Laryngo-pharyngeal carcinoma in childhood

Laryngeal Cancer in Patients Younger than 30 Years: A Review of 99 Cases

Laryngeal cancer in patients younger than 30 years is uncommon. We present data on this population obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. We identified 99 patients in this age group from the SEER 17 registry, which includes data submitted from 1973 through 2003. This population was made up of 52 females and 47 males; most were white, and most were aged 25 to 29 years. Malignancies of the glottis were the most common cancers, followed by supraglottic lesions. The 5-year relative survival rate was lowest among those aged 15 to 19 years—60.1%; 5-year relative survival among those aged 20 to 24 and 25 to 29 years was 87.7 and 87.4%, respectively. The etiology of squamous cell carcinoma (SCC) in children and adolescents remains uncertain, but in the adult population, a history of smoking, drinking, and poor oral hygiene cannot be ignored. Carcinoma of the larynx in young people has been related to malignant degeneration of papillomas and to complications of radiotherapy for papillomas. Infection with the human immunodeficiency virus possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms.

Sinonasal and laryngeal carcinoma in children: correlation of imaging characteristics with clinicopathologic and cytogenetic features

BACKGROUND AND PURPOSE

Pediatric upper airway carcinoma is uncommon, symptoms are nonspecific, and diagnosis is often delayed. In this study, we describe the imaging, cytogenetics, and clinical courses of 4 patients with pediatric upper airway carcinoma.

MATERIALS AND METHODS

Four patients with upper airway carcinoma were identified during a 2.5-year period. CT (n = 4) and MR imaging (n = 3) studies, tumor histopathologic features and cytogenetics, patient treatment, and clinical course were reviewed.

RESULTS

Patients were aged 12 to 15 years. One tumor involved the larynx with poorly defined margins and heterogeneous enhancement; 1 heterogeneously enhancing tumor involved the epiglottis with necrotic cervical lymphadenopathy. There were 2 enhancing sinonasal tumors with bony destruction in 1 tumor. Tumors had a relatively short relaxation time on FSEIR MR imaging. Histopathologic examination revealed poorly differentiated squamous cell carcinoma (n = 3) and well-differentiated squamous cell carcinoma (n = 1). Cytogenetic analysis revealed chromosomal abnormalities in 3 tumors: 2 showed a chromosomal translocation t(15;19), and 1 showed a chromosomal translocation t(1;5) and loss of a portion of chromosome 22q. Results of in situ hybridization for EBV were negative (n = 3). Treatment included tumor resection (n = 2), chemotherapy (n = 4), and radiation therapy (n = 3). Patients with t(15;19) died months after diagnosis. Two patients were alive at 8-year follow-up.

CONCLUSIONS

Childhood carcinoma of the upper airway is uncommon but should be considered in the diagnosis of upper airway tumors that display aggressive imaging characteristics. Carcinoma with t(15;19) is rare but has been reported, usually in young patients with midline carcinoma of the neck or mediastinum, with a rapidly fatal course.

Hypopharyngeal squamous cell carcinoma in a child

Squamous cell carcinoma of the hypopharynx is extremely rare in children. We present a 13-year-old girl with squamous cell carcinoma of the hypopharynx whose father was a coal-miner and a heavy smoker.

Pediatric unilateral vocal fold immobility

Unilateral VFI is a rare entity in the pediatric age group. Initial evaluation should include a thorough history and physical examination, particularly assessing for associated CNS and cardiovascular anomalies. Modalities of investigation include fiberoptic examination, EMG in the older child,diagnostic imaging, and rigid endoscopy. Controversy exists about the relevance of "growth centers" in the developing larynx, although recent studies dispute their existence. Recovery in idiopathic or congenital cases can occur up to 11 years later, which supports some observation between onset of paralysis and surgical intervention. In cases where the etiology is clear and recovery is not anticipated, a few reported series have demonstrated success with endoscopic injection and thyroplasty techniques. Unlike the case in adults, careful identification of the vocal fold level should be performed in children before implant placement. Further research is necessary to prove prospectively that surgical intervention in the pediatric larynx will not affect subsequent growth. Until this occurs, the otolaryngologist will continue to be challenged with decisions regarding the timing and choice of technique for correction of unilateral VFI in neonates and children.