Hemangiopericytoma of the larynx: a case report and review of the literature

Deciphering the Interacting Mechanisms of Circadian Disruption and Alzheimer's Disease

Alzheimer's disease (AD) is one of the crucial causative factors for progressive dementia. Neuropathologically, AD is characterized by the extracellular accumulation of amyloid beta plaques and intracellular neurofibrillary tangles in cortical and limbic regions of the human brain. The circadian system is one of the many affected physiological processes in AD, the dysfunction of which may reflect in the irregularity of the sleep/wake cycle. The interplay of circadian and sleep disturbances inducing AD progression is bidirectional. Sleep-associated pathological alterations are frequently evident in AD. Understanding the interrelation between circadian disruption and AD may allow for earlier identification of AD pathogenesis as well as better suited approaches and potential therapies to combat dementia. In this article, we examine the existing literature related to the molecular mechanisms of the circadian clock and interacting mechanisms of circadian disruption and AD pathogenesis.

Free jejunal graft for hypopharyngeal and esophageal reconstruction

AIMS

This study assessed the techniques of the free jejunal graft for the reconstruction of hypopharynx or cervical esophagus and discussed the main aspects related to those procedures.

METHODS AND RESULTS

By using free jejunal grafts, we reconstructed 54 hypopharyngeal and cervical esophageal cancers. In this study, 23 out of 54 patients had a malignant tumor located in the hypopharynx and 31 in the cervical esophagus (27 primary cases and four secondary cases). Despite the multi-step and time-consuming procedure, we did not incur any trans-operative complication. Furthermore, we undertook the larynx preserving cervical esophagectomy and free jejunal graft reconstruction in six patients with cervical esophageal cancer, and those patients acquired a good quality of life.

CONCLUSION

For the reconstruction of hypopharynx or cervical esophagus, the free jejunal graft is a very useful technique and improves the patient's quality of life.

Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma

Hemangiopericytoma is a rare tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved.

Haemangiopericytoma: current status, diagnosis and management

Haemangiopericytoma (HPC) is a rare tumour, characterized by unidentifiable light microscopic features. Despite first being described over 50 years ago, nothing much was known about this tumour until the early 1980s, when ultrastructural studies and tumour markers made it possible to differentiate it from other mesenchymal tumours. Advancements in radiology and the emergence of MRI technology helped surgeons in better planning. Pre-operative vascular embolization helped to reduce the menace of operative haemorrhage. Improvements in localization and delivery of radiotherapy, coupled with early diagnosis, has tremendously improved the treatment outcome of haemangiopericytoma.

Current management and clinical outcome of hemangiopericytomas

Hemangiopericytoma is a rare vascular tumor with variable malignant potential. We report perioperative embolization of a hemangiopericytoma and review the Virginia Mason Clinic experience with six patients during the period 1975 to 1990 with respect to demographics, diagnosis, treatment, and outcome. Our experience suggests that hemangiopericytomas have a variable but predictable malignant potential based on histology and clinical behavior. Three of six patients died of their disease. The remainder were alive and well at 1, 3.5, and 12 postoperative years. These tumors can be specifically and completely delineated preoperatively using magnetic resonance imaging and angiography, the diagnostic procedures of choice. Hemangiopericytomas are highly vascular and amenable to preoperative transarterial embolization. Our most recent case was performed without blood transfusion. This differs from literature reports of massive transfusion requirements and two cases of exsanguination following resection. Finally, recent literature has reported these tumors to respond to greater than 4,500 cGy of local postoperative radiotherapy. We conclude that this interval review of hemangiopericytomas is both timely and relevant with respect to recent developments in imaging and catheter technology. We recommend routine angiography and perioperative embolization prior to wide excision and postoperative radiotherapy.

Haemangiopericytoma of the larynx

Haemangiopericytoma is an uncommon vascular tumour which has rarely been recorded in the larynx. The diagnostic and histopathological difficulties are discussed. A total laryngectomy was performed because of the size and site of the tumour, the associated risk of local recurrence and the high metastatic rate.