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Dong YJ, Zhang HH, Liang JQ, Gao YY, Xiong M, Yang H. Laryngeal paraganglioma: The analysis of misdiagnosed cases and literature review. Head Neck 2024; 46:1234-1247. [PMID: 38533762 DOI: 10.1002/hed.27762] [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: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Laryngeal paraganglioma (LP) is an exceptionally rare neuroendocrine tumor, underscoring importance of accurate identification to preclude misdiagnoses. In this review, we presented two typical misdiagnosed LPs, and offered reviews of LP cases reported over the preceding decade and all documented misdiagnosed LP cases. Furthermore, we systematically investigated the underlying causes of misdiagnosis and elucidated key points for effective differentiation. A retrospective analysis of 28 LP cases revealed a predominant occurrence in middle-aged women, with an average history of 25.1 months. Through an analysis of all misdiagnosed cases (n = 37), supraglottic LPs were frequently misidentified as laryngeal carcinomas and vascular tumors, while subglottic LPs were often misdiagnosed as thyroid cancers. And the occurrence of misdiagnosis resulted in delayed and inappropriate treatments, contributing to the deterioration of LP patients (14 cases, 37.8%). In conclusion, this review endeavored to heighten awareness of LPs, with the ultimate goal of advancing diagnostic precision and enhancing patient outcomes.
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Affiliation(s)
- Yi-Jun Dong
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong-Hui Zhang
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia-Qiao Liang
- College of Chemistry, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Ya Gao
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Xiong
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Yang
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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2
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Divya GR, Jayamohanan H, Smitha NV, Anoop R, Nambiar A, Krishnakumar T, Pavithran K. Primary Neuroendocrine Carcinoma of the Larynx: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:2149-2152. [PMID: 36452826 PMCID: PMC9702140 DOI: 10.1007/s12070-020-02060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022] Open
Abstract
Neuroendocrine tumours can originate from any part of the body. The most common site in the head and neck is the larynx, accounts for less than 0.6%. The neuroendocrine carcinomas (NECs) of the larynx are rare tumours with high incidence of widespread metastases and poor prognosis. Here we report a 50-year-old male with localised primary moderately differentiated NEC of the larynx. He was treated with surgery followed by adjuvant chemotherapy and concurrent chemoradiation. He is free of his disease and is doing well.
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Affiliation(s)
- G. R. Divya
- Department of Radiation Oncology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Hridya Jayamohanan
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - N. V. Smitha
- Department of Pathology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - R. Anoop
- Department of Radiation Oncology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Ajit Nambiar
- Department of Pathology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Thankappan Krishnakumar
- Department of Head and Neck Surgery Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
- Department of Medical Oncology, Amrita Institute of Medical Science and Research Centre, Amrita VishwaVidyapeetham, Kochi, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Science and Research Centre, Amrita VishwaVidyapeetham, Kochi, India
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3
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Ranjan K, Sah VP, Khemka S, Shenoy AM. Supraglottic Laryngeal Paraganglioma: A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:1854-1856. [PMID: 36452630 PMCID: PMC9702037 DOI: 10.1007/s12070-020-01871-4] [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: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022] Open
Abstract
Laryngeal paraganglioma is a rare tumor with diagnostic challenge. Many a times it can be confused with laryngeal cancers. CECT and MRI has an important role in its diagnosis. Surgical excision is the treatment of choice. Our case presented with stridor. Emergency tracheostomy was done followed by workup for surgery. Excision of the tumor was done by laryngeal fissure.
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Affiliation(s)
- Kunal Ranjan
- Department Head and Neck Oncology, Mahavir Cancer Sansthan, Patna, Bihar India
| | - Ved Prakash Sah
- DNB Resident Surgical Oncology, Mahavir Cancer Sansthan, Patna, Bihar India
| | - Shruti Khemka
- Department Head and Neck Oncology, Mahavir Cancer Sansthan, Patna, Bihar India
| | - Ashok Mohan Shenoy
- Department Head and Neck Oncology, Mahavir Cancer Sansthan, Patna, Bihar India
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4
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Ananthapadmanabhan S, Jabbour J, Tseros E, Sivapathasingam V, Smith M, Riffat F, Sritharan N. Operative technique in laryngeal paraganglioma: A case series and literature review. Laryngoscope Investig Otolaryngol 2022; 7:467-475. [PMID: 35434328 PMCID: PMC9008153 DOI: 10.1002/lio2.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusions Level of Evidence Laryngeal paragangliomas are a rare subset of head and neck neoplasms, of neuroendocrine origin. We present a series of four cases of confirmed laryngeal paragangliomas and discuss our operative technique using coblation‐assisted excision via laryngofissure.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
| | - Evangelos Tseros
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
| | | | - Mark Smith
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
| | - Niranjan Sritharan
- Department of Otolaryngology Nepean Hospital Kingswood New South Wales Australia
- Department of Otolaryngology Westmead Hospital Westmead New South Wales Australia
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5
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Graham NJ, Smith JD, Else T, Basura GJ. Paragangliomas of the head and neck: a contemporary review. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R153-R162. [PMID: 37435464 PMCID: PMC10259325 DOI: 10.1530/eo-22-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 07/13/2023]
Abstract
Head and neck paragangliomas (HNPGLs) are slow-growing, vascular, typically benign tumors whose growth may induce significant lower cranial nerve deficits. While most tumors arise sporadically, a significant portion is associated with defined genetic syndromes. While surgical resection has historically been the gold standard, management strategies have evolved with acknowledgement of high surgical morbidity, slow tumor growth rates, and technological advances. Conservative management approaches via observation and newer radiation therapy techniques have become more common. This review seeks to provide an update on contemporary management strategies for HNPGLs and future directions.
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Affiliation(s)
- Nathan J Graham
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gregory J Basura
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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6
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Hu J, Wang H, Chen J, Pan X, Deng D, Zhuo L, Liu S, He M, Chen F, Yang H. Pitfalls in the management of subglottic paragangliomas at unusual location: a case report and literature review. BMC Surg 2021; 21:340. [PMID: 34496808 PMCID: PMC8424930 DOI: 10.1186/s12893-021-01337-6] [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: 11/24/2020] [Accepted: 08/31/2021] [Indexed: 02/08/2023] Open
Abstract
Background Subglottic paragangliomas (PGs) are exceptionally rare and unpredictable, occasionally presenting at an atypical location. There are three different clinical forms of subglottic PGs: intraluminal (tracheal PGs), extraluminal (thyroid PGs) and the mixed type (both intraluminal and extraluminal, mixed-subglottic PGs). These tumors are usually misdiagnosed as other relatively common primary thyroid or laryngotracheal tumors, and the treatment is troublesome. Case presentation A 22-year-old male patient with subglottic PGs has been successively misdiagnosed as thyroid tumors and subglottic hemangiomas, and lastly underwent local extended lumpectomy and laryngotracheal reconstruction with a pedicled thoracoacromial artery perforator flap (PTAPF). The patient was decannulated successfully after the second-stage tracheal reconstruction with a local flap, and no evidence of local recurrence and distant metastasis of the tumor until now. Conclusion Subglottic PGs can be easily misdiagnosed as laryngotracheal or thyroid tumors when presented at an atypical location. It is essential for otolaryngologists and head and neck surgeons to remain vigilant against these tumors. If the tumor is not diagnosed or removed completely, patients may encounter a risk of lethal paroxysm, which is incredibly troublesome.
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Affiliation(s)
- Juanjuan Hu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Haiyang Wang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianli Chen
- Department of Burn and Plastic Surgery, Dazhou Central Hospital, Dazhou, Sichuan, People's Republic of China
| | - Xuelin Pan
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Di Deng
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lufang Zhuo
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shixi Liu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Maiyue He
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fei Chen
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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7
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Ong AC, Huh EH, Moreland AJ, Rooper LM, Aygun N, Akst LM, Best SR, Khan MA. Nonepithelial Tumors of the Larynx: Single-Institution 13-Year Review with Radiologic-Pathologic Correlation. Radiographics 2020; 40:2011-2028. [PMID: 33035134 DOI: 10.1148/rg.2020190210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nonepithelial tumors of the larynx are rare and represent a minority of all laryngeal neoplasms. Imaging has an important role in the diagnosis, treatment planning, and surveillance of these entities. However, unfamiliarity with these neoplasms can cause diagnostic difficulties for radiologists, especially because many of the imaging findings are nonspecific. By using a systematic approach based on clinical history, patient age and gender, lesion location, endoscopic results, and specific imaging findings, the differential diagnosis can often be narrowed. These tumors typically affect the submucosal layer, so if a tumor has an intact mucosa at endoscopy, a nonepithelial neoplasm is the most likely diagnosis. Nonepithelial tumors of the larynx can arise from the laryngeal cartilage or muscle or from the surrounding lymphoid tissue or blood vessels. Consequently, imaging findings typically correspond to the specific cell type from which it originated. Recognizing specific features (eg, metaplastic bone formation, macroscopic fat, or enhancement pattern) can often help narrow the differential diagnosis. In addition, identification of noncircumscribed borders of the lesion and invasion of the adjacent structures is key to diagnosis of a malignant process rather than a benign neoplasm. Understanding the pathologic correlation is fundamental to understanding the radiologic manifestations and is ultimately crucial for differentiation of nonepithelial laryngeal neoplasms. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Andrew C Ong
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Eric H Huh
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Anna J Moreland
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Lisa M Rooper
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Nafi Aygun
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Lee M Akst
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Simon R Best
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
| | - Majid A Khan
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.C.O., E.H.H., A.J.M., N.A., M.A.K.), Department of Pathology (L.M.R.), and Department of Otolaryngology-Head and Neck Surgery (L.M.A., S.R.B.), Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore. MD 21287
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8
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Pavan Kumar L, Armugham N, Rama Krishna M, Triveni B. Small-Cell Neuroendocrine Tumor of Larynx: A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2019; 71:5-10. [PMID: 31741918 DOI: 10.1007/s12070-015-0866-z] [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: 02/13/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022] Open
Abstract
Here we report a 60 year aged male presented with complaints of right neck swelling of 3 months duration, swelling was initially small in size and gradually increasing. On examination right level II, hard mobile lymph node was palpable measuring 4 × 4 cm in size, oral cavity and oropharynx was normal. Computed tomography of face neck showed moderately enhancing soft tissue mass of 2 × 3 cm in the supra glottis and left level II cervical lymphadenopathy of size 5 × 5 cm with infiltrating into left sternomastoid muscle. Direct laryngoscopy revealed an ulcero proliferative growth in the supra glottis extending into vallaculla biopsy from the growth showed small round cells with scant amount of cytoplasm with hyperchromatic nucleus, atypical mitosis and at places rosettoid arrangement was seen. Immunohistochemistry with pancytokeratin, CD 56 and synaptophysin were positive, LCA was negative and Ki 67 was >70 %, features consisted with neuroendocrine carcinoma small cell type. Computed tomography of chest, abdomen and pelvis was normal. Finally it was labeled as localized neuro endocrine carcinoma small cell type of larynx (supraglottis). This patient treated with external beam radiotherapy 70 Gy in 35 fractions @ 2 Gy per fraction over 7 weeks along with concurrent chemotherapy with weekly cisplatin followed by adjuvant chemotherapy with Cisplatin and Etoposide for six cycles.
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Affiliation(s)
- Lachi Pavan Kumar
- Department of Radiation Oncology, MNJIO & RCC, Hyderabad, 500082 India
| | - N Armugham
- Department of Radiation Oncology, MNJIO & RCC, Hyderabad, 500082 India
| | - M Rama Krishna
- Department of Radiation Oncology, MNJIO & RCC, Hyderabad, 500082 India
| | - B Triveni
- Department of Pathology, MNJIO & RCC, Hyderabad, India
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9
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Papagiannopoulos P, Raman A, Miller C, Jhaveri M, Ghai R, Husain I. Laryngeal Paraganglioma with Chronic Cough: A Case Report. Turk Arch Otorhinolaryngol 2019; 56:233-236. [PMID: 30701120 DOI: 10.5152/tao.2018.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022] Open
Abstract
Laryngeal paragangliomas are rare lesions originating from paraganglion cells within the supraglottis or subglottis. As per the latest review, only 76 such cases have been reported in the literature. Symptoms typically include dysphonia or dysphagia. We present, to the best of our knowledge, the first known case of laryngeal paraganglioma with chronic cough as the primary complaint. A 77-year-old male presented with chronic cough. Flexible laryngoscopy revealed a supraglottic submucosal mass emanating from the region of the right false vocal cord and aryepiglottic fold. Postcontrast computed tomography scan showed a well-defined intensely enhancing mass arising from the right paraglottic space and bulging into the right pyriform sinus. Biopsies and immunohistochemical markers supported the diagnosis of paraganglioma. A complete submucosal excision of the mass via a right transcervical approach with tracheostomy was performed. Postoperatively, the patient's cough resolved. Laryngeal paragangliomas are rare tumors that are known to present with dysphonia or dysphagia. This is the first case report of a patient presenting with chronic cough as the primary complaint.
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Affiliation(s)
- Peter Papagiannopoulos
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Illinois, USA
| | - Anish Raman
- Rush University Medical Center, Rush Medical College, Illinois, USA
| | - Courtney Miller
- Rush University Medical Center, Rush Medical College, Illinois, USA
| | - Miral Jhaveri
- Department of Radiology, Rush University Medical Center, Illinois, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Illinois, USA
| | - Inna Husain
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Illinois, USA
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10
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Paraganglioma. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Samal S, Pradhan P, Preetam C, Patra S. Oropharyngeal paraganglioma presenting with stridor: an unusual presentation. BMJ Case Rep 2018; 2018:bcr-2018-225607. [PMID: 29973412 PMCID: PMC6040529 DOI: 10.1136/bcr-2018-225607] [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] [Accepted: 06/14/2018] [Indexed: 11/04/2022] Open
Abstract
Head and neck paraganglioma is a rare disease to encounter in clinical practice and involvement of the base of the tongue in the oropharynx is yet to be described in the current literature. Although various surgical approaches have been described in the literature, transcervical mandibular swing is an effective technique for adequate exposure and complete excision of the oropharyngeal paraganglioma with adequate control on bleeding especially when it is assisted by coblation.
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Affiliation(s)
| | | | | | - Susama Patra
- Department of Pathology, AIIMS, Bhubaneswar, Odisha, India
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12
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Sankar G, Rajaraman V, Ganesh RN, Halanaik D, Pandit N, Ponnusamy M. Multiple Cutaneous Metastases on 99mTC-HYNIC-TOC Scan in a Rare Case of Malignant Laryngeal Paraganglioma. Indian J Nucl Med 2018; 33:348-350. [PMID: 30386061 PMCID: PMC6194765 DOI: 10.4103/ijnm.ijnm_54_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Laryngeal paraganglioma is a rare neuroendocrine tumor arising from neural crest cells of larynx, contributing to 0.6% of the laryngeal tumors. Patients usually present with compressive symptoms such as hoarseness of voice. These tumors express somatostatin receptors, which can be imaged with radioligands such as 99mTc labeled hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC). The percentage of malignant transformation in laryngeal paraganglioma is 2%, and they usually metastasize to lymph nodes, bone, and liver. Here, we report a 99mTc HYNIC-TOC scan of a 55-year-old male patient with recurrent laryngeal paraganglioma, who presented with painful multiple metastatic cutaneous nodules.
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Affiliation(s)
- Gowri Sankar
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishnukumar Rajaraman
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nandini Pandit
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Madhusudhanan Ponnusamy
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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13
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Abstract
The differential diagnosis of neuroendocrine neoplasms of the larynx is broad and includes lesions of epithelial, mesenchymal, and neuroectodermal origin. These lesions have overlapping clinical and pathologic aspects and must be carefully considered in the differential diagnosis of laryngeal neoplasms. The prognosis and treatment are also different among these tumor types, which necessitates making these distinctions clinically. The current literature was reviewed to provide updated information regarding the epithelial-derived tumors, including carcinoid, atypical carcinoid, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinoma, and squamous cell carcinoma with neuroendocrine component. These tumors are compared and contrasted with non-epithelial-derived tumors such as paraganglioma and nonmucosal tumors, such as medullary thyroid carcinoma. The morphologic and cytologic features are discussed, along with helpful immunohistochemical and ancillary investigations.
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14
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Paragangliomas of the Head and Neck: An Overview from Diagnosis to Genetics. Head Neck Pathol 2017; 11:278-287. [PMID: 28321772 PMCID: PMC5550402 DOI: 10.1007/s12105-017-0803-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 10/19/2022]
Abstract
Paragangliomas (PGL) develop from the parasympathetic system in the head and neck (HN) and arise primarily in four distinct areas: Carotid body, vagal, middle ear, and larynx. Globally, the diagnosis and morphologic features are the same regardless of anatomic site, however the incidence, frequency of genetic alterations/syndromes and differential diagnosis vary. It is now recognized that nearly 40% of all HN PGLs are hereditary, including a significant subset without a known family history. Now pathologists are central to the evaluation for diagnosis and further management of patients with HNPGLs. Specifically, SDHB immunohistochemical evaluation is an excellent screening tool to detect tumors with alterations in the SDH family of genes that represent the majority of hereditary cases in HNPGL. Similarly, SDHB immunohistochemical analysis allows for screening of PGL syndrome associated tumors (gastrointestinal stromal tumor (GIST), renal cell carcinoma (RCC), and pituitary adenomas) that have now been linked by their overlapping gene alterations. Awareness of the spectrum of these syndromes, and their associated tumors, positions the pathologist to augment patient care and surveillance.
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Reznick D, Scharpf J, Doshi K, Siperstein A, Berber E, Chute D, Mitchell J. Malignant Primary Paraganglioma of the Thyroid Gland: The First Reported Case. AACE Clin Case Rep 2016. [DOI: 10.4158/ep14041.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mhawej R, Farah C, Haddad A, Tabchy B. Primary neuroendocrine tumors of the ear, nose and throat: A report of three cases and a review of the literature. Oncol Lett 2015; 10:2533-2536. [PMID: 26622884 DOI: 10.3892/ol.2015.3606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/07/2015] [Indexed: 01/05/2023] Open
Abstract
The aim of the present study was to review all cases of neuroendocrine tumors of the ear, nose and throat in a tertiary care center, as well as the data published in the literature. The study presents all the cases of neuroendocrine tumors (NETs) in the Hotel Dieu De France Hospital (Beirut, Lebanon) between January 2004 and January 2014. The data reported in the English and French literature is also reviewed with regard to the typical clinical presentation and management of these tumors. Three cases of NETs presented to the Department of Otolaryngology-Head and Neck Surgery during the study period. One case was of an atypical carcinoid (AC) tumor of the larynx, one case was of a typical carcinoid tumor in the middle ear and the third case was, to the best of our knowledge, the first reported case of an AC tumor of the nasopharynx. Overall, NETs are rare in the head and neck. The clinical presentation can mimic any other tumor in the same localization in the absence of a carcinoid syndrome. Management of these tumors remains controversial, but a complete excision of the tumor is crucial, followed by possible adjuvant treatment.
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Affiliation(s)
- Rachad Mhawej
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu De France Hospital, Saint Joseph University, School of Medicine, Beirut 166830, Lebanon
| | - Chadi Farah
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu De France Hospital, Saint Joseph University, School of Medicine, Beirut 166830, Lebanon
| | - Amine Haddad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu De France Hospital, Saint Joseph University, School of Medicine, Beirut 166830, Lebanon
| | - Bassam Tabchy
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu De France Hospital, Saint Joseph University, School of Medicine, Beirut 166830, Lebanon
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Berta E, Camuzard O, Poissonnet G. A strange form of dysphonia... . Laryngeal paraganglioma. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:297-300. [PMID: 26123571 DOI: 10.1016/j.anorl.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Etienne Berta
- Centre Antoine-Lacassagne, institut universitaire de la face et du cou, 31, avenue Valombrose, 06100 Nice, France.
| | - Olivier Camuzard
- Centre Antoine-Lacassagne, institut universitaire de la face et du cou, 31, avenue Valombrose, 06100 Nice, France
| | - Gilles Poissonnet
- Centre Antoine-Lacassagne, institut universitaire de la face et du cou, 31, avenue Valombrose, 06100 Nice, France
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Naik SM, Shenoy AM, Chavan P, Patil A, Gupta S. Laryngeal paraganglioma: a rare clinical entity managed by supraselective embolization and lateral pharygotomy. Indian J Otolaryngol Head Neck Surg 2012; 65:95-104. [PMID: 24427624 DOI: 10.1007/s12070-012-0575-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/28/2012] [Indexed: 11/25/2022] Open
Abstract
Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia are the commonest presenting symptoms and usually it presents as an submucosal mass on laryngoscopy. Ninety percentage of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9 %), none are associated with paraneoplastic syndromes. A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied >80 % of the blood supply to the laryngeal mass. Supraselective embolization was done from the right femorals under local anaesthesia and sedation which was uneventfull. The tumor was excised from lateral pharyngotomy approach with an partial laryngectomy procedure. Microscopy and immune-histochemistry confirmed it to be paraganglioma. Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures gives an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and an major meta-analysis is necessary to provide a true biological behaviour of this tumor.
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Affiliation(s)
- Sudhir M Naik
- Department of Head and Neck Oncosurgery, KMIO, Bangalore, India
| | - Ashok M Shenoy
- Department of Head and Neck Oncosurgery, KMIO, Bangalore, India
| | | | | | - Sumit Gupta
- Department of Head and Neck Oncosurgery, KMIO, Bangalore, India
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Tian H, Chen Z, Wang C, Xing G. Hypopharyngeal paraganglioma with a paraneoplastic neurologic syndrome: a case report. Head Neck 2012; 35:E304-7. [PMID: 22987597 DOI: 10.1002/hed.23164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We report an extremely rare case of hypopharyngeal paraganglioma that was accompanied by a paraneoplastic neurologic syndrome (PNS). METHODS The clinical, radiological, and histopathologic findings of the patient are presented. RESULTS A 49-year-old woman presented with a history of progressive asthenia of the lower extremities persisting for 2 months. She also experienced numbness and sensory disturbance of the left lower limbs, 2 epileptic seizures, and constipation during the period. Clinical and radiological evaluations suggested the diagnosis of encephalomyelitis in combination with a left hypopharyngeal mass lesion. The patient underwent surgical excision of the lesion, which subsequently resolved her symptoms. Postoperative pathology was consistent with a paraganglioma. There was no evidence of local recurrence or distant metastasis of the tumor on recent follow-up. CONCLUSIONS To the best of our knowledge, our patient represents the third reported case of hypopharyngeal paraganglioma, and the only one to have a paraneoplastic syndrome.
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Affiliation(s)
- Huiqin Tian
- Department of Otolaryngology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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21
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Laryngeal paraganglioma in an irradiated neck. The Journal of Laryngology & Otology 2012; 126:747-50. [DOI: 10.1017/s0022215112000849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We present the first reported case of a paraganglioma of the larynx occurring concurrently with squamous cell carcinoma in an irradiated neck.Method:We present a case report and a literature review of paraganglioma of the larynx.Case report:A 78-year-old woman was found to have a mass on the laryngeal surface of the epiglottis and non-functioning larynx, four months after radical radiotherapy for biopsy-proven squamous cell carcinoma. Repeated positron emission tomography computed tomography was highly suggestive of residual malignancy. Given these findings, and the fact that the patient was aspirating, she was treated with total laryngectomy, and was found to have a paraganglioma of the larynx.Conclusion:This is the first report of such a case. Its importance is three-fold in that it demonstrates: the coexistence of paraganglioma and squamous cell carcinoma; the difficulties that can be encountered in the diagnosis; and the use of radiotherapy in the treatment of paraganglioma.
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Angouridakis N, Goudakos J, Karayannopoulou G, Triaridis S, Nikolaou A, Markou K. Primary neuroendocrine neoplasms of the larynx. A series of 4 cases reported and a review of the literature. Head Neck 2012; 35:E187-93. [DOI: 10.1002/hed.22955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/08/2022] Open
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Lewis JS, Ferlito A, Gnepp DR, Rinaldo A, Devaney KO, Silver CE, Travis WD. Terminology and classification of neuroendocrine neoplasms of the larynx. Laryngoscope 2011; 121:1187-93. [PMID: 21557244 DOI: 10.1002/lary.21790] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To review the history and literature on neuroendocrine neoplasms of the larynx and discuss the terminology and classification of these tumors. STUDY DESIGN Contemporary review. METHODS Published journal articles identified through PubMed and conference proceedings were reviewed. RESULTS Neuroendocrine neoplasms of the larynx include both epithelial (carcinomas) and neural-type lesions (paragangliomas).The nomenclature of these tumors has changed quite a bit over time, but recently, clearer categories have emerged that are biologically meaningful. They can overlap clinically and histologically so that segregation into the clinically relevant subtypes can be difficult, but it is extremely important to do so as they have a wide range of behaviors going from benign to rapidly fatal. CONCLUSIONS Neuroendocrine neoplasms of the larynx can be clearly categorized into the five tumor types: typical carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma, large cell neuroendocrine carcinoma, and paraganglioma. These have concrete biologic and clinical significance and clearly dictate patient treatment.
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Affiliation(s)
- James S Lewis
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
BACKGROUND Paragangliomas in the region of the thyroid gland are rare tumors that can present a diagnostic challenge by mimicking follicular and c-cell derived thyroid tumors. SUMMARY Thyroid-associated paragangliomas are likely a subset of laryngeal paragangliomas and, although quite rare, should be considered in the differential diagnosis of a hypervascular thyroid nodule. The preoperative diagnosis of thyroid-associated paragangliomas can be challenging since the cytologic and histologic features overlap with more common primary thyroid neoplasms, in particular medullary carcinoma. Differential expression of a panel of immunohistochemical markers, including neuro-specific enolase, chromogranin A, synaptophysin, keratin, and S100, can be used to distinguish thyroid-associated paragangliomas from primary thyroid tumors. Intraoperatively, thyroid-associated paragangliomas may be associated with significant intraoperative bleeding and are often densely adherent to surrounding tissues, including the recurrent laryngeal nerve. Interestingly, the aggressive local behavior of these tumors does not correspond to potential for malignancy, as there are no patients with malignant thyroid-associated paragangliomas reported in the medical literature. Therefore, these tumors may be treated with limited resection. Postoperatively, patients with paragangliomas should receive hormonal evaluation for functional disease, imaging evaluation for multicentric and metastatic disease, and genetic counseling. CONCLUSION Thyroid-associated paragangliomas are an important part of the differential diagnosis of a hypervascular thyroid nodule, especially in a patient with a fine-needle aspiration biopsy suggestive of medullary thyroid carcinoma, but with unremarkable serum calcitonin levels. Consideration of a thyroid-associated paraganglioma also has important operative and postoperative implications for determining the extent of thyroid resection as well as follow-up testing.
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Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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25
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Ferlito A, Silver CE, Bradford CR, Rinaldo A. Neuroendocrine neoplasms of the larynx: an overview. Head Neck 2010; 31:1634-46. [PMID: 19536850 DOI: 10.1002/hed.21162] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Neuroendocrine neoplasms of the larynx are rare but are the most common nonsquamous tumors of this organ. In the past, there has been considerable confusion about the nature and classification of these neoplasms, but the current consensus is that there are 4 different types of laryngeal neuroendocrine tumors composed of paraganglioma, typical carcinoid, atypical carcinoid tumor, and small cell neuroendocrine carcinoma. Carcinoids and small cell neuroendocrine carcinomas are epithelial neoplasms, whereas paragangliomas are of neural origin. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. Precise diagnosis is essential because the natural history, treatment, and prognosis vary widely for the different neoplastic categories. Typical carcinoids are very rare and are treated by wide local excision, usually partial laryngectomy, without elective neck dissection. Atypical carcinoid tumors are more common and more aggressive. They are treated by partial or total laryngectomy with elective or therapeutic neck dissection. Adjuvant chemo/radiotherapy may be of benefit in some cases. Small cell neuroendocrine carcinomas are highly aggressive and should be considered disseminated at initial diagnosis. The treatment is by irradiation and chemotherapy as surgery has proven to be of a little benefit. Paragangliomas are treated by local excision or partial laryngectomy. It is difficult to determine the valid survival statistics for typical carcinoids because of their rarity and confusion in the literature with their atypical counterparts. They have a greater tendency to metastasize, and thus a worse prognosis than was previously believed. Atypical carcinoid tumors have a 5-year survival rate of approximately 50%, which decreases with time. The prognosis of small cell neuroendocrine carcinoma of the larynx is dismal, with 5-year survival rates of 5%. The biological behavior of laryngeal paraganglioma is generally benign and the prognosis is excellent.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy.
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Smolarz JR, Hanna EY, Williams MD, Kupferman ME. Paraganglioma of the endolarynx: a rare tumor in an uncommon location. HEAD & NECK ONCOLOGY 2010; 2:2. [PMID: 20205783 PMCID: PMC2823598 DOI: 10.1186/1758-3284-2-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 01/19/2010] [Indexed: 11/10/2022]
Abstract
Background Less than 80 reported cases of paragangliomas of the larynx are reported in the literature. A role for external beam radiation in this disease has not yet been explored. We present four cases of laryngeal paragangliomas treated at a large tertiary-care cancer center over a 35-year period. Methods 124 cases of head and neck paragangliomas treated at a single institution from 1970 to 2005 were retrospectively studied. Patients with laryngeal paragangliomas were identified, and a comprehensive clinico-pathological review was undertaken. Results We identified 4 patients with tumors arising in the larynx at the following subsites: supraglottis (2), glottis (1), and subglottis (1). Three patients were treated with surgery and one with definitive radiation alone. Conclusions Laryngeal paragangliomas are rare tumors and are adequately treated with surgical resection. We also present one patient who was treated with radiation and had disease stabilization. Accurate histological classification is critical, and the role of genetic testing is emerging.
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Affiliation(s)
- Joseph R Smolarz
- Department of Otorhinolaryngology, Head and Neck Surgery/Otolaryngology, The University of Texas Health Science Center at Houston, 6431 Fannin, Suite MSB 5.036, Houston, TX 77030, USA
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27
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Leung S, Storck K, Lefrancois D. Visual vignette. Endocr Pract 2009; 15:175. [PMID: 19289332 DOI: 10.4158/ep.15.2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sharon Leung
- Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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28
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Kusafuka K, Muramatsu K, Yabuzaki T, Ishiki H, Asano R, Kamijo T, Iida Y, Ebihara M, Onitsuka T, Kameya T. Alveolar soft part sarcoma of the larynx: a case report of an unusual location with immunohistochemical and ultrastructural analyses. Head Neck 2008; 30:1257-63. [PMID: 18286485 DOI: 10.1002/hed.20766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) is a rare mesenchymal neoplasm of uncertain origin. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. METHODS AND RESULTS The patient was a 34-year-old Japanese woman who requested an examination for hoarseness. The tumor showed a proliferation of large polygonal cells with periodic-acid-Schiff-positive diastase-resistant intracytoplasmic granules, arranged in an alveolar growth pattern. The cytoplasm of the tumor cells was eosinophilic. Tumor cells were positive for vimentin and titin. Nuclear immunoreactivity for TFE3 was observed, and the Ki-67 labeling index was 14.7%. Ultrastructurally, electron-dense rod-shaped crystals were infrequently observed in the cytoplasm. This case was finally diagnosed as ASPS of the larynx. CONCLUSION We discuss the histogenesis and differential diagnosis of ASPS with immunohistochemical and ultrastructural findings. TFE3 immunohistochemistry was found to be a very useful marker for the diagnosis of ASPS.
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Affiliation(s)
- Kimihide Kusafuka
- Pathology Division, Shizuoka Cancer Center Hospital and Research Institute, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
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Hobson ML, Walker P, Reid C, Braye S. An unusual presentation of laryngeal paraganglioma: The first pediatric case reported in Australia. Otolaryngol Head Neck Surg 2008; 139:168-9. [DOI: 10.1016/j.otohns.2007.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 05/02/2007] [Indexed: 10/21/2022]
Affiliation(s)
- Megan L. Hobson
- Department of Otolaryngology–Head and Neck Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Paul Walker
- Department of Otolaryngology–Head and Neck Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Colin Reid
- Department of Otolaryngology–Head and Neck Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Stephen Braye
- Department of Anatomical Pathology, John Hunter Children's Hospital, Newcastle, Australia
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31
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Screening for familial paragangliomas. Oral Oncol 2008; 44:532-7. [DOI: 10.1016/j.oraloncology.2007.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 11/20/2022]
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32
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Rubio V, Manuel Tamarit J, Baviera N, Estrems P, López C, Estellés E, Dalmau J. Paraganglioma laríngeo, diagnóstico y tratamiento. Apropósito de un caso. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74939-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferolla P, Faggiano A, Avenia N, Milone F, Masone S, Giampaglia F, Puma F, Daddi G, Angeletti G, Lombardi G, Santeusanio F, Colao A. Epidemiology of non-gastroenteropancreatic (neuro)endocrine tumours. Clin Endocrinol (Oxf) 2007; 66:1-6. [PMID: 17201794 DOI: 10.1111/j.1365-2265.2006.02739.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The widespread availability and reliability of immunohistochemical techniques in the last three decades have allowed researchers to identify cells with common neuroendocrine markers in virtually every organ. As a whole, these neuroendocrine cells form the so-called diffuse neuroendocrine system. Tumours arising from the cells of the diffuse neuroendocrine system are defined as (neuro)endocrine tumours (NETs). NETs have been increasingly described in recent years. However, despite the increase in the number of published papers focused on NET, we still lack adequate epidemiological data, particularly for non-gastroenteropancreatic (GEP) NETs. Furthermore, the real incidence of neuroendocrine differentiation for most sites is not completely known and is probably underestimated. As a consequence, data on the clinical features of many NET subgroups are not well known or confusing. For all of these reasons, we have attempted to evaluate the epidemiology of non-GEP NETs, reviewing the limited data available in the literature.
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Affiliation(s)
- P Ferolla
- Department of Internal Medicine and Endocrine Sciences, University of Perugia, Perugia, Italy
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Rubio V, Tamarit JM, Baviera N, Estrems P, López C, Estellés E, Dalmau J. Laryngeal Paraganglioma: Diagnosis and Treatment. A Propos of a Case. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Ferlito A, Devaney KO, Rinaldo A. Neuroendocrine neoplasms of the larynx: Advances in identification, understanding, and management. Oral Oncol 2006; 42:770-88. [PMID: 16815077 DOI: 10.1016/j.oraloncology.2006.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 01/06/2006] [Indexed: 10/24/2022]
Abstract
While 85-90% of laryngeal malignancies prove to be squamous carcinomas, the second most common tumour type found in the laryngeal region will prove to be a member of the family of neuroendocrine tumours. Laryngeal carcinoid tumours have a capacity for metastasis, and so are more aggressive tumours than their light microscopic features might imply--5-year survival rates are in the vicinity of 50%. Laryngeal atypical carcinoid tumours are lesions with a well-recognized capacity for local recurrence as well as metastasis, with a 5-year survival of just under 50%. Laryngeal small cell neuroendocrine carcinomas are particularly aggressive tumours, with a 5-year survival of no more than 5-10%. Laryngeal paragangliomas are lesions without any real capacity for metastasizing. Surgical excision is the mainstay of treatment of carcinoid tumours, atypical carcinoid tumours, and paragangliomas. Small cell neuroendocrine carcinomas are chiefly treated by way of radiation and chemotherapy; the role of adjuvant therapy in the treatment of atypical carcinoid tumours remains to be established.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy.
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Suárez C, Rodrigo JP, Ferlito A, Cabanillas R, Shaha AR, Rinaldo A. Tumours of familial origin in the head and neck. Oral Oncol 2006; 42:965-78. [PMID: 16857415 DOI: 10.1016/j.oraloncology.2006.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/08/2006] [Indexed: 12/15/2022]
Abstract
Individuals with inherited cancer syndromes are at significant risk of developing both benign and malignant tumours as a result of a germline mutation in a specific tumour suppressor gene. Tumours of familial origin are a rare event in the head and neck but despite this, they deserve a growing interest. Familial paragangliomas are most of the time limited to the paraganglionar system, but also may be part of different syndromic associations. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis in the search of SDHB, SDHC and SDHD mutations in families of affected patients plays a front-line diagnostic role, leading to more efficient patient management. Multiple endocrine neoplasias type 1 are characterized by the simultaneous occurrence of at least two of the three main related endocrine tumours: parathyroid, enteropancreatic and anterior pituitary. These tumours arise from inactivating germline mutations in the MEN-1 gene. No clear correlation of MEN-1 genotype with genotype has emerged to date, and MEN-1 mutation testing in tumours is not used clinically because it have not implications for tumour staging. Multiple endocrine neoplasia type 2 is due to a germline mutation in the RET proto-oncogene. Hallmarks of MEN-2A (the commonest phenotypic variant) include medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. The most central clinical difference with MEN-1 is that the associated cancer can be prevented or cured by early thyroidectomy in mutation carriers. Individuals with neurofibomatosis type 1 present early in life with pigmentary abnormalities, skinfold freckling and iris hamartomas, as result of NF1 gene mutation. Neurofibromatosis 2 is caused by inactivating mutations of the NF2 gene, and is characterized by the development of nervous system tumours (mainly bilateral vestibular schwannomas), ocular abnormalities, and skin tumours. The molecular genetic basis of nasopharyngeal carcinomas remains unknown, but there is evidence for the linkage of these tumours to chromosome 3p. Finally, the high rate of p16 mutations in squamous cell carcinomas and the association of p16 with familial melanoma propose p16 as an ideal candidate gene predisposing to familial squamous cell carcinomas. The elucidation of the cellular processes affected by dysfunction in familial tumours of the head and neck may serve to identify potential targets for future therapeutic interventions.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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37
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Abstract
Laryngeal paragangliomas, although rare, are lesions that warrant appropriate diagnosis and treatment secondary to their location and high risk of bleeding when violated. This article describes a method to workup patients with solid submucosal lesions of the larynx to diagnose a paraganglioma without a biopsy. When recognized preoperatively, a lateral approach to removal can be performed, decreasing the risk of significant bleeding and the need for tracheotomy or permanent laryngostoma. This article also adds two more cases to the reported literature of 75.
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Affiliation(s)
- Seth M Brown
- Department of Otolaryngology and Communicative Disorders, The Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 10040, USA.
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38
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Ferlito A, Rinaldo A. The spectrum of endocrinocarcinomas of the larynx. Oral Oncol 2005; 41:878-83. [PMID: 16154516 DOI: 10.1016/j.oraloncology.2004.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 12/22/2004] [Indexed: 11/21/2022]
Abstract
The authors discuss the terminology, classification, pathology, diagnosis, treatment and prognosis of the endocrinocarcinomas of the larynx.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
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