Laryngotracheal non-Hodgkin's lymphoma

OBJECTIVES

Malignant lymphomas of larynx and trachea are rare tumors and require special diagnostic and therapeutic attention. The authors present an unexpected case of nonHodgkin Lymphoma localized in the subglottic larynx and upper cervical trachea. The clinical presentation, diagnostic and therapeutic approach, evolution and prognosis are discussed.

METHOD

We report a case of 25-year-old male patient, with progressive dyspnea, presented in our ENT Department with severe airway obstruction caused by a large subglottic tumoral mass migrated in the glottic space during an accidental fall. An emergency tracheotomy was performed. The flexible endoscopy and CT-scan revealed a large mass arising from the subglottic larynx and anterior wall of upper cervical trachea with the obstruction of 2/3 of the laryngotracheal lumen.

RESULTS

After a complex assessment, the tumor was excised by external approach (median thyrotomy). The histopathologic exam of the surgical specimen showed malignant nonHodgkin lymphoma and the immunohistochemical profiles were evaluated in order to establish the therapeutic strategy including chemotherapy in the Department of Oncology.

CONCLUSIONS

Invasion of the subglottic larynx and trachea by lymphoma is an uncommon problem which can cause severe airway obstruction and requires multidisciplinary approach (ENT, pneumology, oncology/hematology). The clinicopathological features of this case have been described and compared with previously reported cases.

[The prevalence of Helicobacter pylori infection in gastric cancer and gastric stump cancer]

In 1994, the International Agency for Research in Cancer recognized Helicobacter pylori (Hp) as "a definitive cause of human cancer". The present study aimed at determining the prevalence of Hp infection in the gastric cancer developed on the background of a disordered stomach as compared with gastric stump cancer. The prevalence of Hp infection was a twice higher in the patients with gastric cancer than in those with gastric stump cancer, and in both cases much lower than that reported in the literature. Possible explanation would be the much older mean age of the patients, the protective role of gastrectomy, and the multifactorial etiopathogenesis in both gastric and gastric stump cancers.

[The prevalence of HBsAg in hospitalized children as a marker of hepatitis B virus infection]

The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) in hospitalised children, as specific marker for hepatitis B virus (HBV) infection. Our study group consists of 517 children, 68 of them diagnosed with chronic hepatitis. For HBsAg determination we used an ELISA test (Labsystems); for some children we also tested by ELISA the following markers: the antibodies and anti-hepatitis C virus (HCV) antibodies. From 517 children 24.28% were HBSAg positive and 75% of children with chronic hepatitis were positive for the same marker. Almost 100% of chronic active hepatitis (CAH) patients was positive for HBSAg.

CONCLUSIONS

1. The prevalence of HBsAg was much higher as compared with the healthy population prevalence; it is a clear prove that HBV infection has an important role in chronic hepatitis appearance. 2. For all HBsAg positive patients, it is necessary to determine other markers like HBeAg-anti-HBe antibodies system as well as markers for other viral hepatitis (HDV, HCV). 3. The anti-HBV infection vaccine will reduce significantly the prevalence of HBV and HDV infections; 4. Biological molecular technique, like PCR will be necessary in our country, in the future, even the price is so high, to monitoring the IFN treatment for chronic infection as unique solution for these patients.

[Chronic reactive inflammations in the etiopathogenesis of malignant hematologic proliferations]

The malignant proliferations are induced by a multitude of etiological factors and possible pathogenic mechanisms. Three new clinical cases and other four previously reported cases of haematological malignant proliferations occurring during the evolution of some chronic reactive inflammatory processes due to various forms of immune deficit are discussed. A review of the literature and of the opinions regarding the pathogenic mechanism responsible for the occurrence and growth of malignant proliferations, especially in the cases with inborn or acquired immunodeficiency, are also included. The authors' pathogenic hypothesis for the cases with various acquired immune deficits and with secondary infectious or allergic reactions is that altered immune responses made possible a lasting antigenic stimulation of certain cell clones of the reactive inflammatory process. By this excessive demand, and instability of the genes has occurred and during their rearrangement a mutation with the depression of an oncogene, responsible for malignant growth, has resulted.

[Tumors of the upper urinary tract. Apropos 35 cases]

Thirty-five cases of upper urinary tract tumors treated by the authors in an interval of 10 years (1979-1988) are presented. After a detailed analysis of the cases some general considerations on the anatomopathologic forms of upper urinary tract tumors, stage classification, symptoms and clinical and laboratory diagnosis, therapeutical indications are made.

[The experience of the 3rd Medical Clinic with lymph node pathology]

In the last 8 years, 511 patients (267 men and 244 women) were investigated. It was found that 44 cases (8.6%) were false adenopathies (various types of tumoral masses) but placed in the nodes areas (localized, generalized or deep). There were 467 cases of true lymphadenopathies, 58 new cases yearly (2.32% of all admitted patients and 6.9% of those with blood diseases). Out of these 467 cases, 330 (70.6%) were malignant neoplastic diseases: malignant lymphomas--206 cases (62.4% of all malignancies), leukemias--99 cases (30%), carcinomatous metastases--25 cases (7.6%). Nonmalignant lymphadenopathies were found in 137 cases (29.4%): specific infections (tuberculosis) and nonspecific ones in 87 cases (63.5%), nonimmune diseases (SLE, PAN, sarcoidosis) in 50 cases. Generalized adenopathies were recorded in 47% of the cases, the involvement of a single node group in 21.8% of the cases, other types of distribution being rare. The general symptoms were absent in 20.5% of the cases, being present in the remainder of 79.5%, especially in the malignant lymphomas, leukemias, nonimmune diseases. The main complications occurring against the background of the etiological affections of lymphadenopathies were: infections (respiratory, urinary, tegumental) in 19.7% of the cases and cardiovascular disturbances (myocardiopathies, rythm and conduction disturbances) in 9.6% of the cases.

[Pseudoadenopathies]

The results of a study concerned with the etiology of some lymph node enlargement in 511 cases aged between 16-80 years, admitted to the III-rd Medical Clinic of Iaşi during the last 7 years are presented. A thorough investigation, by histopathological, cytological, haematological, biochemical, immunological, lymphographic, echographic, radiological examinations, has been done. In 44 cases, the results of the above mentioned investigations indicated that there was no lymph node enlargement, but some other masses sharing the same sites with the lymph nodes, which generated the misdiagnosis in outpatient practice. It is important to note that in 28 cases (63% of the 44 cases) the pseudoadenopathies were localized in the cervical area. The pseudoadenopathies, which are the clinical expression of some tumoral diseases, could be classified as follows: a.--single peripheral; b.--generalized, peripheral; c.--deep. The symptoms which permit the differential diagnosis between the true and pseudoadenopathies are analysed.

Gastrin (G) cells in gastric carcinoma

The behaviour of gastrin cells in the antral mucosa in gastric carcinoma was electron microscopically investigated using specimens of surgically resected stomachs. The results pointed out that in gastric carcinoma there takes place a change of the types of G cell population in the antral mucosa. In this condition, a significant fact was the predominance of intestinal G cells, known to store mainly G 34.