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Olson C, Alexander R, Stinnett S. Dysplastic Lesions of the Larynx. Otolaryngol Clin North Am 2023; 56:233-246. [PMID: 37030937 DOI: 10.1016/j.otc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
There have been many advancements in the clinical and histologic diagnosis of laryngeal dysplasia (LD), but diagnosis still necessitates invasive histologic evaluation. Furthermore, despite improved histologic identification of dysplastic lesions, the exact details of pathophysiologic progression and the risk of malignant transformation is still uncertain. These unknowns create a barrier to establishing an ideal grading and classification system, which prevents the establishment of a precise and consistent treatment paradigm. Identifying these gaps in knowledge serves to highlight where further studies are warranted, ideally focusing on a better understanding of the biological behavior of LD. This would ultimately allow for the creation of a reliable grading and classification system and for the formalization of management and treatment guidelines for LD.
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Laryngeal dysplasia: a 10-year review of rates of progression to invasive carcinoma and treatment-specific outcomes in a regional ENT department in Northern Ireland. The Journal of Laryngology & Otology 2022; 136:547-553. [DOI: 10.1017/s0022215122000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundLaryngeal dysplasia represents a complex pre-malignant condition characterised by a spectrum of mucosal changes, with a reported malignant transformation rate from dysplasia to invasive carcinoma of 14.0 per cent.ObjectiveTo identify whether increasing glottic dysplasia severity is associated with higher local malignant transformation rates or adverse clinical outcomes.MethodsThis retrospective cohort study identified 125 patients with any histopathological grade of glottic dysplasia over a 10-year period who were followed up for a standardised 10-year period.ResultsThe malignant transformation rate was 21.8 per cent over 10 years, demonstrating a statistically significant greater risk with increasing dysplasia severity. The mean time to transformation was 52 months, with time to transformation statistically associated with increasing dysplasia severity. Rapid progression to carcinoma within 12 months occurred in 40 per cent of cases, and 58 per cent of subsequently diagnosed laryngeal squamous cell carcinomas were tumour stage T1.ConclusionLaryngeal dysplasia carries a significant malignant potential, appearing greatest within 12 months of diagnosis and with increasing severity of dysplasia.
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The expression and significance of AKR1B10 in laryngeal squamous cell carcinoma. Sci Rep 2021; 11:18228. [PMID: 34521883 PMCID: PMC8440551 DOI: 10.1038/s41598-021-97648-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
Aldosterone reductase family 1 member B10 (AKR1B10) is a nicotinamide adenine dinucleotide phosphate (reduced coenzyme II)-dependent oxidoreductase, and its biological functions include carbonyl detoxification, hormone metabolism, osmotic adjustment, and lipid synthesis. Studies suggested that AKR1B10 is a new biomarker for cancer based on its overexpression in epithelial tumors, such as breast cancer, cervical cancer, and lung cancer. At present, studies on the expression of AKR1B10 in laryngeal cancer have not been reported. However, we found that AKR1B10 is upregulated in laryngeal carcinoma, and its expression was negatively correlated with the degree of differentiation. In addition, AKR1B10 expression was positively correlated with tumor size; lymph node metastasis; alcohol use; and Ki-67, mutant p53, and matrix metalloproteinase 2 expression. AKR1B10 was overexpressed in Hep-2 laryngeal carcinoma cells. Oleanolic acid inhibited AKR1B10 activity and expression in Hep-2 cells and suppressed Hep-2 cell proliferation, migration, and invasion. Therefore, AKR1B10 may be related to the development of laryngeal carcinoma, suggesting its use as a prognostic indicator for laryngeal cancer.
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Odell E, Eckel HE, Simo R, Quer M, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part I: aetiology and pathological classification. Eur Arch Otorhinolaryngol 2020; 278:1717-1722. [PMID: 33051798 PMCID: PMC8131293 DOI: 10.1007/s00405-020-06403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
Purpose of review To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. As most cases of dysplasia occur at the glottic level and data on diagnosis and management are almost exclusively from this location, laryngeal dysplasia in this position paper is taken to be synonymous with dysplasia of the vocal folds. Summary LD has long been recognized as a precursor lesion to laryngeal squamous cell carcinoma (SCC). Tobacco and alcohol consumption are the two single most important etiological factors for the development of LD. There is currently insufficient evidence to support a role of reflux. Although varying levels of human papillomavirus have been identified in LD, its causal role is still uncertain, and there are data suggesting that it may be limited. Dysplasia has a varying presentation including leukoplakia, erythroleukoplakia, mucosal reddening or thickening with exophytic, “tumor-like” alterations. About 50% of leukoplakic lesions will contain some form of dysplasia. It has become clear that the traditionally accepted molecular pathways to cancer, involving accumulated mutations in a specific order, do not apply to LD. Although the molecular nature of the progression of LD to SCC is still unclear, it can be concluded that the risk of malignant transformation does rise with increasing grade of dysplasia, but not predictably so. Consequently, grading systems are inherently troubled by the weak correlation between the degree of the dysplasia and the risk of malignant transformation. The best data on LD grading and outcomes come from the Ljubljana group, forming the basis for the World Health Organization classification published in 2017.
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Affiliation(s)
- Edward Odell
- Head and Neck Pathology, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Feschnigstr. 11, Klagenfurt, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Chatzipantelis P, Koukourakis M, Kouroupi M, Giatromanolaki A. P16 detection in benign, precursor epithelial lesions and carcinomas of head and neck. Pathol Res Pract 2020; 216:153035. [PMID: 32703498 DOI: 10.1016/j.prp.2020.153035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) had recently been implicated in the pathogenesis of Head and Neck SCCs. The biological role of HPV in benign and pre-cancerous lesions is far less studied. p16 is a widely accepted marker to detect immonohistochemically the presence of HPV. METHODS We evaluated, immunohistochemically, expression of p16 in 212 specimens: glottis, supraglottis, oropharynx, nasal/paranasal, with various diagnoses: hyperplasia, polyp/nodule, keratosis, papilloma, inverted papilloma, dysplasia, cancer (SCC). Analysis was completed according to location and disease. RESULTS Hyperplasias/polyps were all negative for p16. A small percentage of papillomas was p16+ regardless of their location (12.5 %), the majority of inverted papillomas were p16+ (78.6 %) and statistically significant (p < 0.04). In carcinomas, 18/59 were p16+ (30.5 %): nasal/paranasal SCCs had a significantly higher percentage of p16+ cancer cells compared to glottis (p = 0.009), while tumours of the supraglottis/oropharynx had an intermediate score for p16+ cells (p = 0.07). Dysplasias were p16+ in 9/64 (14 %) regardless of grading (p = 0.03 compared to carcinomas). CONCLUSION p16 was highly detected in inverted papillomas and in certain anatomic sites; however, it failed to be traced in benign lesions and only rarely encountered in dysplasias.
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Affiliation(s)
- Paschalis Chatzipantelis
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Michail Koukourakis
- Department of Radiotherapy-Oncology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
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Galletti F, Freni F, Gazia F, Gallo A. Vocal cord surgery and pharmacological treatment of a patient with HPV and recurrent respiratory papillomatosis. BMJ Case Rep 2019; 12:12/11/e231117. [PMID: 31732543 DOI: 10.1136/bcr-2019-231117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is caused by persistent infection of the respiratory epithelium by human papillomavirus (HPV), especially HPV 6 and 11. We present a case of surgically treated RRP. The main purpose of our protocol is to remove the lesions with a non-aggressive surgical technique and prevent recurrences with the use of cidofovir for local infiltrations in multiple sessions. We use low-power energy CO2 laser, directed towards the upper part of the vocal cord, to determine a retraction of the mucosa with consequent coverage of the epithelium of the free edge. The aim of this technique is to treat and stop the formation of synechia of the anterior commissure and the free margin of the vocal cords in the anterior commissure. After 8 years follow-up, there are no signs of recurrence of the disease. The voice had a net improvement confirming the effectiveness of the protocol.
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Affiliation(s)
- Francesco Galletti
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Francesco Gazia
- Department of Adult and Development Age Human Pathology 'Gaetano Barresi', Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Andrea Gallo
- UOC Otorinolaringoiatria - Polo Pontino, Università degli Studi di Roma La Sapienza Facoltà di Medicina e Odontoiatria, Roma, Italy
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Garcia JA, Best SR, Rooper LM. HPV RNA in-situ hybridization as a diagnostic aid in papillary laryngeal lesions. Laryngoscope 2019; 130:955-960. [PMID: 31283030 DOI: 10.1002/lary.28159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In the larynx, differentiating squamous papillomas from de-novo papillary squamous dysplasias or squamous cell carcinomas (SCC) has significant consequences for management. Overlapping clinical presentations and cytologic changes across the spectrum of papillary lesions presents diagnostic challenges for otolaryngologists and pathologists. In this study, we evaluate whether ribonucleic acid (RNA) in-situ hybridization (ISH) for low-risk and high-risk human papillomavirus (HPV) can help distinguish these lesions. METHODS We constructed tissue microarrays from 97 papillary laryngeal lesions, including 61 squamous papillomas, two papillomas with dysplasia, two SCCs-ex papilloma, 14 papillary squamous dysplasias, and 18 papillary SCCs identified at the Johns Hopkins Hospital between 2000 and 2017. We performed RNA ISH using probes for low-risk and high-risk HPV types. RESULTS Low-risk HPV RNA was identified in 55 benign papillomas (90%), two papillomas with dysplasia (100%), and two SCCs-ex papilloma (100%) but was absent in de-novo papillary dysplasias and SCCs (0%). High-risk HPV RNA ISH was positive only in four papillary SCC (22%). Overall, low-risk HPV RNA ISH was 90% sensitive and 89% specific for benign papillomas with a positive predictive value of 93% and negative predictive value of 84%. In contrast, high-risk HPV was 20% sensitive for SCC. CONCLUSION Low-risk HPV RNA ISH is a useful diagnostic adjunct for distinguishing laryngeal squamous papillomas from papillary squamous dysplasia and SCC. However, it is not entirely specific for benign processes as it is also retained in papillomas with dysplasia and SCCs-ex papilloma. Because high-risk HPV is rare in papillary laryngeal lesions, high-risk HPV RNA ISH has limited utility. LEVEL OF EVIDENCE Level 4 Laryngoscope, 130:955-960, 2020.
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Affiliation(s)
- Jordan A Garcia
- Department of Otolaryngology, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Simon R Best
- Department of Otolaryngology, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.,Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
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Clinical relevance of human papillomavirus outside of oropharynx. Curr Opin Otolaryngol Head Neck Surg 2019; 27:80-84. [DOI: 10.1097/moo.0000000000000518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mitsumoto GL, Bernardi FDC, Paes JF, Villa LL, Mello B, Pozzan G. Juvenile-onset recurrent respiratory papillomatosis with pulmonary involvement and carcinomatous transformation. Autops Case Rep 2018; 8:e2018035. [PMID: 30101139 PMCID: PMC6066261 DOI: 10.4322/acr.2018.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
Abstract
Papilloma associated with recurrent respiratory papillomatosis (RRP), caused by human papilloma virus (HPV) infection types 6 and 11, is the most common benign neoplasm of the larynx. The clinical features of RRP vary widely from mild to aggressive forms. RRP in children is known as juvenile-onset recurrent respiratory papillomatosis (JORRP). Its outcome may be poor or even fatal due to the high rate of recurrence and eventual spread to the entire respiratory tract. Pulmonary invasion is reported to occur in 3.3% of patients with RRP, and malignant transformation in 0.5% of patients. We report the case of a 39-year-old female patient with a diagnosis of JORRP from the age of 3 years, with extensive bilateral pulmonary involvement and malignant transformation. Analysis of the papilloma and carcinomatous tissues revealed the presence of HPV type 11, which is associated with rapid and aggressive progression. We discussed the case on the basis of a literature review on pulmonary invasion, malignant transformation, and HPV 11 aggressiveness.
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Affiliation(s)
| | - Fabiola Del Carlo Bernardi
- Santa Casa de São Paulo School of Medical Sciences, School of Medicine. São Paulo, SP, Brazil.,Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pathologic Sciences. São Paulo, SP, Brazil
| | - Juliana Fracalossi Paes
- Santa Casa de São Paulo School of Medical Sciences, School of Medicine. São Paulo, SP, Brazil
| | - Luisa Lina Villa
- Universidade de São Paulo, Faculty of Medicine, Department of Radiology and Oncology. São Paulo, SP, Brazil.,Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brazil
| | - Barbara Mello
- Universidade de São Paulo, Faculty of Medicine, Department of Radiology and Oncology. São Paulo, SP, Brazil.,Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brazil
| | - Geanete Pozzan
- Santa Casa de São Paulo School of Medical Sciences, School of Medicine. São Paulo, SP, Brazil
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Song S, Gong S, Singh P, Lyu J, Bai Y. The interaction between mitochondria and oncoviruses. Biochim Biophys Acta Mol Basis Dis 2018; 1864:481-487. [PMID: 28962899 PMCID: PMC8895674 DOI: 10.1016/j.bbadis.2017.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 12/24/2022]
Abstract
Mitochondria play important roles in multiple aspects of viral tumorigenesis. Mitochondrial genomes contribute to the host's genetic background. After viruses enter the cell, they modulate mitochondrial function and thus alter bioenergetics and retrograde signaling pathways. At the same time, mitochondria also regulate and mediate viral oncogenesis. In this context, oncogenesis by oncoviruses like Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human papilloma virus (HPV), Human Immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) will be discussed.
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Affiliation(s)
- Shujie Song
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, College of Laboratory Medicine and Life sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shasha Gong
- School of Medicine, Taizhou College, Taizhou, Zhejiang, China
| | - Pragya Singh
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jianxin Lyu
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, College of Laboratory Medicine and Life sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China,Corresponding author: Wenzhou Medical University, Chashan, Wenzhou 325035, China. (J. Lyu); (Y. Bai). Fax: 86-577-86689771; Tel: 86-577-86689805
| | - Yidong Bai
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, College of Laboratory Medicine and Life sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China,Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas, USA,Corresponding author: Wenzhou Medical University, Chashan, Wenzhou 325035, China. (J. Lyu); (Y. Bai). Fax: 86-577-86689771; Tel: 86-577-86689805
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Milad P, Kassamy H, Askoura A, Abuelela S, Salem R, Ragab D. Prevalence of human papillomavirus in benign and malignant laryngeal lesions in Egyptian patients: Cross-sectional study. Clin Otolaryngol 2017; 43:312-316. [PMID: 28891598 DOI: 10.1111/coa.12979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of human papillomavirus (HPV) in benign and malignant laryngeal lesions among Egyptian patients. DESIGN Observational analytical cross-sectional study. SETTING Ain Shams University hospital, Otorhinolaryngology department PARTICIPANTS: Formalin-fixed paraffin-embedded specimens of 126 patients (70 benign laryngeal lesions and 56 squamous cell carcinoma lesions) were assessed for the presence of HPV DNA using MY09/11 PCR-based DNA detection. MAIN OUTCOME MEASURES Percentage of positive samples was calculated. RESULTS All 70 benign laryngeal lesion specimens were negative for the HPV DNA, while 2 of the 56 squamous cell carcinoma lesions (3.6%) were positive. CONCLUSIONS The presence of HPV DNA in only two specimens in our study suggests that the proportion of laryngeal squamous cell carcinomas attributable to infection by HPV seems to be very low in Egypt.
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Affiliation(s)
- P Milad
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H Kassamy
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Askoura
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S Abuelela
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R Salem
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - D Ragab
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
Squamous cell carcinoma (SCC) is a malignant epithelial tumor showing evidence of squamous differentiation. It is the most common malignancy of the larynx, with several variants (verrucous, exophytic or papillary, spindle-cell, basaloid, acantholytic, adenosquamous) recognized, with well-established precursor lesions. Dysplasia is now separated into only low-grade and high-grade categories. Each SCC variant has unique cytomorphologic features and histologic differential diagnoses that are important to consider, as management and outcomes are different.
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Affiliation(s)
- Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91367, USA.
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Belvisi V, Martellucci S, Garbuglia AR, Del Borgo C, Martellucci S, Baiocchini A, Manicone AM, Bagni O, Mastroianni CM, Gallo A. Case report: human papilloma virus type 120-related papillomatosis mimicking laryngeal carcinoma. Infection 2017; 45:709-713. [PMID: 28534319 DOI: 10.1007/s15010-017-1028-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The relationship between human papilloma virus (HPV) and upper respiratory tract pathology was better understood in recent years and represents now an issue of particular interest in carcinogenesis and in immunocompromised host. We describe a case in which a rare genotype HPV-related papillomatosis mimics laryngeal carcinoma in an immunocompromised host. METHODS A 54-year-old woman with a history of HIV-HCV coinfection and anal and laryngeal cancer successfully treated some years before was hospitalized for severe dyspnea, cough and dysphagia. Fiberoptic endoscopic evaluation raised the suspicion of tumor relapse showing the presence of a large glottic-supraglottic ulcerated mass. Several laryngeal biopsies demonstrated koilocytosis and p16 expression, according to a possible HPV infection, and focal figures of mild dysplasia of epithelium. 18 F-FDG PET/CT did not show high glycolytic activity at laryngeal level. An invasive upper respiratory tract papillomatosis in an immunocompromised host was suspected because of the patient's clinical improvement after antiretroviral therapy. CONCLUSION Pharyngeal swab and oral rinse harboured the same HPV120 genotype sequence, a betapapillomavirus of recent description and not yet related to any similar clinical presentations.
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Affiliation(s)
- Valeria Belvisi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Via Giulio Cesare 41\B, 04100, Latina, Italy.
| | - Salvatore Martellucci
- Department of Surgical Biotechnologies and Sciences, ENT Section, "Sapienza" University of Rome, Latina, Italy
| | | | - Cosmo Del Borgo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Via Giulio Cesare 41\B, 04100, Latina, Italy
| | - Stanislao Martellucci
- Department of Surgical Biotechnologies and Sciences, ENT Section, "Sapienza" University of Rome, Latina, Italy
| | | | | | - Oreste Bagni
- Department of Nuclear Medicine, "S.M. Goretti" Hospital, Latina, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Via Giulio Cesare 41\B, 04100, Latina, Italy
| | - Andrea Gallo
- Department of Surgical Biotechnologies and Sciences, ENT Section, "Sapienza" University of Rome, Latina, Italy
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Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What is New in the 2017 WHO Blue Book for Tumours of the Hypopharynx, Larynx, Trachea and Parapharyngeal Space. Head Neck Pathol 2017; 11:23-32. [PMID: 28247231 PMCID: PMC5340729 DOI: 10.1007/s12105-017-0788-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/02/2017] [Indexed: 01/08/2023]
Abstract
Chapter 3 "Tumours of the hypopharynx, larynx, trachea, and parapharyngeal space" of the World Health Organization (WHO) Blue Book 2017 "Classification of Head and Neck Tumours" shows a shortened list of entities, especially due to reducing the number of benign and malignant soft tissue tumours, malignant melanoma and some others, which are transferred to more frequently affected regions of the head and neck. The basic concept of the new edition is to assimilate all advances concerning the discussed tumours in a shorter framework, appropriate for daily work. The main emphasis is on the most frequent lesions and tumors originating from the covering squamous epithelium. Laryngeal and hypopharyngeal conventional squamous cell carcinoma (CSCC), its variants and precursor lesions, occupy a major part of the chapter. New data on etiopathogenesis, with the focus on human papillomavirus (HPV) infection, are discussed in relation to the entities of the squamous epithelium. Although only a small fraction of these lesions are HPV-related, further studies are required for evaluation of the potential prognostic and therapeutic benefit of mRNA HPV determination. In contrast to earlier data, laryngeal and hypopharyngeal verrucous SCC, spindle cell SCC and basaloid SCC are not anymore considered as HPV-related tumours. New data on the pathogenesis of spindle cell SCC exhibiting divergent differentiation by epithelial-mesenchymal transition, are also briefly discussed. The most important innovation is brought by the section on precursor lesions, in which a unified two-tier classification, consisting of low- and high-grade dysplasia, is introduced. The proposed two-tier system can also be transformed into a three-tier classification for treatment purposes, with a distinction between carcinoma in situ and high-grade dysplasia. The reviewed morphological criteria of the proposed system are based on the amended Ljubljana classification. The section on laryngeal neuroendocrine carcinomas (NEC) represents a considerable improvement in terminology and classification. NEC are divided into well-, moderate- and poorly-differentiated neuroendocrine carcinoma. The latter is additionally divided into small cell NEC and large cell NEC (LCNEC). It is of extreme importance that LCNEC, which was associated in the WHO 2005 edition with atypical carcinoid/moderately differentiated neuroendocrine carcinoma, grade II, has now been transferred into the group of poorly differentiated NEC, grade III, displaying a specific morphology and poorer prognosis.
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Laryngeal Squamous Intraepithelial Lesions: An Updated Review on Etiology, Classification, Molecular Changes, and Treatment. Adv Anat Pathol 2016; 23:84-91. [PMID: 26849814 DOI: 10.1097/pap.0000000000000106] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laryngeal carcinogenesis is a multistep process, characterized by an accumulation of genetic changes associated with architectural and cytologic alterations, ranging from squamous hyperplasia to carcinoma in situ and encompassed by the terminology of squamous intraepithelial lesions (SILs). The etiology, classification, genetic changes, and malignant progression of these lesions are reviewed. Tobacco remains the principal etiological factor with gastroesophageal reflux disease recently considered as a possible factor. In contrast, there is little evidence that microbiological agents, especially human papillomavirus infection, are frequently involved in laryngeal carcinogenesis and probably <10% of SILs are driven by biologically active human papillomavirus infection. Light microscopy, despite a degree of subjectivity, remains the mainstay of accurate diagnosis, prognosis, and guidance for a patient's treatment. The currently used classifications, the dysplasia system, squamous intraepithelial neoplasia, and the Ljubljana classification, reflect different standpoints on this important topic. The modified Ljubljana classification, with good interobserver agreement, could be considered as a proposal for a unified classification of laryngeal SILs. This review also briefly discusses recently discovered genetic changes, such as CDKN2A and CTNNB1 genes, and chromosome instability of chromosomes 1 and 7; however, none of these can at present improve histologic diagnosis. Malignant progression of precursor lesions varies from 2% to 74%, according to different studies. Cold-steel microinstruments, CO2 laser, and radiotherapy are used to treat the different grades of precursor lesions. There is as yet no worldwide agreement on the treatment of high-grade lesions and carcinoma in situ.
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