Hodgkin's disease: old and recent clinical concepts

The diagnosis of Hodgkin's disease (HD) is still primarily based on the histopathologic criteria presented by Lukes et al in 1965. Over the past three decades, however, advances in immunohistochemistry, molecular studies, and virologic findings have provided evidence that HD exhibits significant heterogeneity. Whereas the nodular sclerosis subtype is the major subset of the "classic" disease, it has become evident that the nodular, lymphocytic predominance subtype may represent a minor distinct subset, and possibly a distinct disease entity. Furthermore, there is strong evidence that the mixed cellularity subtype may be an Epstein-Barr virus-related disorder. Finally, based on phenotypic and genotypic features, the existence of a "continuum" between a fraction of HD cases, including the lymphocytic depletion subtype, and CD30-positive anaplastic large cell lymphomas has been suggested.

Laryngeal lymphoma derived from mucosa-associated lymphoid tissue

Extranodal lymphomas account for as many as 40% of non-Hodgkin's lymphomas, and most arise in the gastrointestinal tract, but other mucosal organs may be involved, especially the upper aerodigestive tract. Low-grade B-cell lymphomas arising in the gastrointestinal tract and other mucosae have been found to recapitulate the structure and cytologic features of mucosa-associated lymphoid tissue (MALT). Histologically low-grade MALT lymphomas are characterized by centrocyte-like B-cells with a phenotype similar to that of so-called marginal zone B-cells. Tumors evolving from MALT are generally rare among lymphomas of the upper aerodigestive tract, but a few cases of laryngeal lymphomas derived from MALT have been reported. Primary MALT lymphoma of the larynx should always be considered in tumors with histopathologic features of low-grade B-cell lymphoma, or so-called pseudolymphoma.

Morphologic patterns and molecular pathways of AIDS-related head and neck and other systemic lymphomas

Head and neck manifestations of human immunodeficiency virus (HIV) infection include lymph nodal and extranodal localization of non-Hodgkin's lymphoma (NHL). A histopathologic characteristic common to head and neck NHLs and to all the other systemic lymphomas in HIV patients is the frequent occurrence of cases displaying pleomorphic features and some overlap between established histologic subtypes. This article highlights the difficulties in defining HIV-related NHLs correctly, and proposes a specific pathologic categorization of these disorders accounting for their pathogenic aspects as gathered from molecular data.

The association of cancers of the larynx with cancers of the lung

We report 77 cases of associated primary cancers of the larynx and lung that were managed at the Department of Otolaryngology, University of Padua, between 1980 and 1994. To our knowledge, this is the largest series reported in the literature to date. This association is not a chance finding, but presumably the result of common pathogenetic factors.

Mucosal adenoid squamous cell carcinoma of the head and neck

Adenoid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. The lesion is histologically distinctive and it is usually localized on the skin of the head and neck region; it only rarely involves the mucosal sites. The differential diagnoses include adenosquamous carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, basaloid squamous cell carcinoma, and metastatic adenocarcinoma. Surgery is the treatment of choice. The biologic behavior of this neoplasm is more aggressive when it involves mucosal areas, and the prognosis seems worse than that of conventional squamous cell carcinoma.

Laryngeal pleomorphic rhabdomyosarcoma. A critical review of the literature

A case report of pleomorphic rhabdomyosarcoma of the larynx is presented. It is the first case in which the diagnosis is supported by immunohistochemical investigation. A critical review of the literature follows, evaluating the clinicopathologic features of this rare malignancy.

"Early" cancer of the larynx: the concept as defined by clinicians, pathologists, and biologists

Since a great deal of confusion surrounds the different uses made by clinicians, pathologists, and biologists of the term, this paper clarifies the concept of "early" cancer of the larynx. Clinically, this is usually a glottic neoplasm in which full cordal mobility is still present; early supraglottic cancer is infrequent, and usually a chance finding. Whatever the site, early laryngeal cancer is a minimally invasive neoplastic lesion that does not invade the muscle or cartilage, but is still capable of metastasis. Being confined to the lamina propria, it is more than a carcinoma in situ but less than a deeply infiltrating carcinoma. Superficial extending carcinoma is therefore an early cancer. Biologically, early cancer belongs to stage II.

Basaloid squamous cell carcinoma of the head and neck: clinicopathological features and differential diagnosis

Basaloid squamous cell carcinoma is a recently recognized variant of squamous cell carcinoma. The lesion is histologically distinctive and manifests a predilection for the supraglottis, pyriform sinus, and tongue base. The immunohistochemical profile is discussed. The differential diagnoses include adenoid cystic carcinoma, small cell neuroendocrine carcinoma, basal cell adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma, spindle cell squamous carcinoma, mucoepidermoid carcinoma, and adenoid squamous cell carcinoma. Basaloid squamous cell carcinoma is a biologically high-grade tumor with a propensity for nodal as well as systemic metastases. It is a morphologic and phenotypic entity with a separate prognostic significance.

Developmental lesions of the head and neck: terminology and biologic behavior

As much confusion has been generated in the literature by the inaccurate or improper use of terms describing developmental lesions such as hamartoma, choristoma, and teratoma, a number of different benign and malignant developmental lesions are described and distinguished in the hope that these lesions can be more reliably identified and consequently also more adequately managed.

Are clinical classifications for laryngeal cancer satisfactory?

All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.

Malignant laryngeal tumors: phenotypic evaluation and clinical implications

Malignant laryngeal tumors include a variety of oncotypes with differing biologic connotations, each calling for a different therapeutic approach and giving rise to a different prognosis. But the oncotype can only be accurately identified histologically by means of a technically adequate, representative biopsy specimen. Intrinsic malignancy varies with the structure of the neoplasm, so the choice of surgery, radiotherapy, chemotherapy, or laser therapy depends largely on tumor type. Most malignant laryngeal neoplasms are squamous cell carcinomas, but the rare cases of nonsquamous tumor include a wide array of oncotypes of which the true incidence is difficult to assess. Diagnosis is based on light microscopy, but may be supported by histochemical, immunocytochemical, and ultrastructural investigations that improve the accuracy of categorization of the specific tumor type. A precise histologic diagnosis, based on representative biopsy material, will lead to a better understanding of the tumor's likely behavior, and consequently to more effective treatment.

Immunohistochemical markers in the diagnosis of neuroendocrine neoplasms of the head and neck

Immunohistochemistry is important in the diagnosis of neuroendocrine neoplasms of the head and neck, particularly in the differential diagnosis of the various neuroendocrine neoplasms, although the results of staining should never be interpreted alone, but together with conventional histopathologic findings. It is emphasized that there are currently no markers capable of distinguishing between benign and malignant tumors. A correct diagnosis is of paramount importance, since treatment depends on the diagnostic accuracy and prognosis is naturally related substantially to the phenotype.

The natural history of early vocal cord cancer

Pure "early cancer" is an intramucosal lesion, but does not include carcinoma in situ or dysplasia in which the malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. The term is often erratically used to describe lesions with invasion of the muscle or cartilage structures and such a careless terminology adds confusion to the nomenclature for these neoplastic lesions. Malignant tumour development involves complex interactions between several factors, both environmental (or exogenous) and endogenous (i.e. genetic, hormonal, etc.). The natural history of neoplastic disease coincides with three chronologically distinct stages: initiation and promotion (the sub-clinical latency period), and progression (when the tumour usually becomes clinically visible). Early vocal cord cancer may be asymptomatic and more advanced than it seems. It has a high cure rate with various treatments: there is no treatment of choice for early cancer, but a choice of treatments. As it is obviously difficult, or even impossible, to control far-advanced laryngeal cancer, it is essential to concentrate efforts on study the initial steps in tumour development to facilitate early detection and timely therapy.

Cartilaginous tumors of the larynx

Cartilaginous tumors of the larynx, while rare, will on occasion be encountered by the otolaryngologist in routine daily practice. True laryngeal chondromas are exceedingly rare, and as a consequence, a putative diagnosis of chondroma should be viewed with suspicion. On pathologic examination, laryngeal chondromas usually prove to be small lesions (less than 2 cm in maximum dimension) and may arise in children or adults. Laryngeal chondrosarcomas, by contrast, usually prove to be larger lesions (exceeding 3 cm in greatest dimension) and are typically found in adults. While high-grade chondrosarcomas are readily identifiable on light microscopic study, the distinction between a chondroma and a low-grade chondrosarcoma is often not so clear-cut. Some low-grade chondrosarcomas may show a slight increase in both cellularity and cytologic atypia when compared with chondromas, but the two patterns often overlap. When faced with a limited biopsy specimen of a laryngeal cartilaginous lesion in which neither increased cellularity nor recognizable cytologic atypia is found, a diagnosis of "cartilaginous tumor without obvious evidence of malignancy--further classification dependent on examination of the lesion in its entirety," or words to this effect, is recommended.

Laryngeal paraganglioma versus atypical carcinoid tumor

Paraganglioma and atypical carcinoid tumor of the larynx are two neuroendocrine neoplasms that have often been confused in the past, and even in the present, in the literature. The clinicopathological profile of the two lesions is presented and the differential diagnosis is discussed. A correct diagnosis is of paramount importance, since treatment and prognosis depend on diagnostic accuracy and differ for the two lesions. Paraganglioma of the larynx is usually benign, whereas atypical carcinoid tumor is malignant and has an aggressive clinical course.

Identification, classification, treatment, and prognosis of laryngeal paraganglioma. Review of the literature and eight new cases

This study details the clinicopathologic features of 62 cases of laryngeal paraganglioma (LP), including 54 acceptable cases identified in the literature (although clinical information is lacking on 7 of these) and 8 previously unpublished cases identified from the Registry of Otolaryngic-Endocrine Pathology at the Armed Forces Institute of Pathology. Demographic findings show that the overwhelming majority of cases affect women (41:14), mainly in the fourth to sixth decades of life (age range, 14 to 83 years; median, 44 years), with a prevalence in the supraglottic larynx. These neoplasms are treated by surgical resection and are benign. Despite the characteristic pathologic features associated with LP, it is sometimes confused with other neoplasms, particularly neuroendocrine carcinomas of the larynx, and this confusion leads to unfortunate designations such as malignant paraganglioma and metastasizing paraganglioma of the larynx. Judging from the cases reported in this study and those identified in the literature, we conclude that malignant biologic behavior associated with LP is extraordinarily rare (< 2%). Because of the misdiagnoses of LP, the prognosis associated with this entity has been skewed to suggest that LP may behave aggressively. This has led to the inappropriate classification of LP among the malignant categories of laryngeal neuroendocrine neoplasms. The goal of this study is to detail the features diagnostic of LP and to discuss the appropriate treatment, prognosis, and classification of these neoplasms.

The World Health Organization's revised classification of tumours of the larynx, hypopharynx, and trachea

A second edition of the Histological Typing of Upper Respiratory Tract Tumours in the WHO series International Histological Classification of Tumours was published in 1991. The new edition has been entitled Histological Typing of Tumours of the Upper Respiratory Tract and Ear. The task of revising the first edition, which was published in 1978, was undertaken at the WHO Center for Upper Respiratory Tract Tumours by K. Shanmugaratnam in collaboration with L. H. Sobin and pathologists in 8 countries. Several tumour types have been added to the classification, and some have been redefined in light of current knowledge. This presentation outlines the changes in the revised WHO classification as regards tumours of the larynx, hypopharynx, and trachea and discusses the grounds for said revisions.

A review of the definition, terminology and pathology of aural cholesteatoma

Despite a considerable amount of discussion and research in the course of many years, aural cholesteatoma has remained a matter of controversy. This review concerns only the definition, terminology and pathology of this common and severe disease.

[Long-term sedation with propofol in ICU: hemocoagulation problems]

The Authors have studied the effects of propofol on coagulation in 15 patients admitted to ICU. Propofol was used for long-term sedation (therapeutic range 3 mg/kg/h). Variables monitored included: platelets, PTT, PT, Fibrinogen, FDP, AT III. The effects on coagulation has been investigated in three groups of patients: group I) 5 patients that received propofol for 1-3 days; group II) 5 patients that received propofol for 4-10 days; group III) 5 patients that received propofol for 11-35 days. No difference were found about blood coagulation in this groups of patients before and after administration of propofol.

Non-occupational recurrent bilateral pneumoparotitis in an adolescent

This is a case report of recurrent bilateral parotid swelling with intraglandular gaseous bubbles in a 14-year-old boy, together with a review of the literature on this condition, which is usually called pneumoparotitis. The disorder has been reported as an occupational hazard in wind instrument players and glass-blowers and also as a rare non-occupational disease, mainly in adolescents and often associated with psychological problems.

Supraglottic versus glottic laryngeal cancer: epidemiological and pathological aspects

Between 1979 and 1988, 432 cases of previously untreated laryngeal cancers were histologically diagnosed at the Institute of Pathological Anatomy of the University of Trieste. Of these cases, 192 were supraglottic and 182 glottic cancers. The overall crude incidence was 31.06 0/0000 in males and 2.29 0/0000 in females, with a male/female ratio of 10.2:1 for supraglottic cancers vs. 20.4:1 for glottic cancers. Our incidence values for laryngeal cancer, and supraglottic lesions in particular, are similar to those recorded in France, Spain and other areas of Italy, i.e. in nations where wine production and consumption is very high. The 3-year adjusted survival rate was 45.7% for supraglottic and 83% for glottic cancer patients. Subjects with supraglottic cancer often had a poor prognosis because of the high frequency of cervical lymph node involvement, recurrences and visceral metastases; cancers of the aryepiglottic folds presented the worst clinical evolution.

[Fluconazole in the therapy of candidiasis in intensive care]

The authors studied four patients in ICU suffering from Candida infections who were treated with a new bis-triazole antimycotic, fluconazole. Various parameters of blood chemistry and blood and urine drug levels were monitored. After treatment all microbiological tests had become negative and clinical conditions had improved considerably within 30 to 60 days. No significant side effects were observed.

Italian experience of voice restoration after laryngectomy with tracheoesophageal puncture

This report concerns 102 cases of tracheoesophageal puncture performed as a means of secondary voice restoration after total laryngectomy, in 70 patients proving unable to learn esophageal speech and as a treatment of choice in a further 32 cases. Complications arose in 21 cases but were generally minor and could be overcome. Results were favorable in 45 of 70 and 29 of 32 cases, respectively. The method was considered effective, particularly when supported by the patient's determination to learn a verbal communication method.

Terminology and classification of neuroendocrine neoplasms of the larynx

The authors discuss the terminology and classification of all neuroendocrine neoplasms of the larynx. After a review of the relevant literature, they suggest adopting the nomenclature recently recommended by the World Health Organization: carcinoid tumor, atypical carcinoid tumor, small cell neuroendocrine carcinoma and paraganglioma. This terminology is easy to apply, clinically meaningful and biologically sound. Carcinoid tumor, atypical carcinoid tumor and small cell neuroendocrine carcinoma are of epithelial origin whereas paraganglioma is of neural type. The authors emphasize that it is inadequate to make a diagnosis of 'neuroendocrine tumor or carcinoma', without its proper qualification.

Endolaryngeal synovial sarcoma. An update on diagnosis and treatment

An extremely rare case of synovial sarcoma localized in the larynx is reported together with a review of 6 similar neoplasms previously reported in this unusual region. In this case, the patient is still tumor free 16 years after therapy.