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Affiliation(s)
- S Ghauth
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - L Y Toong
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - G Sakina
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Y T Liew
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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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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3
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Abstract
Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.
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Hong YT, Hong KH. Localized Laryngeal Amyloidosis-Transoral Laser Excision. EAR, NOSE & THROAT JOURNAL 2019; 99:298-299. [PMID: 31032656 DOI: 10.1177/0145561319840233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yong Tae Hong
- Department of Otolaryngology-HNS, Research Institute for Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea
| | - Ki Hwan Hong
- Department of Otolaryngology-HNS, Research Institute for Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea
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Zainol S, Azman M, Muthusamy S. Isolated laryngeal amyloidosis: a case report. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2018. [DOI: 10.4103/ejo.ejo_12_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Amyloidosis of the nasopharynx is a rare presentation of localized amyloidosis. The majority of systemic amyloidosis cases involve the heart, gastrointestinal tract, kidneys, and upper and lower respiratory tract. Localized amyloidosis involving only one site is less common, but has been observed in the head and neck area, particularly in the larynx or the oral cavity. Amyloidosis in the nasopharynx has been reported in only seven previous cases in the English literature.
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Affiliation(s)
- Jonathan A. Lesserson
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, New York Presented at the International Advanced Sinus Symposium, Philadelphia, Pennsylvania, July 21–24, 1993
| | - Douglas G. Finn
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, New York Presented at the International Advanced Sinus Symposium, Philadelphia, Pennsylvania, July 21–24, 1993
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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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8
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Sánchez Legaza E, Cervera Oliver C, Guerrero Cauqui R. Amyloidosis of the Nasopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Celenk F, Durucu C, Baysal E, Karatas ZA, Polat M, Bakir K, Mumbuc S, Kanlikama M. Management of Upper Aerodigestive Tract Amyloidosis. Ann Otol Rhinol Laryngol 2013; 122:535-40. [DOI: 10.1177/000348941312200810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis. Methods: Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis. Results: Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease. Conclusions: Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.
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Amyloidosis of the nasopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:377-8. [PMID: 22698591 DOI: 10.1016/j.otorri.2012.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 02/08/2012] [Accepted: 02/13/2012] [Indexed: 11/20/2022]
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11
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Durbec M, Ambrun A, Barnoud R, Poupart M, Pignat JC, Merrot O. Localized nasopharyngeal amyloidosis. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:160-2. [PMID: 22475977 DOI: 10.1016/j.anorl.2011.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 08/29/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To illustrate, via a case report, how a differential diagnosis of amyloidosis is to be suspected in case of a nasopharyngeal mass. CASE REPORT A 59-year-old woman presented with bilateral nasal obstruction with associated episodic tubal dysfunction. Physical examination found a mass occupying the entire nasopharynx, initially suggestive of tumor. DISCUSSION Amyloidosis was diagnosed on histopathologic study of the biopsy and surgical specimens. Exploration for systemic disease proved negative. The localized amyloidosis was managed conservatively. At 9 months' follow-up, there was no recurrence. CONCLUSION Localized amyloidosis, however rare, should be considered as differential diagnosis in any case of nasal obstruction with tubal dysfunction, even if bilateral. ENT physicians need to recognize and understand this pathology for adapted diagnostic and treatment planning.
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Affiliation(s)
- M Durbec
- Département d'otorhinolaryngologie et de chirurgie cervico-faciale, université Claude-Bernard Lyon I, hôpital de la Croix-Rousse, 93, Grande-rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France.
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12
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Abstract
Laryngeal amyloidosis is uncommon and poorly understood, with limited long-term studies. Although primary localized laryngeal amyloidosis is extremely rare, it frequently involves the ventricles and the false and true vocal cords. We present a 58-year-old woman with localized laryngeal amyloidosis who presented no symptoms. On indirect laryngoscopic examination, the mass involved both arytenoids only, and had a likeness to a "boxer glove." She was treated surgically by microlaryngoscopy under general anesthesia and the mass was excised using a carbon dioxide laser. We present this case and a review of literature.
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Abstract
A mass in the nasopharynx often implies a malignancy in adults, particularly in the endemic areas of Epstein-Barr virus-associated undifferentiated carcinoma. We report an 86-year-old male patient who presented to our rhinologic outpatient department with postnasal drip for several years, with no other associated nasal symptoms. Physical examination with nasal endoscopy found a prominent bulge in the nasopharynx. Pathological examination of the biopsied specimens identified features consistent with amyloidosis. Magnetic resonance imaging demonstrated an enhanced soft-tissue mass localized to the nasopharyngeal region. We excluded the possibility of a partial representation of a potential systemic amyloidosis. Regular follow-up including nasal endoscopy was undertaken. Over 3 years of observation, the disease process remained silent. Here, the clinical presentation, diagnosis and treatment options of this rare entity are discussed.
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Affiliation(s)
- Yen-Sheng Chen
- Department of Otolaryngology, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, Taiwan, R.O.C
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Gallivan GJ, Gallivan HK. Laryngeal Amyloidosis Causing Hoarseness and Airway Obstruction. J Voice 2010; 24:235-9. [DOI: 10.1016/j.jvoice.2008.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 07/24/2008] [Indexed: 11/30/2022]
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Passerotti GH, Caniello M, Hachiya A, Santoro PP, Imamura R, Tsuji DH. Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review. Braz J Otorhinolaryngol 2008; 74:462-6. [PMID: 18661024 PMCID: PMC9442075 DOI: 10.1016/s1808-8694(15)30584-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 09/16/2005] [Indexed: 01/28/2023] Open
Abstract
There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.
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Primary exophytic laryngeal amyloidosis presenting as sudden airway obstruction. Indian J Otolaryngol Head Neck Surg 2007; 59:357-9. [PMID: 23120473 DOI: 10.1007/s12070-007-0101-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Primary amyloidosis of larynx is an uncommon phenomenon, the precise etiopathogenesis of which is not yet clear. It can present with slowly increasing hoarseness or difficulty in breathing. It presents more commonly as infiltrative lesion, exophytic presentation is a rare occurrence.
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Panda NK, Saravanan K, Purushotaman GP, Gurunathan RK, Mahesha V. Localized amyloidosis masquerading as nasopharyngeal tumor: a review. Am J Otolaryngol 2007; 28:208-11. [PMID: 17499143 DOI: 10.1016/j.amjoto.2006.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Accepted: 08/10/2006] [Indexed: 10/23/2022]
Abstract
Amyloidosis comprises a diverse collection of disease characterized by the presence of amorphous extracellular eosinophilic deposits of unique protein fibrils that gives apple green birefringence under polarized light after staining with Congo red. Head and neck region is the commonest site for localized form of amyloidosis. We report a case of a 43-year-old man with localized amyloidosis of nasopharynx with oropharyngeal extension and its management, along with a review of relevant literatures.
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Abstract
BACKGROUND Amyloidosis is a rare disease with multifactorial pathogenesis. Localized amyloidosis affecting the head and neck region is an uncommon and benign process, which has almost no clinical consequences. The most reported characteristic features of localized oral amyloidosis appear as multiple soft nodules of the tongue, lip and cheek. METHODS We report the case of a 68-year-old woman suffering from a primary localized amyloidosis presenting as a purple patch on the palate. CONCLUSIONS The presence of systemic amyloidosis or underlying plasma cell dyscrasia have to be ruled out in patients presenting with a diagnosis of amyloidosis of the oral mucosa. If a primary localized amyloidosis is proven, the surgical therapy may be useful to eliminate a functional impairment.
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Affiliation(s)
- M Pentenero
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Corso Dogliotti, 38--Turin, Italy.
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Penner CR, Muller S. Head and neck amyloidosis: a clinicopathologic study of 15 cases. Oral Oncol 2006; 42:421-9. [PMID: 16488655 DOI: 10.1016/j.oraloncology.2005.09.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 09/21/2005] [Indexed: 11/22/2022]
Abstract
Amyloidosis refers to the idiopathic, extracellular deposition of fibrillar proteins, termed amyloid, in tissues. Although amyloidosis is a rare disease, the head and neck region has been reported as a frequent site of amyloid deposits, accounting for approximately 19% of reported amyloid cases in one review. Fifteen cases of head and neck amyloid, excluding the brain, with clinical follow-up were identified in the Surgical Pathology files from 1985 to 2005 at Emory University Hospital. The histopathology, histochemistry, and patient follow-up were reviewed. Nine men and six women with an age range of 18-76 years (mean 55.7 years) were identified. The initial clinical presentation was dependent on the site of amyloid deposits. The clinical types of amyloidosis included localized amyloid deposits in the larynx and tongue, plasma cell dyscrasia associated AL amyloidosis, and hemodialysis-associated amyloidosis. Secondary amyloidosis developed in one patient with carcinoid tumor.
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Affiliation(s)
- Carla R Penner
- Department of Pathology, University of Manitoba, MS477D Thorlakson Building, 820 Sherbrook Street, Winnepeg, Manitoba, Canada R3A 1R9
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Abstract
Amyloidosis is a disease entity defined by the presence of extracellular deposits of proteinacious material. These deposits have a characteristic apple-green birefringence with polarized light after staining with Congo red. Amyloid involvement of the tongue is almost universally secondary to systemic disease. The mean survival of patients with a systemic form of amyloidosis is between 5 to 15 months, whereas those with the localized form have an excellent prognosis. This article presents a case of the more unusual localized form. A thorough evaluation, including abdominal fat or rectal biopsy, is essential in every patient to identify any systemic involvement. The absence of systemic amyloidosis offers a much more favorable prognosis and may be treated with simple surgical excision.
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Affiliation(s)
- Kristen S Fahrner
- Department of Otolaryngology-Head and Neck Surgery, University of Vermont, Burlington, USA
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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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Ashimori N, Hayashi Y, Mineta H, Hoshino T. Dialysis-related amyloidosis of the external auditory canals. Am J Otolaryngol 2002; 23:374-7. [PMID: 12430131 DOI: 10.1053/ajot.2002.128043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present a patient with dialysis-related amyloidosis of the external auditory canals. This diagnosis was supported by histological and immunohistochemical studies. This is to the best of our knowledge the first reported case of amyloidosis of the external auditory canals that relate to the chronic hemodialysis.
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Affiliation(s)
- Naoki Ashimori
- Department of Otorhinolaryngology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
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23
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Abstract
The localized form of amyloidosis affecting the head and neck region is rare. The characteristic features of localized amyloidosis appeared as multiple nodules on the tongue, lip, and cheek on computed tomography (CT) and magnetic resonance imaging (MRI). Contrast-enhanced CT scans represented this lesion as a marked nodular enhancement. MR features of this lesion appeared slightly low on T1-weighted images and slightly high on T2-weighted images compared with T1-T2 images of residual normal tongue. Time contrast intensity curves obtained from dynamic MRI rapidly increased to reach a plateau and gradually decreased during the late and delayed phases. MR findings suggest that such lesions might be comprised of fibrous tissue with abundant vessels. This report suggests that dynamic MRI might be helpful for diagnosing localized amyloidosis.
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Affiliation(s)
- J Asaumi
- Department of Oral Radiology, Okayama University Dental School, 2-5-1 Shikata-cho, Okayama 700-8525, Japan.
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Nagasaka T, Lai R, Kuno K, Nakashima T, Nakashima N. Localized amyloidosis and extramedullary plasmacytoma involving the larynx of a child. Hum Pathol 2001; 32:132-4. [PMID: 11172308 DOI: 10.1053/hupa.2001.20896] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extramedullary plasmacytoma of the larynx and localized laryngeal amyloidosis are 2 uncommon disease entities that are exceedingly rare in children. We report a case of a 12-year-old girl presenting with progressive hoarseness who was subsequently found to have extramedullary plasmacytoma coexisting with localized amyloidosis involving the larynx. Results from the immunohistochemical and molecular studies showed that the tumor cells of the plasmacytoma were monoclonal (kappa-restricted), strongly supporting their neoplastic nature. The biochemical nature of the amyloid deposits was also shown to be of kappa immunoglobulin light chain, suggesting the pathogenetic relationship between the plasmacytoma and amyloid deposition in the larynx of this patient. There was no other evidence of malignancy or amyloidosis elsewhere. On a follow-up period of 4 years, this patient was well and asymptomatic. We believe that this represents the first case in the literature showing the coexistence of extramedullary plasmacytoma and localized amyloidosis of the larynx in children. This case also supports the concept that localized laryngeal amyloidosis may be a manifestation of low-grade B-cell neoplasms.
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Affiliation(s)
- T Nagasaka
- Division of Pathology, Clinical Laboratory, Nagoya University Hospital, Nagoya University, School of Medicine, Nagoya, Japan
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Abstract
OBJECTIVE To demonstrate the role of two-dimensional reconstruction images on computed tomography (CT) in the treatment planning for laryngeal amyloidosis. To discuss the treatment for isolated laryngeal amyloidosis and compare the role of endoscopic versus an open surgical approach to management. STUDY DESIGN Retrospective review. METHODS The medical records from 1984 to the present with the diagnosis of localized respiratory tract amyloidosis at Geisinger Medical Center were reviewed. RESULTS Five previously unpublished cases of localized laryngeal amyloidosis were identified with the supraglottic region the major site of involvement. Hoarseness and airway compromise were the presenting symptoms. CT two-dimensional reconstruction imaging was used to evaluate two cases with extensive laryngeal involvement that required an external surgical approach to relieve symptoms. CONCLUSIONS Localized laryngeal amyloidosis is a rare disease that requires surgical management when symptomatic. CT two-dimensional reconstruction can be helpful in detailing the extent of disease and planning surgery. A lateral external supraglottic approach has been found to be successful in treating patients with large supraglottic masses.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology--Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1333, USA
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Abstract
The cutaneous deposition disorders are a group of unrelated conditions characterized by the presence of either endogenous or exogenous substances within the dermis or the subcutis. Part I of this two-part series will focus on metabolic processes involved in the endogenous deposition in the various forms of amyloidosis, porphyria, colloid milium, and lipoid proteinosis. We will also review the clinical, histologic, biochemical, and ultrastructural findings relevant to each disorder. Basic mechanisms of pathogenesis, diagnostic modalities, and treatment options are also discussed.
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Affiliation(s)
- D M Touart
- Dermatology Service, Walter Reed Army Medical Center, Washington DC, USA
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De Foer B, Hermans R, Van der Goten A, Delaere PR, Baert AL. Imaging features in 35 cases of submucosal laryngeal mass lesions. Eur Radiol 1996; 6:913-9. [PMID: 8972332 DOI: 10.1007/bf00240704] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the clinical and radiological findings in 35 patients with submucosal laryngeal masses. The presenting symptoms were hoarseness, stridor, dysphagia and external neck mass. In 20 cases an important delay between the onset of symptoms and direct laryngoscopy was found. There was a considerable delay between laryngoscopy and definitive diagnosis in 13 cases due to repeated negative biopsies. Computed tomography pointed out the location and extension of the masses in all cases. In 27 mass lesions CT allowed correct prediction of the malignant or benign character of the lesion. In 6 cases no reliable differentiation could be made. The lesion was mischaracterised in 2 cases. Magnetic resonance imaging was also performed in 4 patients, and showed the extent of the lesion better; in 1 case MRI narrowed the differential diagnosis. In the case of a negative biopsy result, radiological findings should incite further investigation, reducing the possible delay between the onset of symptoms and definitive diagnosis.
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Affiliation(s)
- B De Foer
- Department of Radiology, University Hospitals, Leuven Belgium
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Domínguez S, Wienberg P, Clarós P, Clarós A, Vila J. Primary localized nasopharyngeal amyloidosis. A case report. Int J Pediatr Otorhinolaryngol 1996; 36:61-7. [PMID: 8803693 DOI: 10.1016/0165-5876(96)01330-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Primary localized amyloidosis of the nasopharynx is a rare disease. We present the case of a 13-year-old girl, to our knowledge only the second pediatric case reported in the literature. Symptoms were nasal obstruction and bleeding from the oral cavity. Physical examination revealed a mass in the nasopharynx and left side of the soft palate. The diagnosis was made by biopsy and histopathologic study of the surgical specimen. Immunohistochemical study revealed amyloid light chains (AL). The main treatment was surgical. At follow-up 9 months later, no recurrence had developed. While rare, localized amyloidosis should be considered in the differential diagnosis of nasal obstruction, epistaxis and glue ear, and must be recognized and understood by the otolaryngologist to allow appropriate diagnostic and therapeutic planning.
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Affiliation(s)
- S Domínguez
- E.N.T. Department, Hospital Universitari Sant Joan De Deu, Barcelona, Spain
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Abstract
The history, examination and operative findings of primary amyloidosis of the larynx are very suggestive of carcinoma, indicating the need for careful histological examination. Staining with Congo red shows a characteristic birefringence. Systemic amyloidosis may be present.
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Affiliation(s)
- J D Bennett
- Department of ENT Surgery, Queen Elizabeth Military Hospital, Woolwich, London
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