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Localized laryngeal amyloidosis: A systematic review. Am J Otolaryngol 2022; 43:103550. [DOI: 10.1016/j.amjoto.2022.103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022]
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Wu X, Zhang J, Wei C. Curative effect of cold micro forceps and CO 2 laser in the treatment of laryngeal amyloidosis. Acta Otolaryngol 2019; 139:1122-1127. [PMID: 31642730 DOI: 10.1080/00016489.2019.1680864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Amyloidosis is a benign, slowly progressive disease. However, the treatment of laryngeal amyloidosis (LA) has not been studied systematically.Objectives: To investigate the treatment results of cold micro forceps or carbon dioxide laser under microlaryngoscope in the treatment of LA.Methods: A retrospective review was conducted for the cases collected from January 1990 to March 2016 at our department.Results: One hundred and eighteen patients (44 males and 74 females, with an average age of 51.7 years) with LA were identified. The amyloidosis was not found in organs other than the larynges and tracheas. The patients most commonly presented with hoarseness and dyspnea. All patients underwent surgical removal of the amyloid deposits (via micro forceps or CO2 laser). Twenty-nine patients developed recurrences requiring further treatments. The mean interval from treatments to recurrences in these patients was 16.5 months. Five patients were treated more than once. No significant difference was found between cold micro forceps and CO2 laser methods in recurrences.Conclusions: LA generally behaves as a benign disease. Resection of LA either via cold micro forceps or CO2 laser under microlaryngoscope is both safe and effective methods. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence.
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Affiliation(s)
- Xiufa Wu
- Department of Otolaryngology – Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
| | - Jing Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
| | - Chunsheng Wei
- Department of Otolaryngology – Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
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Risk factors for recurrence of laryngeal amyloidosis treated by microforceps and CO 2 laser. Eur Arch Otorhinolaryngol 2019; 277:521-525. [PMID: 31745631 DOI: 10.1007/s00405-019-05730-z] [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: 10/04/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Laryngeal amyloidosis is a benign, slowly progressive disease. The factors affecting the recurrence of LA have not been studied before for the rarity and incomplete understanding of this disease. To investigate the risk factors for the laryngeal amyloidosis treated by microforceps or carbon dioxide laser under microlaryngoscope, a retrospective review was conducted. MATERIALS AND METHODS One hundred and four patients (42 male and 72 female, with an average age of 51.3 years) with laryngeal amyloidosis were identified. The cases were collected from January 1989 to May 2014 at the Eye, Ear, Nose, and Throat Hospital of Fudan University. RESULTS Seventy-five patients complained of hoarseness, 36 patients complained of hoarseness and dyspnea, and 3 patients complained of foreign body sensation. All patients underwent surgical removal of the amyloid deposits (via microforceps, CO2 laser and tracheotomy). Thirty patients developed recurrences requiring further treatments. The duration from onset to the treatment and age affected the recurrence of laryngeal amyloidosis, the surgery method, stenotic degree and stenotic area of subglottic area and trachea did not affect the recurrence of the disease. CONCLUSION Early diagnosis and treatment of laryngeal amyloidosis may reduce the recurrence of the disease. Regular follow-up is necessary to find any recurrence.
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Laryngeal amyloidosis: diagnosis, pathophysiology and management. The Journal of Laryngology & Otology 2017; 131:S41-S47. [DOI: 10.1017/s0022215117000780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Laryngeal amyloidosis represents approximately 1 per cent of all benign laryngeal lesions, and can cause variable symptoms depending on anatomical location and size. Treatment ranges from observation through to endoscopic microsurgery, laser excision and laryngectomy.Objectives:To highlight the diversity of presentations, increase awareness of paediatric amyloidosis and update the reader on current management.Case series:Five cases are illustrated. Four adult patients were female, and the one child, the second youngest in the literature, was male. Amyloid deposits were identified in all laryngeal areas, including the supraglottis, glottis and subglottis. Treatment consisted of balloon dilatation, endoscopic excision, laser cruciate incision, and resection with carbon dioxide laser, a microdebrider and coblation wands.Conclusion:Laryngeal amyloidosis remains a rare and clinically challenging condition. Diagnosis should be considered for unusual appearing submucosal laryngeal lesions. Treatment of this disease needs to be evaluated on a case-by-case basis and managed within an appropriate multidisciplinary team.
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Bartels H, Dikkers FG, van der Wal JE, Lokhorst HM, Hazenberg BPC. Laryngeal Amyloidosis: Localized versus Systemic Disease and Update on Diagnosis and Therapy. Ann Otol Rhinol Laryngol 2016; 113:741-8. [PMID: 15453534 DOI: 10.1177/000348940411300913] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical and pathological characteristics, possibility of systemic disease, and effect of local therapy were studied in laryngeal amyloidosis. Records of all patients with localized laryngeal amyloidosis in a single tertiary referral center were examined retrospectively at diagnosis and after local therapy. Of 188 new patients with amyloidosis between 1990 and 2003, 5 patients had localized laryngeal amyloidosis. A sixth patient with localized laryngeal amyloidosis turned out to have systemic AL (immunocyte-derived) amyloidosis 8 years later. Free light chains were found in this patient, as well as in 1 of the other 5 patients. Amyloid interfering with laryngeal or airway function was removed during microlaryngoscopy with a carbon dioxide laser or cold endoscopic excision. The best results were seen when glottic deposits were removed by cold endoscopic excision, and supraglottic deposits by a carbon dioxide laser. Four patients had recurrent disease. A systematic workup, including measurement of free light chains, helps to rule out systemic disease.
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Affiliation(s)
- Hilke Bartels
- Department of Otorhinolaryngology, University Hospital Groningen, Groningen, the Netherlands
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Deviprasad D, Pujary K, Balakrishnan R, Nayak DR. KTP Laser in Laryngeal Amyloidosis: Five Cases with Review of Literature. Indian J Otolaryngol Head Neck Surg 2013; 65:36-41. [PMID: 24427613 PMCID: PMC3718958 DOI: 10.1007/s12070-011-0435-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/20/2011] [Indexed: 10/14/2022] Open
Abstract
To study the clinical presentation and review the options in the management of laryngeal amyloidosis. To study the efficacy of KTP 532 laser in the excision of laryngeal amyloidosis. Study was conducted in our department in a tertiary care hospital between Jan 2001 and Feb 2010. We report five patients who presented with hoarseness of voice and localized laryngeal lesions. The biopsy proven laryngeal amyloidosis lesions were excised microendoscopically using KTP 532 laser in three patients and other two patients were kept only on follow-up as they refused further surgery. The patients were evaluated for systemic amyloidosis. The average duration of follow up was 2.6 years (3 months 6 years). All the five patients in our study were asymptomatic with no evidence of recurrence at their last follow up. In our small case series, KTP 532 laser excision of the laryngeal amyloidosis had a favorable outcome. Long term follow up is required to rule out recurrence and systemic involvement.
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Affiliation(s)
- D. Deviprasad
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - K. Pujary
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - R. Balakrishnan
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - D. R. Nayak
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
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Abstract
Although AL amyloidosis usually is a systemic disease, strictly localized AL deposits are not exceptionally rare. Such case reports form a considerable body of published articles. Although both AL amyloidosis types are formed from an N-terminal segment of a monoclonal immunoglobulin light chain, a typical localized AL amyloid differs from the systemic counterpart by the morphological appearance of the amyloid, and presence of clonal plasma cells and of giant cells. In this article it is pointed out that localized AL amyloidosis ('amyloidoma') represents a true plasma cell neoplasm and not a pseudotumor. The pathogenesis of localized AL amyloidosis may differ from that of the systemic type, a suggestion underlined by the fact that localized AL amyloidosis of kappa type is as common as that of lambda origin, in contrast to the systemic form where lambda chains constitute the overwhelming majority of cases. It is suggested that oligomeric assemblies of the produced immunoglobulin light chain are toxic to plasma cells, which in this way commit suicide.
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Affiliation(s)
- Per Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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Abstract
AbstractBoth laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.
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Pribitkin E, Friedman O, O'Hara B, Cunnane MF, Levi D, Rosen M, Keane WM, Sataloff RT. Amyloidosis of the upper aerodigestive tract. Laryngoscope 2004; 113:2095-101. [PMID: 14660909 DOI: 10.1097/00005537-200312000-00007] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS To delineate the clinical and pathologic characteristics of upper aerodigestive tract amyloidosis with particular attention to laryngeal amyloidosis. STUDY DESIGN Retrospective chart review of patients with amyloidosis of Thomas Jefferson University and its affiliated hospitals. MATERIAL AND METHODS The charts of 16 patients with upper aerodigestive tract amyloidosis identified from the databases of the Thomas Jefferson University pathology department were reviewed and included in the study. RESULTS Sixteen patients (9 male and 7 female, with an average age of 49.8 years) with upper aerodigestive tract amyloidosis were identified. The most common site of amyloid involvement was the larynx. Consequently, patients most commonly presented with hoarseness (14 of 16). All patients underwent surgical removal of the amyloid deposits. Fourteen patients had primary localized amyloidosis. Two experienced systemic involvement. Seven of the 16 patients developed recurrences requiring further treatment. CONCLUSIONS Amyloidosis of the upper aerodigestive tract generally behaves as a benign, localized condition treatable by surgical resection. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence, and multiple surgical procedures may be required to control symptoms.
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Affiliation(s)
- Edmund Pribitkin
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, 1721 Pine Street, Philadelphia, PA, USA
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To EW, Tsang WM, Pak MW, Cheng JH, Tse GM, Van Hasselt CA. Cowden's Disease with Vocal Fold Involvement. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108001015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cowden's disease is a hereditary disorder characterized by oropharyngeal fibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old man who had fibrotic lesions on the left vocal fold and an extensive amount of papillomatous lesions on the mucosa of the lips, tongue, and pharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic of Cowden's disease. To the best of our knowledge, this is the first reported case of Cowden's disease involving a vocal fold.
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Affiliation(s)
- Edward W.H. To
- Division of Head and Neck/Plastic and Reconstructive Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Wai-Ming Tsang
- Oral Maxillofacial Surgery and Dental Unit, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Martin W. Pak
- Division of Otorhinolaryngology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Jack H.H. Cheng
- Division of Head and Neck/Plastic and Reconstructive Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Gary M.K. Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Charles A. Van Hasselt
- Division of Otorhinolaryngology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
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Nandapalan V, Jones TM, Morar P, Clark AH, Jones AS. Localized amyloidosis of the parotid gland: a case report and review of the localized amyloidosis of the head and neck. Head Neck 1998; 20:73-8. [PMID: 9464956 DOI: 10.1002/(sici)1097-0347(199801)20:1<73::aid-hed12>3.0.co;2-q] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Localized amyloidosis in the head and neck is a rare and benign process. METHODS We present the first case report in the literature of localized amyloidosis of the parotid glands and also comprehensively review the literature regarding localized amyloidosis of the head and neck. RESULTS Amyloidosis affecting the head and neck region is uncommon and is mostly in the form of localized amyloidosis. Larynx is the commonest site of involvement and accounts for 0.2% to 0.5% of benign laryngeal tumors. Laryngeal involvement could be either diffuse subepithelial deposition or discrete tumor nodules. Although localized amyloidosis occurs much more frequently in the oral cavity and pharynx, only seven cases of nasopharyngeal amyloidosis and eight cases of nasal septum amyloidosis have been reported. There is no documentation to suggest that localized amyloidosis can progress to systemic amyloidosis. Local surgical excision is the treatment of choice for laryngeal amyloidosis and laser excision is probably the best. CONCLUSION While localized amyloidosis of the head and neck region is rare, it should be recognized, understood, evaluated, and properly treated.
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Affiliation(s)
- V Nandapalan
- Department of Otolaryngology, University of Liverpool, UK
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Abstract
Upper airway obstruction is a potentially life-threatening event that can be managed effectively when promptly recognized and treated. For this reason, all patients who are suspected of having disease affecting the larynx or trachea should be regarded as having a potentially compromised airway until proven otherwise. Although clinically significant upper airway diseases occur infrequently in rheumatic disorders, these manifestations should be considered in such patients who present with upper airway symptomatology.
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Affiliation(s)
- C A Langford
- Laboratory of Immunoregulation, national Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Localized laryngeal amyloidosis is a rare and benign process. Only three cases have been reported in children. We present the case of a 9-year-old girl with localized laryngeal amyloidosis that was excised via laryngofissure. The patient presented with a 3- to 4-week history of progressive hoarseness. Direct laryngoscopy revealed a smooth, firm, submucosal mass extending from the anterior aspect of the left false vocal cord to the vocal process. Biopsy of the mass revealed findings consistent with amyloidosis. The mass was approached via laryngofissure and excised with the thyroid cartilage and left true vocal cord left intact. An extensive workup for systemic amyloidosis was negative, including bone marrow biopsy. The postoperative recovery was uneventful, with good vocal quality and a sluggish but mobile left true vocal cord. This case is significant because of the young age of the child, the extent of disease, and the use of laryngofissure for excision.
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Affiliation(s)
- L R O'Halloran
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis Children's Hospital, Missouri 63110
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Lewis JE, Olsen KD, Kurtin PJ, Kyle RA. Laryngeal amyloidosis: a clinicopathologic and immunohistochemical review. Otolaryngol Head Neck Surg 1992; 106:372-7. [PMID: 1565488 DOI: 10.1177/019459989210600410] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical nature of laryngeal amyloidosis has not been well established, and the natural history of the disease remains a controversial matter. To address these issues, we reviewed the clinicopathologic and immunohistochemical features of 22 cases (11 men and 11 women; mean age, 56 years) of laryngeal amyloidosis. Hoarseness was the most common symptom, and the most frequent site affected was the false vocal cords. Six patients had concomitant tracheal amyloidosis. Paraffin blocks were available for immunostaining in 20 cases. Nineteen cases were positive for amyloid P component. lambda-Light chains were detected in 12 cases and kappa-light chains in 5; three cases did not show definite light-chain staining. Ten patients underwent repeated operations for persistent or recurrent respiratory tract disease. One patient died of progressive tracheobronchial amyloidosis, but systemic amyloidosis did not develop in any of the patients. Laryngeal amyloidosis is a form of localized amyloidosis characterized by monoclonal light-chain deposition. Recurrent respiratory tract disease is not uncommon, but the usual clinical course is relatively benign.
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Affiliation(s)
- J E Lewis
- Section of Surgical Pathology, Mayo Clinic, Rochester, MN 55905
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Abstract
A 14-year-old girl developed progressive hoarseness and breathing difficulty due to a mass in the subglottic larynx. A biopsy specimen obtained at direct laryngoscopy showed localized aggregates of amyloid. The lesion was excised completely with a carbon dioxide laser. This is the second case of laryngeal amyloidosis in a child reported in the English-language literature.
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Affiliation(s)
- C G Hurbis
- Department of Otolaryngology Head and Neck Surgery, University of Illinois College of Medicine, Chicago
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Abstract
Laryngeal amyloidosis is a rare disease. Surgery has been the mainstay of treatment either endoscopically or by an external neck approach. In more recent years, surgery with the carbon dioxide laser has been advocated for this condition. Four cases of laryngeal amyloidosis are presented. The application and the advantages of the carbon dioxide laser for the treatment of laryngeal amyloidosis are discussed.
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Affiliation(s)
- A R Talbot
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 31-1986. A 39-year-old woman with stenosis of the subglottic area and pulmonary artery. N Engl J Med 1986; 315:378-87. [PMID: 3736611 DOI: 10.1056/nejm198608073150607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
A 40-year-old totally deaf male presented with submucosal masses in the subglottic space and multiple subcutaneous nodules in the eyelids, scrotum and thighs. Biopsies of these masses revealed dense fibrosis associated with non-specific chronic inflammation. Although the findings were clinically similar to those of neurofibromatosis, amyloidosis, multifocal fibrosclerosis with cutaneous nodules, and familial multicentric fibromatosis, they did not fit completely with any of the above-mentioned conditions. It is possible that this case represents a peculiar entity of its own.
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Abstract
Four cases of laryngeal amyloidosis are reported. For the present three of these cases have to be considered as primary localized amyloidosis, the type usually found in the larynx. Amyloid in the larynx may be a manifestation of the generalized or secondary form, which has to be excluded in each case. Diagnosis is provided by various histochemical stainings of which Congo red is the most specific one. Electron microscopy can be very helpful. Treatment consists of local excision. Recurrence may become manifest after several years and long-term follow-up is recommended.
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Watanabe H, Makishima K, Komiyama S, Hiroto I. Surgical treatment of the laryngotracheal amyloidosis. Auris Nasus Larynx 1984; 11:157-62. [PMID: 6529374 DOI: 10.1016/s0385-8146(84)80023-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two cases of primary localized amyloid tumor in the larynx and trachea surgically treated were herein reported. As recurrence of the amyloid tumor might lead to repeated resection in the same region, first trial of eradicative laryngofissure or laryngotracheofissure proved to be the effective approaches. The denuded area of the respiratory tract after removing amyloid tumor was covered with a split thickness skin graft and/or neighbouring mucosa applying soft rubber stent, then extensive scarring and schrinkage of the airways after surgery could thus be eliminated.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 51-1983. A 60-year-old man with progressive hoarseness. N Engl J Med 1983; 309:1569-74. [PMID: 6419101 DOI: 10.1056/nejm198312223092509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Laryngeal amyloidosis and laryngoceles are uncommon. A unique case of both conditions occurring simultaneously is discussed. Preoperative computerized tomographic sections clearly demonstrated both disease processes, their extensiveness, and their intimate relation. These findings are correlated with the endoscopic and surgical findings. Gross and histopathologic specimens give full confirmation of the diagnosis. To our knowledge, this is the first case of laryngocele secondary to amyloidosis.
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