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Horton G, Philteos J, Lin RJ. Malignant Transformation of Dysplastic Vocal Fold Lesions: A Systematic Review and Meta-Analysis. JAMA Otolaryngol Head Neck Surg 2024; 150:556-563. [PMID: 38753339 PMCID: PMC11099843 DOI: 10.1001/jamaoto.2024.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
Importance The reported rates of malignant transformation of dysplastic laryngeal lesions are highly variable, as is time to malignant degeneration. Objective To evaluate the rate of and time to malignant transformation of dysplastic laryngeal lesions based on the World Health Organization (WHO) dysplasia classification system. Data Sources PubMed, MEDLINE, Embase, CINAHL, CENTRAL, and Cochrane Reviews were searched from the date of database inception to June 8, 2023. Study Selection English-language articles assessing the rate of malignant transformation using the 2005 WHO dysplasia classification system were included in this systematic review and meta-analysis. Data Extraction and Synthesis The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was performed by 2 independent investigators. Study quality was assessed using a validated quality tool. When possible, data were pooled using random-effects meta-analysis. Main Outcome Measures The primary outcome measure was the malignant transformation rate in each laryngeal dysplasia category. Secondary outcome measure was the time interval over which malignant transformation had occurred. Results A total of 5585 records were screened, 61 full texts were assessed, and 18 retrospective cohort studies with 3243 participants were included in the final review. The weighted pooled mean malignant transformation rates of mildly, moderately, and severely dysplastic lesions were 10.9%, 23.3%, and 30.5%, respectively. Malignant transformation rate of nondysplastic laryngeal lesions was 4.5%. Moderately and severely dysplastic lesions had significantly higher odds of malignant transformation compared with mildly dysplastic lesions (moderate: odds ratio [OR], 2.90 [95% CI, 2.06-4.09]; I2 = 0%; severe: OR, 3.42 [95% CI, 2.11-5.52]; I2 = 40%). Lesions without dysplasia had a significantly lower odds of malignant transformation compared with lesions with mild dysplasia (OR, 0.48; 95% CI, 0.28-0.81; I2 = 0%). The overall mean time to malignant transformation was 28.8 months (range, 22.0-35.6 months) for all dysplasia grades. Conclusion and Relevance This systematic review and meta-analysis found that the rate of malignant transformation increased with the grade of laryngeal dysplasia. Moderately dysplastic lesions were more likely to undergo malignant degeneration compared with mildly dysplastic lesions.
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Affiliation(s)
- Garret Horton
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R. Jun Lin
- Department of Otolaryngology–Head & Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Unity Health Toronto–St Michael’s Hospital, Toronto, Ontario, Canada
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Chen Z, Zhang JY, Jiang Q, Bao YY, Li ZM, Zhou SH, Zhong JT, Fu ZM, Cao ZZ, Fan J, Yao HT. Pepsin Increases the Proliferation of Vocal Cord Leukoplakia Epithelial Cells by Inducing Autophagy. Otolaryngol Head Neck Surg 2023; 169:1247-1258. [PMID: 37264983 DOI: 10.1002/ohn.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the role of H+ /K+ ATPase in the proliferation of pepsin-induced vocal cord leukoplakia (VCL) cells. STUDY DESIGN Translation research. SETTING Affiliated Hospital of University. METHODS Immunohistochemistry was used to detect pepsin, H+ /K+ ATPase (ATP4A and ATP4B subunits) in VCL cells with varying degrees of dysplasia. After primary cultures of VCL cells had been established, the effects of acidified pepsin on the proliferation, autophagy, and H+ /K+ -ATPase distribution of VCL cells were investigated. RESULTS The levels of pepsin, ATP4A, and ATP4B were significantly higher in VCL tissue with moderate-to-severe dysplasia than in normal tissue (p < .05); these levels gradually increased according to dysplasia severity. The expression levels of ATP4A and ATP4B were significantly correlated with the amount of pepsin in VCL cells (p < .01). Acidified pepsin enhanced the levels of proliferation and autophagy in human VCL epithelial cells. The cloning- and autophagy-promoting effects of acidified pepsin on VCL cells were partially reversed by pantoprazole; these effects were completely blocked by the autophagy inhibitor chloroquine. Finally, acidified pepsin promoted the colocalization of H+ /K+ -ATPase and lysosomes in VCL cells; it also mediated lysosome acidification. CONCLUSION Pepsin and H+ /K+ -ATPase may contribute to the progression of VCL. Specifically, acidified pepsin may regulate lysosome acidification by promoting lysosomal localization of H+ /K+ -ATPase.
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Affiliation(s)
- Zhe Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jia-Yu Zhang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Qian Jiang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zhi-Mei Li
- Department of Otolaryngology, The Zhoushan Hospital of Zhejiang University, Zhoushan, Zhejiang, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jiang-Tao Zhong
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zi-Ming Fu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zai-Zai Cao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jun Fan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Hong-Tian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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Esmaeili N, Davaris N, Boese A, Illanes A, Navab N, Friebe M, Arens C. Contact Endoscopy - Narrow Band Imaging (CE-NBI) data set for laryngeal lesion assessment. Sci Data 2023; 10:733. [PMID: 37865668 PMCID: PMC10590430 DOI: 10.1038/s41597-023-02629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
The endoscopic examination of subepithelial vascular patterns within the vocal fold is crucial for clinicians seeking to distinguish between benign lesions and laryngeal cancer. Among innovative techniques, Contact Endoscopy combined with Narrow Band Imaging (CE-NBI) offers real-time visualization of these vascular structures. Despite the advent of CE-NBI, concerns have arisen regarding the subjective interpretation of its images. As a result, several computer-based solutions have been developed to address this issue. This study introduces the CE-NBI data set, the first publicly accessible data set that features enhanced and magnified visualizations of subepithelial blood vessels within the vocal fold. This data set encompasses 11144 images from 210 adult patients with pathological vocal fold conditions, where CE-NBI images are annotated using three distinct label categories. The data set has proven invaluable for numerous clinical assessments geared toward diagnosing laryngeal cancer using Optical Biopsy. Furthermore, given its versatility for various image analysis tasks, we have devised and implemented diverse image classification scenarios using Machine Learning (ML) approaches to address critical clinical challenges in assessing laryngeal lesions.
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Affiliation(s)
- Nazila Esmaeili
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University of Giessen, 35392, Giessen, Germany.
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748, Munich, Germany.
- SURAG Medical GmbH, 04103, Leipzig, Germany.
| | - Nikolaos Davaris
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen University Hospital, 35392, Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Magdeburg University Hospital, 39120, Magdeburg, Germany
| | - Axel Boese
- INKA-Innovation Laboratory for Image Guided Therapy, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | | | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748, Munich, Germany
| | - Michael Friebe
- INKA-Innovation Laboratory for Image Guided Therapy, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- Department of Biocybernetics and Biomedical Engineering, AGH University Kraków, 30-059, Kraków, Poland
- CIBE - Center for Innovation, Business Development & Entrepreneurship, FOM University of Applied Sciences, 45141, Essen, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen University Hospital, 35392, Giessen, Germany
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Olson C, Alexander R, Stinnett S. Dysplastic Lesions of the Larynx. Otolaryngol Clin North Am 2023; 56:233-246. [PMID: 37030937 DOI: 10.1016/j.otc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
There have been many advancements in the clinical and histologic diagnosis of laryngeal dysplasia (LD), but diagnosis still necessitates invasive histologic evaluation. Furthermore, despite improved histologic identification of dysplastic lesions, the exact details of pathophysiologic progression and the risk of malignant transformation is still uncertain. These unknowns create a barrier to establishing an ideal grading and classification system, which prevents the establishment of a precise and consistent treatment paradigm. Identifying these gaps in knowledge serves to highlight where further studies are warranted, ideally focusing on a better understanding of the biological behavior of LD. This would ultimately allow for the creation of a reliable grading and classification system and for the formalization of management and treatment guidelines for LD.
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Doğan E, Boran C, Cevizci MC, Sarıoğlu S. Comparison of the prognoses of laryngeal preneoplastic lesions based on Ljubljana and World Health Organization classifications. Turk J Med Sci 2023; 53:396-404. [PMID: 36945918 PMCID: PMC10387883 DOI: 10.55730/1300-0144.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/04/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the prognosis of patients with laryngeal preneoplastic lesions based on Ljubljana classification (LC), Revised LC, World Health Organization Dysplasia System (WHO-DS) 2005 and WHO-DS 2017. METHODS Patients diagnosed with a laryngeal preneoplastic lesion in our clinic between 2005 and 2018 were included in the study. Biopsy preparations of patients were reexamined by the pathology unit and classified based on LC, Revised LC, WHODS 2005, and WHO-DS 2017. Patients with carcinoma were identified during follow-up. The prognosis of preneoplastic lesions was statistically analyzed based on carcinoma development and duration using these four different classifications. RESULTS Carcinoma developed in 16 of 142 patients after repeated biopsy. The risk for carcinoma development was found to be more statistically significant in atypical hyperplasia than in squamous cell hyperplasia and basal-parabasal cell hyperplasia according to LC (p: 0.027 and 0.035), no statistically significant difference was observed between squamous and basal-parabasal cell hyperplasia and CIS groups. The risk of carcinoma development was more statistically significant in high-grade squamous intraepithelial lesion (SIL) than in low-grade SIL according to revised LC (p: 0.04); in severe hyperplasia than in other groups according to WHO-DS 2005; and in highgrade dysplasia than in low-grade dysplasia according to WHO-DS 2017 (p: 0.013). The Cox regression analysis demonstrated that the risk of developing carcinoma statistically increased with age in all classifications, independent of the severity of dysplasia (p < 0.01). According to Cox regression analysis, there was no effect of sex on carcinoma development. DISCUSSION : In revised classifications, such as the revised LC and WHO-DS 2017, it is seen that facilitating clinical use is achieved by reducing the number of subgroups by combining the subgroups that do not statistically differ in terms of carcinoma development.
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Affiliation(s)
- Ersoy Doğan
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Cafer Boran
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | | | - Sülen Sarıoğlu
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Boricic N, Boricic I, Soldatovic I, Milovanovic J, Trivic A, Terzic T. Utility of CK8, CK10, CK13, and CK17 in Differential Diagnostics of Benign Lesions, Laryngeal Dysplasia, and Laryngeal Squamous Cell Carcinoma. Diagnostics (Basel) 2022; 12:diagnostics12123203. [PMID: 36553210 PMCID: PMC9777365 DOI: 10.3390/diagnostics12123203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
There are no reliable immunohistochemical markers for diagnosing laryngeal squamous cell carcinoma (SCC) or diagnosing and grading laryngeal dysplasia. We aimed to evaluate the diagnostic utility of CK8, CK10, CK13, and CK17 in benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC. This retrospective study included 151 patients diagnosed with laryngeal papilloma, laryngeal polyps, laryngeal dysplasia, and laryngeal SCC who underwent surgical treatment between 2010 and 2020. Immunohistochemistry (IHC) was carried out using specific monoclonal antibodies against CK8, CK10, CK13, and CK17. Two experienced pathologists performed semi-quantitative scoring of IHC positivity. The diagnostic significance of the markers was analyzed. CK13 showed a sensitivity of 100% and a specificity of 82.5% for distinguishing between laryngeal SCC and laryngeal dysplasia and benign lesions. CK17 showed a sensitivity of 78.3% and specificity of 57.1% for the detection of laryngeal SCC vs. laryngeal dysplasia. CK10 showed a sensitivity of 80.0% for discriminating between low-grade and high-grade dysplasia, and a specificity of 61.1%. Loss of CK13 expression is a reliable diagnostic tool for diagnosing laryngeal lesions with malignant potential and determining resection lines. In lesions with diminished CK13 expression, CK17 could be used as an auxiliary immunohistochemical marker in diagnosing laryngeal SCC. In CK13-negative and CK17-positive lesions, CK10 positivity could be used to determine low-grade dysplasia. CK8 is not a useful IHC marker in differentiating between benign laryngeal lesions, laryngeal dysplasia, and laryngeal SCC.
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Affiliation(s)
- Novica Boricic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence:
| | - Ivan Boricic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Jovica Milovanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Terzic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Videolaryngoendoscopic and Stroboscopic Evaluation in Predicting the Malignancy Risk of Vocal Fold Leukoplakia. J Clin Med 2022; 11:jcm11195789. [PMID: 36233657 PMCID: PMC9571578 DOI: 10.3390/jcm11195789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95%CI 0.748−0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting.
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Viana Pinto J, Ruas JJ, Rodrigues JA, Pinto I, Leal M, Vales F, Moura CP. Prognostic Role of the Initial Grade of Dysplasia on Premalignant Vocal Fold Lesions. J Voice 2022:S0892-1997(22)00217-X. [PMID: 36075803 DOI: 10.1016/j.jvoice.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The main objective of this study was to analyze the prognostic role of the initial grade of dysplasia on the progression to SCC. STUDY DESIGN Retrospective cohort. METHODS This study was performed in the Otorhinolaryngology Department of a tertiary hospital center from January 2010 to December 2020. Every patient submitted to a microlaryngoscopy during this period with a histology of dysplasia on the first biopsy was included. RESULTS A total of 112 patients were included and median follow-up was 24 months (range 1-120 months). Mean age at diagnosis was 59.71 (+/- 12.03) and 88 patients were male (78.6%). Initial grade of dysplasia was mild on 60 patients (53.6%), moderate on 24 (21.4%), severe on 18 (16.1%), and carcinoma in situ in 10 (8.9%). Overall, 25 patients (21.4%) developed invasive squamous cell carcinoma (SCC) and 15 (13.4%) died during follow-up. On an adjusted 5 year's progression free survival analysis, considering gender, age, dysplasia grade, tobacco and alcohol consumption, the initial grade of dysplasia was the only factor significantly associated with progression to carcinoma (P = .047). When compared to mild dysplasia, moderate dysplasia had a Hazard Ratio (HR) of 0.81 (95%CI 0.21-3.22); severe dysplasia had a HR of 1.76 (95%CI 0.59-5.30) and carcinoma in situ had a HR of 4.25 (95%CI 1.44-12.59). CONCLUSION The initial dysplasia grade seems to be the most important prognostic factor regarding progression to SCC in patients with premalignant vocal fold disease.
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Affiliation(s)
- João Viana Pinto
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Unidade de Otorrinolaringologia, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal.
| | - José João Ruas
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Unidade de Otorrinolaringologia, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - João Aragão Rodrigues
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Isabel Pinto
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Unidade de Otorrinolaringologia, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Manuel Leal
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Unidade de Otorrinolaringologia, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Vales
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Unidade de Otorrinolaringologia, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carla Pinto Moura
- Serviço de Otorrinolaringologia, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Serviço de Genética Médica, Centro Hospitalar Universitário S. João/Faculdade Medicina da Universidade do Porto, Porto, Portugal; I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Szczepanek E, Drozd-Sokołowska J, Sokołowski J, Rzepakowska A, Moskwa A, Pachla J, Grzybowski J, Woźnica K, Niemczyk K, Jamroziak K. Solitary Extramedullary Plasmacytoma of the Larynx and Secondary Laryngeal Involvement in Plasma Cell Myeloma: Single-Centre Retrospective Analysis and Systematic Literature Review. J Clin Med 2022; 11:jcm11154390. [PMID: 35956004 PMCID: PMC9369432 DOI: 10.3390/jcm11154390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023] Open
Abstract
The involvement of the larynx in plasma cell myeloma (PCM) may manifest as solitary extramedullary plasmacytoma of the larynx (sEMP-L) or as infiltration of the larynx during newly diagnosed or relapsed systemic disease with bone marrow involvement (plasma cell myeloma with laryngeal involvement, PCM-L). To increase knowledge about these rare conditions, we performed a retrospective analysis along with a comprehensive literature review of cases of sEMP-L or PCM-L. Six patients (two sEMP-L and four PCM-L) were identified in our tertiary laryngological centre from 2009 to 2021, constituting 0.88% of all malignant laryngeal tumours. The literature search yielded 187 cases, including 152 sEMP-L and 35 sPCM-L. A comparison of baseline characteristics between sEMP-L and PCM-L performed in the combined cohort of cases from literature review and retrospective analysis revealed that patients with sEMP-L were younger (56 vs. 64 years, p ≤ 0.001) and presented less commonly with thyroid or cricoid cartilage involvement (2.2% vs. 30.8%, p ≤ 0.001). The prognosis of sEMP-L was better than PCM-L (overall survival 86% vs. 55% at 5 years, p = 0.002). Analysis of potential factors that could influence progression-free survival (PFS) in the group of sEMP-L revealed that male sex and cartilage involvement negatively affected PFS in univariate analyses, while only cartilage involvement retained statistical significance in multivariate analysis (HR = 19.94, p = 0.024). In conclusion, PCM with laryngeal involvement is sporadic. Secondary involvement of the larynx during PCM might be more common than sEMP-L and is associated with worse survival. The involvement of cartilage adversely influences the outcome of sEMP-L.
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Affiliation(s)
- Elżbieta Szczepanek
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
- Doctoral School in Medical Sciences and Health Sciences, Jagiellonian University Medical College, 31-530 Cracow, Poland
- Correspondence: ; Tel.: +48-660-107-595
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.D.-S.); (K.J.)
| | - Jacek Sokołowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
| | - Anna Rzepakowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
| | - Arkadiusz Moskwa
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
| | - Jakub Pachla
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
| | - Jakub Grzybowski
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, 00-661 Warsaw, Poland;
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.S.); (A.R.); (A.M.); (J.P.); (K.N.)
| | - Krzysztof Jamroziak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.D.-S.); (K.J.)
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Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Hypopharynx, Larynx, Trachea and Parapharyngeal Space. Head Neck Pathol 2022; 16:31-39. [PMID: 35312977 PMCID: PMC9018940 DOI: 10.1007/s12105-021-01405-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
In this article, we review the chapter on tumors of the larynx, hypopharynx, trachea and parapharyngeal space in the new edition of the WHO book, focusing on the new developments in comparison to the previous edition. Squamous cell carcinoma (SCC) and its variants are by far the most common malignancies at these locations, with very limited new insights. The most important is the introduction of new targeted treatment-checkpoint inhibitors, with a new task for pathologists, who may help to predict the response to treatment by analyzing the expression of targeted proteins in biopsy samples. Precancerous lesions remain a controversial topic and, similarly to other organs, it is acceptable to use the terms "dysplasia" or "squamous intraepithelial lesion" (SIL), but there is a slight difference between low-grade dysplasia and low-grade SIL: in the former, mild atypia must be present, while the latter also includes hyperplastic epithelium without atypia. Two approaches have been proposed: a two-tiered system with low- and high-grade dysplasia/SIL and a three-tiered system with an additional category, carcinoma in situ. We are still searching for reliable diagnostic markers to surpass the subjectivity in biopsy diagnosis, with a few potential candidate markers on the horizon, e.g., stem cell markers. Other tumors are rare at these locations, e.g., hematolymphoid, neuroendocrine and salivary gland neoplasms, and are no longer included in Chapter 3. They must be diagnosed according to criteria described in specific chapters. The same holds true for soft tissue tumors, with the exception of cartilaginous neoplasms, which are still included in Chapter 3.
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