotid sheath are well seen. Multiplanar imaging capability allows easy distinction of false and true cords and optimal evaluation of the preepiglottic and paralaryngeal spaces. Computed tomography is easier to perform than MR and is superior to MR in depicting the laryngeal cartilages. However, with improved technology, MR may become the imaging modality of choice in evaluation of the larynx and adjacent hypopharynx and subglottic regions.
Four rare cases of congenital saddle-nose deformity and slowly progressive degeneration of laryngeal cartilages with stenosis are described. The term inherited degenerative chondropathy is suggested for this disease entity. To our knowledge this is the first article on such a disease.
Seven patients with known carcinoma of the larynx underwent computed tomography (CT) of the larynx prior to surgery. Whole-mount sections of the extirpated larynx cut in the horizontal plane were compared with the corresponding level of the preoperative CT sections to demonstrate the validity of CT scanning in the evaluation of tumors of the larynx. The results indicate that CT scanning accurately demonstrates the anatomic location and gross size of laryngeal tumor, although early invasion of the laryngeal cartilages may be difficult to diagnose with CT. It is concluded that preoperative CT scanning of the larynx is the radiologic procedure of choice for evaluating carcinoma of the larynx.
The mouse alpha 1(II) collagen gene has been isolated and a 5' portion of the gene which has low homology to other collagen genes was used to study the pattern of expression during mouse embryogenesis. In situ hybridization studies show that in the mouse, like the chick, alpha 1(II) collagen is expressed in chondrogenic tissues in advance of chondrocyte differentiation. The gene is expressed early in embryogenesis at 9.5 days both in the cranial mesenchyme destined for the chondrocranium, and the sclerotome of the somites, and at 12.5 days in the primordia of the hyoid and the laryngeal cartilage. Type II collagen gene transcripts were found in all the chondrogenic tissues of the axial and appendicular skeleton until the onset of endochondral ossification. Expression of alpha 1(II) collagen mRNA was also observed in non-chondrogenic tissues such as the notochord which may be responsible for inducing chondrogenesis in somitic mesoderm, neural retina, the corneal and conjunctival epithelia and sclera of the developing eye. Expression in the tail tendon was late, at 16.5-18.5 days. Transient expression was also found in the heart at 9.5-12.5 days, the epidermis at 10.5-14.5 days, the calvarial mesenchyme at 12.5-16.5 days, the inner ear at 14.5 days and the fetal brain from 9.5-14.5 days. Within the neural tube, alpha 1(II) collagen mRNA was localized in the proliferative ventricular cells of the forebrain and midbrain of 9.5- to 10.5-day embryos. Subsequently, transcription of the alpha 1(II) collagen gene was confined to restricted areas of the rhombencephalic basal plate, the ventricular layer of the hindbrain and the cervical spinal cord. These examples of expression of the type II collagen gene in the developing nervous system seem to suggest that active transcription of this gene might be associated with early stages of neuroblast differentiation. Type II collagen may therefore have additional roles in development unrelated to chondrogenesis.