Smoking and alcohol consumption with the risk of 11 common otolaryngological diseases: a bidirectional Mendelian randomization

PURPOSE

In this study, a bidirectional mendelian randomization was applied to evaluate the association of smoking and alcohol consumption with 11 otolaryngological diseases.

METHODS

A total of 85,22,34 and 7 single nucleotide polymorphisms were used as instrumental variables for smoking initiation, cigarettes per day, alcoholic drinks per week and alcohol consumption, respectively. Genetic associations with 11 common otolaryngological diseases were obtained from the UK Biobank and FinnGen dataset. IVW, weighted median, MR-Egger, MR-PRESSO and leave-one-out method were used in this analysis.

RESULTS

Smoking initiation increased the risk of vocal cord and larynx diseases (OR 1.002; 95% CI 1.001-1.004; P = 4 × 10-4), head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.027), thyroid cancer (OR 1.538; 95% CI 1.006-2.351; P = 0.047) and sleep apnoea (OR 1.286; 95% CI 1.099-1.506; P = 0.002). Cigarettes per day was associated with chronic sinusitis (OR 1.152; 95% CI 1.002-1.324; P = 0.046), chronic rhinitis and pharyngitis (OR 1.200; 95% CI 1.033-1.393; P = 0.017), vocal cord and larynx diseases (OR 1.001; 95% CI 0.999-1.002; P = 0.021) and head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.017). Alcoholic drinks per week only was significantly associated with the risk of head and neck cancer (OR 1.003; 95% CI 1.001-1.006; P = 0.014). However, there was no evidence to support that genetically predicted alcohol consumption increased the risk of otolaryngological diseases. Reverse MR also did not find outcomes effect on exposures.

CONCLUSION

This study shows that smoking and heavy alcohol consumption promote the occurrence of some otolaryngological diseases indicating that lifestyle modification might be beneficial in preventing otolaryngological diseases.

[A pedigree study of laryngo-onycho-cutaneous syndrome with a novel mutation on LAMA3 gene]

Objective:To detect genetic mutations in a case of laryngo-onycho-cutaneous syndrome, and to explore the possible molecular biological pathogenic causes. Methods:With informed consent, the family clinical data of the child with laryngo-onycho-cutaneous syndrome were collected, peripheral blood of the protester and his parents was collected and DNA was extracted, and gene detection was performed by high-throughput sequencing method. Sanger sequencing was used to verify and analyze the mutation sites of the probs and their families. Results:Genetic testing of the proband revealed homozygous mutation of LAMA3 gene c.171+1G>A site, which is splicing mutation. There was no report in the literature, which was a new mutation site. The parents of the proband had normal phenotype and heterozygous mutation at this locus was detected. Conclusion:Homozygous mutation of LAMA3 c.171+1G>A is the likely pathogenic of the proband, and this study expands the mutant spectrum of LAMA3. The clinical phenotype of laryngo-onycho-cutaneous syndrome is highly variable, and the multidisciplinary diagnosis and treatment can effectively avoid missed diagnosis and misdiagnosis.

Phenomenology, genetics, and CNS network abnormalities in laryngeal dystonia: A 30-year experience

OBJECTIVE

Laryngeal dystonia (LD) is a functionally specific disorder of the afferent-efferent motor coordination system producing action-induced muscle contraction with a varied phenomenology. This report of long-term studies aims to review and better define the phenomenology and central nervous system abnormalities of this disorder and improve diagnosis and treatment.

METHODS

Our studies categorized over 1,400 patients diagnosed with LD over the past 33 years, including demographic and medical history records and their phenomenological presentations. Patients were grouped on clinical phenotype (adductor or abductor) and genotype (sporadic and familial) and with DNA analysis and functional magnetic resonance imaging (fMRI) to investigate brain organization differences and characterize neural markers for genotype/phenotype categorization. A number of patients with alcohol-sensitive dystonia were also studied.

RESULTS

A spectrum of LD phenomena evolved: adductor, abductor, mixed, singer's, dystonic tremor, and adductor respiratory dystonia. Patients were genetically screened for DYT (dystonia) 1, DYT4, DYT6, and DYT25 (GNAL)-and several were positive. The functional MRI studies showed distinct alterations within the sensorimotor network, and the LD patients with a family history had distinct cortical and cerebellar abnormalities. A linear discriminant analysis of fMRI findings showed a 71% accuracy in characterizing LD from normal and in characterizing adductor from abductor forms.

CONCLUSION

Continuous studies of LD patients over 30 years has led to an improved understanding of the phenomenological characteristics of this neurological disorder. Genetic and fMRI studies have better characterized the disorder and raise the possibility of making objective rather than subjective diagnoses, potentially leading to new therapeutic approaches. Laryngoscope, 128:S1-S9, 2018.

Gene amplification of epidermal growth factor receptor in atypical glottic hyperplasia

The study searched for epidermal growth factor receptor (EGFR) gene amplification in hyperplastic glottis lesions. After classical pathohistological findings of hematoxylin-eosin (HE) slides and quantitative immunohistochemical (IHC) analysis, fluorescent in situ hybridization (FISH) was used on tissue microarrays of laryngeal hyperplastic tissue ranging from normal mucosa to abnormal and atypical hyperplastic lesions. FISH analysis of two atypical hyperplastic lesions discovered the amplification of EGFR gene while it was not found in simple and abnormal hyperplastic lesions. The results may indicate that EGFR gene amplifications could possibly correlate with the histopathologic picture. Tissue samples burdened with specific oncogen signatures like EGFR gene amplification could be detected in precancerous lesion. This might improve follow-up and treatment protocols of glottic lesions which are an everyday problem for ENT practitioners. Further research is mandatory to confirm our findings.

Laryngo-onycho-cutaneous syndrome

Laryngo-onycho-cutaneous (LOC) syndrome was reclassified as a subtype of junctional epidermolysis bullosa (JEB) based on clinical features similar to JEB and its association, in the majority of patients from the Punjab, with a unique mutation affecting the N terminus of the alpha3 chain of LM332. Although LOC syndrome is now a subtype of JEB(JEB-LOC) JEB-LOC has a distinct clinicopathologic appearance and molecular fingerprint. The intricacies of the JEB-LOC subtype are discussed in this article with regard to disease presentation, pathogenesis, management, and prognosis.

Cyclin D1 and cancer development in laryngeal premalignancy patients

In a previous trial, we found that combined 13-cis-retinoic acid, IFN-alpha, and alpha-tocopherol more effectively reversed advanced premalignant lesions of the larynx than of the oral cavity and that cyclin D1 (CD1) G/A870 single nucleotide polymorphism correlated with cancer risk. We conducted the present trial primarily to confirm the clinical activity of the combination in advanced laryngeal premalignancy and to confirm and extend our findings on CD1, both genotype and protein expression, in association with cancer risk in this setting. Twenty-seven moderate-to-severe laryngeal dysplasia patients underwent induction with combined 13-cis-retinoic acid daily, alpha-IFN twice weekly, and alpha-tocopherol daily for 1 year; 14 nonprogressing patients then were randomized to maintenance fenretinide or placebo for 2 years. During induction, two patients had pathologic complete responses, six had partial responses (30% overall response rate), and five developed laryngeal cancer. There were no significant differences between maintenance fenretinide and placebo in response or cancer rates. Ten patients developed cancer overall. Twenty-four patients were evaluated for the CD1 G/A870 genotype, and 23 for pretreatment and posttreatment CD1 protein expression. Consistent with our earlier report, shorter cancer-free survival was associated with the CD1 AA/AG genotype (P = 0.05). Extending our earlier work, high CD1 expression was associated with worse cancer-free survival overall (P = 0.04) and within each CD1 genotype group. These findings support CD1 genotype and protein expression as important risk markers for laryngeal cancer and suggest future trials targeting upstream regulators of CD1 transcription.

Papilomas intraductales de mama en paciente afectada de síndrome de Costello

Costello syndrome is a multisystemic congenital disorder with a very low prevalence. The pathogenesis remains unclear and predisposes to the development of tumors of ectodermal origin. Diagnosis is clinical, based on findings of mental and growth retardation and a characteristic phenotype. We report the case of a patient with Costello syndrome who was referred to our unit with a suspected diagnosis of intraductal papilloma based on the presence of various episodes of nipple discharge. Postoperative histopathological study confirmed the diagnosis of multiple intraductal papilloma. We review the literature on the topic and discuss the advisability of aggressive surgical therapy, given the predisposition of these patients to develop both benign and malignant tumors.

Surgical correction of brachycephalic syndrome in dogs: 62 cases (1991–2004)

OBJECTIVE

To assess results of surgical correction of brachycephalic syndrome (including stenotic nares, elongated soft palate, and everted laryngeal saccules) in dogs and determine whether dogs with hypoplastic trachea have a less favorable long-term outcome.

DESIGN

Retrospective case series.

ANIMALS

62 dogs with brachycephalic syndrome.

PROCEDURES

Medical records from 1991 to 2004 were reviewed for information regarding signalment, clinical signs, diagnosis, surgery, and long-term outcome. Surgical outcome was rated by owners as excellent, good, fair, or poor. Common abnormalities, treatments, and long-term outcomes among the 62 dogs were assessed.

RESULTS

Predominantly affected breeds included English Bulldog, Pug, and Boston Terrier. Elongated soft palate was the most common abnormality (54/62 [87.1%] dogs); the most common combination of abnormalities was elongated soft palate, stenotic nares, and everted saccules (16/62 [25.8%] dogs). The English Bulldog was the most common breed for all abnormalities, including elongated soft palate (27/54 [50%] dogs), stenotic nares (14/36 [38.9%] dogs), everted saccules (20/36 [55.6%] dogs), hypoplastic trachea (7/13 [53.9%] dogs), and laryngeal collapse (2/5 [40%]). No dogs had everted saccules alone. Outcome did not differ between dogs under-going staphylectomy by use of laser or scissor resection. Follow-up information was obtained for 34 dogs; 16 (47.1%) had an excellent outcome, and 16 (47.1%) had a good outcome. Overall treatment success rate was 94.2%, and overall mortality rate was 3.2%.

CONCLUSIONS AND CLINICAL RELEVANCE

Surgical treatment of brachycephalic syndrome in dogs appeared to be associated with a favorable long-term outcome, regardless of age, breed, specific diagnoses, or number and combinations of diagnoses.

Granulation tissue in the eyelid margin and conjunctiva in junctional epidermolysis bullosa with features of laryngo-onycho-cutaneous syndrome

Eye and adnexal involvement in epidermolysis bullosa can range from symptoms of mild irritation resulting from conjunctival involvement to severe cicatrization of the ocular surface and adnexa. We describe a unique case of granulation tissue in the eyelid margin and conjunctiva in a patient with junctional epidermolysis bullosa. The eyelid granulation tissue resembled granulomas that seen in laryngo-onycho-cutaneous syndrome, which is caused by a mutation in an isoform of the LAMA3 gene, LAMA3a. On investigation, our patient had a combination of a unique mutation in LAMA3 and the mutation I17N in LAMA3a, providing further evidence that laryngo-onycho-cutaneous syndrome is a variant of junctional EB.

Familial primary localized laryngeal amyloidosis in two sisters

Laryngeal amyloidosis is rare, accounting for less than 1% of all benign laryngeal tumors. Although familial primary localized amyloidosis has been reported in other parts of the body, no familial cases have been reported in the larynx. Primary localized laryngeal amyloidosis was detected in two sisters whose ages were 35 years and 38 years, respectively. In the elder patient, a previous endolaryngeal biopsy for symptoms of dysphonia yielded no pathologic findings. Laryngoscopic examination of the patient showed a significant submucosal accumulation at the level of ventricles and vocal folds. The younger sister had a complaint of hoarseness for five years. The results of endolaryngeal biopsies performed in both patients were reported as amyloidosis. Further evaluations were negative for systemic amyloidosis. No surgical intervention was considered. The patients were monitored for more than two years without any other coexisting disease.

Differential gene expression profiling of vocal fold polyps and Reinke's edema by complementary DNA microarray

OBJECTIVES

Our purpose was to determine whether complementary DNA (cDNA) microarray analysis (MA) can establish distinct gene expression profiles for 2 phenotypically similar vocal fold lesions: Reinke's edema (RE) and polyps. Established transcript profiles can provide insight into the molecular and cellular processes involved in these diseases.

METHODS

Eleven RE specimens and 17 polyps were analyzed with MA for 8,745 genes. Further MA profiling was attempted within each lesion group to identify molecular markers for reflux exposure and smoking. Prediction analysis was used to predict lesion classification for 2 unclassified samples. A real-time polymerase chain reaction was performed to corroborate MA transcript levels for selected significant genes.

RESULTS

Sixty-five genes were found to differentiate RE and polyps (p = .0088). For RE, 19 genes were differentiated for reflux exposure (p = .016). No genes were found to differentiate smokers from nonsmokers. For polyps, no genes were found to differentiate for reflux (p = .16) and smoking (p = .565). Categorization of unclassified lesions was possible with a minimum of 13 genes.

CONCLUSIONS

We demonstrate the feasibility of benign lesion classification based on MA. Microarray analysis is useful not only for improving diagnosis and classification of such lesions, but also for potentially generating prognostic indicators and targets for therapy.

The Prevalence of Laryngeal Disease in a Large Population of Competition Draft Horses

OBJECTIVES

(1) To determine the effect of age, height, weight, breed, sex, and specific use on the prevalence of idiopathic left laryngeal hemiplegia (ILH) in a population of draft performance horses; (2) to determine the association between tracheal mucus and laryngeal dysfunction, and the prevalence of exercise-induced pulmonary hemorrhage (EIPH) in a population of draft performance horses.

STUDY DESIGN

Cross-sectional.

ANIMALS

Draft horses competing at the 2005 Michigan Great Lakes Draft Horse Show.

METHODS

Endoscopic examinations were performed on horses competing at the 2005 Michigan Great Lakes Draft Horse Show. Signalment, height, and weight were obtained from the owners and trainers.

RESULTS

Belgian, Percheron, and Clydesdale horses (n=183) were studied. Prevalence of ILH was 35%. Horse height was significantly associated with the risk of ILH in Belgian and Percheron horses but not Clydesdales. There was a significantly different prevalence of ILH among the breeds such that 42% Belgians, 31% Percherons, and 17% Clydesdales were affected. Laryngeal disease was a risk factor for increased tracheal mucus. None of the horses had acute evidence of EIPH.

CONCLUSIONS

The prevalence of ILH in draft horses has increased or is higher in competition horses compared with previously studied groups. Tracheal and/or pulmonary inflammation may be more common in draft horses with ILH based on our findings that horses with ILH have more tracheal mucus than horses with normal laryngeal function.

CLINICAL RELEVANCE

Selection pressure for large, taller, longer-necked horses may be responsible for a seemingly increased incidence of ILH in competitive draft horses.

Laryngeal paralysis-polyneuropathy complex in young related Pyrenean mountain dogs

OBJECTIVES

To characterise clinical, electrophysiological and histopathological findings. To analyse pedigree information in six young related Pyrenean mountain dogs with laryngeal paralysis-polyneuropathy complex (LP-PNC).

METHODS

A retrospective study of clinical records and pedigrees of six young related Pyrenean mountain dogs with LP-PNC was carried out.

RESULTS

All dogs were presented with laryngeal paralysis and concurrent megaoesophagus. Electrodiagnostic testing was performed in three dogs and showed electrophysiological abnormalities in the distal appendicular muscles. Histopathological findings of peripheral nerve samples were dominated by distal axonal degeneration. Clinical, electrophysiological and histopathological findings were supportive of a diagnosis of degenerative, sensorimotor LP-PNC, similar to that reported in young dalmatians and rottweilers. All dogs died or were euthanased by two years of age. An autosomal recessive mode of inheritance was suspected based on pedigree analysis.

CLINICAL SIGNIFICANCE

Congenital LP-PNC should be suspected in any young dog presenting with laryngeal dysfunction and other concurrent neurological abnormalities. The prognosis is usually poor.

Laryngeal collapse in seven brachycephalic puppies

OBJECTIVES

To document the histories, clinical findings, and management of seven puppies with laryngeal collapse occurring secondarily to brachycephalic airway syndrome.

METHODS

Seven brachycephalic puppies aged between 4.5 and six months underwent surgery for management of brachycephalic airway syndrome following presentation for exercise intolerance and increased respiratory noise and effort.

RESULTS

Stenotic nares of varying severity and an elongated soft palate were common to all dogs. All dogs had tracheal hypoplasia and this was severe in four dogs. Laryngeal collapse was present in all dogs. Two dogs had stage I, four dogs stage II, and one dog stage III laryngeal collapse. The dog with stage III laryngeal collapse and one dog with stage II laryngeal collapse died. There was no apparent association between the changes evident on thoracic radiographs or the degree of tracheal hypoplasia and postoperative outcome.

CLINICAL SIGNIFICANCE

The development of severe secondary laryngeal changes in dogs aged six months or less supports the suggestion that immature brachycephalic dogs should undergo assessment and, if indicated, surgery as soon as any clinical signs of BAS are apparent.

Divergent Patterns of Allelic Alterations in Premalignant Laryngeal Lesions Indicate Differences in the Impact of Morphological Grading Characteristics

OBJECTIVES

Classic histological grading and molecular genetic analysis of epithelial hyperplastic laryngeal lesions (EHLL) were correlated in an attempt to elucidate, which classic marker reflects best the gradual progression of laryngeal premalignant lesions as determined by an increasing number of molecular genetic aberrations.

METHODS

Thirty-two EHLL were grouped according to four grades of nuclear atypia, four degrees of epithelial maturation and three groups of overall and suprabasal mitotic activity. Overall and suprabasal proliferative activity were measured by MIB-1 immunostaining and staged according to four levels. Allelic imbalance was determined by PCR using 32 microsatellite loci at nine chromosomal arms.

RESULTS

Of the six classic criteria, only progressive mitotic indices correlated with allelic alterations in a remarkable variety of microsatellite markers, especially at chromosome 17p.

CONCLUSION

Using the number of allelic alterations as standard for assessment, this preliminary study gives first evidence that certain morphological criteria could reflect differently the gradual progression of premalignant laryngeal lesions with mitotic index being the most promising marker. Further studies with long-term follow-up are required to prove the predictive value of these criteria in daily practice.

[Prevalence, incidence rate and structure of congenital and hereditary forms of ENT diseases in population of Azerbaijan Republic]

The primary field study in Azerbaijan Republic (AR) aimed at registration of the prevalence, incidence rate and structure of congenital and hereditary forms of ENT diseases in population of the AR. A total of 7725 patients with the above diseases were registered. The phenotyping frequency of ENT pathology was 94 patients per 100,000. The highest morbidity was documented for deafness (3571, 47.5%) and hypoacusis (3025, 39.1%), the least--for congenital laryngeal pathology (2, 0.026%). Congenital and hereditary ENT diseases occurred most frequently in the population of the Lenkoran-Astarin zone, Baku and Baku Region, among refugees, least frequently--in the population of Kuba-Khachmass, Shirvan and Central Aran zones.

The supplementary diagnostic power of selected immunohistochemical, molecular genetic and infective parameters in epithelial hyperplastic laryngeal lesions

OBJECTIVES

MIB-1 and p53 protein expression, loss of heterozygosity (LOH), microsatellite instability (MSI) of di- and mononucleotide repeats, and HPV status were tested for their potential to characterize different stages of epithelial hyperplastic laryngeal lesions (EHLL).

METHODS

Thirty-two EHLL were reclassified according to the Ljubljana classification into simple (SH), abnormal (AbH), atypical hyperplasia (AtH) and carcinoma in situ, and investigated by immunohistochemical methods, PCR and direct sequencing analysis.

RESULTS

MIB-1 increased with progressive grades of EHLL, whereas p53 protein expression was distinctive only between SH and AbH. LOH showed increasing frequency with grades of the lesions, but the distribution of altered loci (9p, 9q, 10q, 11q, 17p) was not qualified to differentiate between the stages. MSI was detected in SH, AbH and AtH without clear correlation to histopathological grading. HPV infection occurred mostly in SH and AbH (both: 66.7%).

CONCLUSION

MIB-1 labeling and allelic loss could assist histopathological diagnosis in the entire spectrum of EHLL, whereas the MSI results point to a genetic instability of the laryngeal mucosa in general and are therefore not helpful in the distinction of different stages of EHLL. However, future molecular genetic analyses should consider more late events of laryngeal carcinogenesis to improve their diagnostic potential. Furthermore, our results indicate that nonrisky and risky EHLL could probably be caused by different exogenous factors.

Cell biology of laryngeal epithelial defenses in health and disease: further studies

This is the second annual report of an international collaborative research group that is examining the cellular impact of laryngopharyngeal reflux (LPR) on laryngeal epithelium. The results of clinical and experimental studies are presented. Carbonic anhydrase (CA), E-cadherin, and MUC gene expression were analyzed in patients with LPR, in controls, and in an in vitro model. In patients with LPR, we found decreased levels of CAIII in vocal fold epithelium and increased levels in posterior commissure epithelium. The experimental studies confirm that laryngeal CAIII is depleted in response to reflux. Also, cell damage does occur well above pH 4.0. In addition, E-cadherin (transmembrane cell surface molecules, which have a key function in epithelial cell adhesion) was not present in 37% of the LPR laryngeal specimens. In conclusion, the laryngeal epithelium lacks defenses comparable to those in esophageal epithelium, and these differences may contribute to the increased susceptibility of laryngeal epithelium to reflux-related injury.

DNA microarray gene expression analysis of a vocal fold polyp and granuloma

Genome-wide transcriptional profiling has important applications in advancing knowledge of vocal fold biology. With the use of DNA microarray technology, analysis of global patterns of gene expression can reveal unexpected networks of coordinated regulation in the extracellular matrix of the lamina propria. Transcriptional gene expression patterns for 2 vocal fold pathologies--vocal fold polyp (VP; N = 1) and vocal fold granuloma (VG; N = 1) were analyzed by means of DNA microarray analysis for 4,632 human genes using another patient's true vocal fold (TVF; N = 1) as a control. Twenty-four and 29 genes for VG and VP, respectively, were established to be either over- or underexpressed compared to that of TVF. Five-way cluster analysis revealed broad patterns that suggest a potential degree of organization underlying gene expression in these tissues. For the 1 VG, genes involved represent inflammation and wound healing; for the 1 VP, involved genes demonstrate a tempered wound repair response and increased epithelial manifestations. These results successfully demonstrate the use of DNA microarray technology as a new approach for further investigations dissecting vocal fold disease. Further investigation is needed on larger sample sizes to establish transcriptional gene expression patterns for VP and VG.

Alopecia universalis congenita, XY gonadal dysgenesis and laryngomalacia: a novel malformation syndrome

We report on five individuals with the following consistent findings: alopecia universalis congenita, XY gonadal dysgenesis and laryngomalacia persisting beyond infancy. The clinical presentation of the XY gonadal dysgenesis was ambiguous genitalia, appearing as male or, more commonly, female. In one affected individual müllerian structures were present. The affected individuals come from two unrelated families. While in the first family the two affected individuals come from two related sibships, three affected individuals come from one sibship in the second family. Parents of affected individuals in the three sibships are first cousins. To our knowledge, this association has not been reported before. We speculate that the mode of inheritance of this disorder is autosomal recessive with probable sex limitation.

Fibronectin: an interesting vocal fold protein

A great deal of information is accruing regarding the function of the extracellular matrix. Once thought to be simply a structural entity to surround cells, it is now known to do much more. Fibronectin in particular has received specific attention. Fibronectin is a ubiquitous glycoprotein found most abundantly in the extracellular matrix of regenerating, healing, and embryonic tissue. Vast evidence supports the fact that fibronectin participates in many diverse functions throughout the body that are relevant to vocal fold biology. This article introduces the structure of fibronectin and its isoforms and provides an introduction to some of the many functions it plays. It also reviews the evidence about fibronectin's place in vocal folds and vocal fold pathology. It discusses fibronectin's presence in vocal nodules, vocal polyps, vocal scarring, and Reinke's edema, and reviews the data on its role in mucosal wave impairment. Lastly, it discusses preliminary microarray data that show gene expression for fibronectin to be upregulated in true vocal folds when compared to false vocal folds.

Induction of the CBP transcriptional co-activator early during laryngeal carcinogenesis

PURPOSE

CREB-binding protein (CBP) is a transcriptional "integrator" that is suspected of contributing to tumorigenesis. This is the first systematic morphologic study evaluating CBP expression in a large series of human laryngeal tissues containing normal epithelium, premalignant lesions (hyperplasia and/or dysplasia), and squamous cell carcinoma.

METHODS

Immunohistochemical methodology was performed on formalin-fixed paraffin-embedded sections by using a monoclonal anti-CBP antibody. CBP expression was screened and compared in 156 patients with various laryngeal histologic entities.

RESULTS

Nuclear expression of CBP was found in 44 out of 91 (48.4%) specimens with normal-appearing epithelium (46.2% weak and only 2.2% moderate positivity), 92 out of 100 (92%) with hyperplastic lesions (56% weak, 36% moderate/strong, and only 8% no positivity), 80 out of 103 (77.7%) with dysplastic lesions (45.6% weak, 32.1% moderate/strong, and 22.3% no positivity), 37 out of 45 (82.2%) with well-differentiated carcinoma (42.2% weak, 40% moderate/strong, and 17.8% no positivity), 31 out of 43 (72.1%) with moderately differentiated carcinoma (32.6% weak, 39.5% moderate/strong, and 27.9% no positivity) and eight out of 12 (66.7%) with poorly differentiated carcinoma (41.7% weak, 25% moderate/strong, and 33.3% no positivity). Statistical analysis and correlation of the intensity of nuclear immunostaining among the various histologic entities revealed statistically significant results.

CONCLUSIONS

Overexpression of CBP is detected from the very early stages of laryngeal carcinogenesis, suggesting that CBP may play a role in malignant transformation of precancerous laryngeal lesions. It is possible that overexpression of this protein is a prerequisite for the observed p53 upregulation in premalignant lesions, implying an indirect role of CBP in p53-mediated tumorigenic potential.

Localized amyloidosis and extramedullary plasmacytoma involving the larynx of a child

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.

Laryngeal involvement in the Dowling-Meara variant of epidermolysis bullosa simplex with keratin mutations of severely disruptive potential

The clinical features of the Dowling-Meara variant of epidermolysis bullosa simplex (EBS-DM) can, in an infant, be indistinguishable from other severe forms of epidermolysis bullosa (EB). Two unrelated infants with no family history of skin disease are described who, within hours of birth, developed extensive blistering of skin and oral mucosae and who both subsequently developed hoarse cries. Despite this superficial resemblance to other forms of EB, electron microscopy revealed a basal cell rupture and keratin aggregates characteristic of EBS-DM in the skin of both infants and in the vocal cord epithelium of one. Molecular analysis confirmed the diagnosis by identification of mis-sense point mutations in basal cell keratin genes in both cases. One patient carries a point mutation in keratin 14 (converting arginine at position 125 to histidine) and the other has a novel point mutation in keratin 5 (converting serine at position 181 to proline). Hoarseness is not a well documented feature of EBS-DM and is usually associated with junctional EB. These two patients demonstrate that the presence of a hoarse cry in an infant affected by severe EB does not necessarily indicate a poor prognosis.

Chromosomes 7,17 polysomies and overexpression of epidermal growth factor receptor and p53 protein in epithelial hyperplastic laryngeal lesions

PURPOSE

To visualize directly a sequence of genetic changes underlying the entire spectrum of epithelial hyperplastic laryngeal lesions (EHLL) and laryngeal cancer by the use of non-isotopic in situ hybridization (ISH) for chromosomes 7 and 17 in correlation with overexpression of p53 protein and epidermal growth factor receptor (EGFR). The specific aim was to compare the results and prognostic significance between the two types of EHLL: isolated, mainly atypical hyperplasia or risky epithelium, and EHLL associated with squamous cell carcinoma (SCC).

PATIENTS AND METHODS

59 tissue specimens of EHLL obtained from 34 patients, graded according to the Ljubljana classification into simple (SH), abnormal (AbH) and atypical hyperplasia (AtH), and carcinoma in situ (CIS) were included in the study. Non-fluorescent ISH for chromosomes 7 and 17 was performed by biotinylated alpha-satellite DNA probes. Immunohistochemical staining for EGFR and p53 protein was analyzed on the same tissue samples.

RESULTS

Polysomy for both chromosomes increased in correlation with progressive grades of EHLL. The most important finding was the statistically significant difference in chromosome copy numbers between the isolated AtH and AtH associated with SCC. Overexpression of EGFR and p53 protein was found in 61 (36/59) and 52% (31/59) of cases, respectively. The immunoreactivity for both markers increased with the grade of lesions, but the staining pattern was not so uniform in isolated EHLL. On the other hand, the immunoreactivity was expressed more constantly in EHLL adjacent to SCC.

CONCLUSIONS

Numerical changes in chromosomes 7 and 17 might be associated with an upregulation of EGFR and p53 genes, and could contribute to critical events in laryngeal carcinogenesis. For daily practice, the cytogenetic and immunohistochemical analyses could be of assistance in distinguishing between low- and high-risk groups of AtH. However, the isolated forms of atypical hyperplasia need considerable further study by evaluating genetic changes with the described methods regarding their ultimate transformation to carcinoma.

[Genetic aspects of congenital pathology of the larynx and trachea]

Medical-genetic examination covered 24 families of patients with congenital defects of the larynx and trachea. These developmental defects can be attributed to multiple unestablished defects (66.7%) or can be part of some congenital-hereditary syndromes (25%) such as chromosomal, genetic, teratogenic, of unknown etiology. The percentage of isolated developmental laryngeal and tracheal defects is relatively small--8.3%.

Withdrawn: Opitz oculo-genito-laryngeal syndrome: a rare cause of recurrent aspiration pneumonia in an adult

This paper has been withdrawn for data protection reasons.

Evaluation of DNA content in epithelial hyperplastic lesions of the larynx

Quantification of cellular DNA by image or flow cytometry has achieved acceptance as an objective and reproducible component of diagnostic pathology. Although the majority of investigations have focused on the prognostic utility of DNA content measurements in malignant neoplasms, the detection of abnormal DNA content can also be useful for the detection of early neoplasia or premalignant change. Several studies of laryngeal epithelial hyperplastic lesions by image cytometry have shown that a proportion of these lesions exhibit abnormal DNA content and that the incidence of this finding correlates with the degree of dysplasia or atypia. Similar results were obtained by flow cytometry, which has only rarely been used for investigation of these lesions. Although there is some evidence that lesions with abnormal DNA content are more likely to progress to carcinoma, additional studies are needed to define the clinical importance of DNA cytometry in hyperplastic epithelial lesions of the larynx.

Potential biomarkers in predicting progression of epithelial hyperplastic lesions of the larynx

Factors contributing to malignant transformation of laryngeal pre-neoplastic lesions remain largely unknown. Potential etiologic factors may be related to a genetically controlled sensitivity to environmental carcinogens. In this study, we investigated bleomycin-induced chromosome fragility in 15 patients with laryngeal keratoses who experienced a malignant transformation of pre-neoplastic lesions during follow-up, as compared with chromosome fragility in 15 historical controls with no progression of laryngeal keratoses during a 10-year follow-up, in a match-paired analysis. Chromosomal analysis demonstrated a higher sensitivity to clastogens in patients with malignant progression of laryngeal pre-neoplastic lesions than that of control patients with no evolution of their original laryngeal keratoses (p < 0.01). Furthermore, in the attempt to identify possible prognostic markers we studied proliferative activity (MIB-1 expression) and p53 gene aberration in biopsy samples from non-invasive and invasive laryngeal lesions in both groups. p53 immunostaining was observed in 10/15 (66.7%) of pre-neoplastic lesions and in 11/15 (73.3%) of metachronous laryngeal cancers. No differences in terms of p53 expression were noted between transformed and not-transformed lesions. Mutations at p53 gene were observed in 3/15 (20%) of pre-invasive biopsies and in 4/5 (80%) of the laryngeal cancers analyzed. Our data suggest that p53 alteration is an early event in the genesis of a subset of laryngeal carcinomas and that there is no conclusive data about the possible clonal development of metachronous laryngeal carcinoma from a p53 mutated pre-invasive disease in the same patient. MIB-1 expression was found to progressively increase with degree of epithelial hyperplasia and dysplasia in both transformed (p = 0.007) and not-transformed (p < 0.1) lesions. Surprisingly, pre-invasive lesions with tumor evolution showed a lower proliferative activity when compared with laryngeal lesions without malignant transformation (p = 0.013). These data suggests that subjects with pre-neoplastic laryngeal lesion showing an increased susceptibility to carcinogens and with less proliferative disease could be at a higher risk for development of laryngeal carcinoma.

Morphological assessment of malignant potential of epithelial hyperplastic lesions

The spectrum of conventional and advanced morphological methods for the assessment of malignant potential of precancerous lesions of the laryngeal mucosa is discussed.

Increased mutagen-induced chromosome damage in patients with transformed laryngeal pre-cancerosis

Factors that contribute to malignant transformation of laryngeal pre-neoplastic lesions remain largely unknown. Potential etiological factors may be related to a genetically controlled sensitivity to environmental carcinogens. In this study, we investigated bleomycin-induced chromosome damage in 15 patients who experienced a malignant transformation of preneoplastic laryngeal lesions during follow-up, as compared with chromosome fragility in 30 historical controls with no progression of keratoses during a 10-year follow-up, in a match-paired analysis. Chromosomal analysis demonstrated higher sensitivity to clastogens in patients with malignant progression of laryngeal pre-neoplastic lesions than that of control patients with no evolution of their original laryngeal keratoses (p = 0.003). Furthermore, among the study patients, chromosome sensitivity was most apparent in non-tobacco users with malignant transformation of laryngeal disease. Our data suggest that subjects with pre-neoplastic laryngeal lesion showing increased susceptibility to carcinogens could be at higher risk for development of laryngeal carcinoma.

[Manifestation of Urbach-Wiethe syndrome in the ENT area]

Urbach-Wiethe's syndrome (hyalinosis cutis et mucosae) is a rare genetic defect of probably autosomal recessive origin. The exact nature concerning the pathogenesis of this disorder is still controversial. A characteristic symptom in early childhood might bei hoarseness, later on manifestations with hyalin deposits in the larynx, oral cavity and oropharynx might occur as well as yellowish-white papular deposits in the skin. The overall prognosis of this disease is good, therapeutic intervention might be necessary for functional purposes (narrowing of the laryngeal lumen) and consists of surgical removal of the lesions.

Adductor laryngeal breathing dystonia in a patient with lubag (X-linked dystonia-Parkinsonism syndrome)

We report a patient with Lubag (X-linked dystonia-parkinsonism) who presented with severe respiratory stridor from adductor laryngeal breathing dystonia. Emergency tracheostomy was necessary, and subsequent laryngeal injection with botulinum toxin led to worsening aspiration. Botulinum toxin injection for severe lingual dystonia was successful.

Over-expression of p53 protein in human laryngeal carcinoma

We examined the expression of tumor-suppressor protein p53 in a variety of laryngeal carcinomas from 43 patients (25 primary, 13 metastatic and 5 recurrent cases), 13 normal laryngeal tissues and 7 benign laryngeal nodule biopsy specimens, using the polyclonal antibody CM-1. Previously we have reported a high incidence of ras mutations (51%) and human papillomavirus (HPV) infection (37%) in these laryngeal carcinomas. p53 protein was detected by immunohistochemistry in 65% of laryngeal carcinomas (60% of primary, 69% of metastatic and 80% of recurrent cases). No correlation was found between p53 over-expression and histological grading of the tumors. None of the specimens from normal larynx and laryngeal nodules revealed any detectable level of this protein. Furthermore, 11 (69%) of 16 HPV-positive cases and 17 (77%) of 22 cases with ras mutation showed variable grades of p53 expression. Twelve (71%) of 17 laryngeal carcinomas in current study having both p53 over-expression and ras mutation were moderately or poorly differentiated. Likewise, positivity for these 2 parameters was significantly increased in metastatic tumors (9 of 13 cases, 69%) as compared with primary and recurrent tumors (8 of 30 cases, 27%) (p < 0.01). Our results suggest that multiple factors are involved in this malignancy, and that the simultaneous over-expression of p53 and the presence of ras mutation may be related to the progression stage of laryngeal carcinoma.

Autosomal dominant congenital laryngomalacia

A family is presented in which congenital stridor due to laryngomalacia was evident in 9 individuals through 3 generations. This report confirms the autosomal dominant transmission of at least one type of laryngomalacia.

Primary localized amyloidosis in one family

Primary localized amyloidosis was found in a family. A 66-year-old woman had suffered from hoarseness for 18 years. A biopsy specimen from the larynx showed amyloid deposits in the submucosal connective tissue. Her 40-year-old daughter noticed a subcutaneous nodule on her philtrum. Histologic examination showed the deposition of amyloid in the middle and lower dermis, which also encased the blood vessels and epidermal appendages. In both cases the amyloid deposits were positively stained with Congo red and the staining was resistant to potassium permanganate treatment. These amyloid deposits were strongly positive against the anti-amyloid antibody of the lambda light chain. These results indicate that the amyloid substance is derived from protein AL. There was no clinical or laboratory evidence of systemic amyloidosis or multiple myeloma in either patient.

The otolaryngologic manifestations of Pelizaeus-Merzbacher disease

Pelizaeus-Merzbacher disease is a condition of central nervous system dysmyelination. We describe a familial series in which both otologic and laryngologic abnormalities were present. The diagnosis of this invariably fatal disorder can be made on a clinical and/or pathologic basis. As the otolaryngologic manifestations are often the first to appear, the consulting head and neck surgeon may be essential in the initial diagnosis of this hereditary disease.

Inherited nasal and laryngeal degenerative chondropathy

Four rare cases of congenital saddle-nose deformity and slowly progressive degeneration of laryngeal cartilages with stenosis are described. The term inherited degenerative chondropathy is suggested for this disease entity. To our knowledge this is the first article on such a disease.

Hereditary angioedema: association with IgA deficiency and otolaryngologic disorders

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by recurrent edema of the oropharynx, the extremities, and by abdominal pain. This disorder is caused by a defect in the C1 esterase inhibitor (C1 INH) which inhibits the first component of complement (C1). Four generations of a family are described and laboratory data of five individuals of this family are given as these individuals presented for general otolaryngologic procedures. The mortality of acute laryngeal edema is described to vary from 6% to 54% and may necessitate a tracheotomy as a life saving measure A deficiency of IgA is also noted in this family, and to our knowledge, this is the first time this has been shown in association with HAE. Present therapy consists of long utilization of danazol, an attenuated androgen. Recently a partially purified C1 INH has been reported for acute episodes of HAE, and preliminary results are promising.

Pachyonychia congenita with involvement of the larynx

Pachyonychia congenita is a genetic syndrome of epithelial dysplasia that is inherited as an autosomal dominant trait. Its unique involvement within the larynx of a 3-year-old boy prompted this brief report of its clinical behavior and management.

Familial laryngomalacia: a case report

This report describes the hereditary occurrence of severe laryngomalacia in three of five siblings of a Mexican-American family. The mother, who experienced respiratory difficulties in the first year of life, may also have been affected. All three affected children required neonatal tracheostomy, and two died of pulmonary complications. Histological studies of tracheal cartilage revealed distinct hypercellularity and histochemical staining abnormalities of the cartilaginous matrix without defects in skeletal cartilage. Although laryngomalacia is not uncommon, this disorder previously has not been documented to occur as a familial trait, nor have distinct abnormalities of cartilage been associated with laryngomalacia. This report suggests that etiologic and pathophysiologic heterogeniety exists for the clinical syndrome of laryngomalacia.

A case of hyalinosis cutis et mucosae (lipoid proteinosis of Urbach and Wiethe) with common ancestors in four remote generations

We report a case of hyalinosis cutis et mucosae, a rare disorder of hyalin deposition in skin and mucous membranes, in a 27-year-old male, whose coefficient of inbreeding was 0-0106 due to seven common ancestors, including an aunt of an early American president, in the eight preceding generations.