Hemangiopericytoma: Conducts and perioperative management of an extent sinonasal tumor in a Jehovah's Witnesses patient - Case report

Background

Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself.

Case

We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per‐operative care and restrictions being respected and attended.

Conclusions

The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.

Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long-Term Results with Indwelling Voice Prosthesis

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use.

STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up.

RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% ( P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary ( P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up.

CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer

CONCLUSION

In patients with early glottic squamous cell carcinoma (SCC) submitted to CO2 laser endoscopic resection, local disease recurrence was significantly correlated with the presence of positive additional surgical margins on permanent sections.

OBJECTIVES

To evaluate the rate of cancer recurrence in patients with early glottic SCC submitted to CO2 laser endoscopic resection according to margin status after resection, stage of disease and postoperative radiotherapy. The rate of larynx preservation and the length of hospital stay were also evaluated.

MATERIAL AND METHODS

Forty consecutive patients with early glottic cancer were subjected to laser endoscopic resection surgery of glottic cancer followed by frozen-section control of margins, with intraoperative enlargement of margins when positive. Adjuvant radiation therapy or enlargement of previous margins was indicated in the case of positive additional surgical margins on permanent section.

RESULTS

Local recurrence occurred in three patients (7.5%), all with positive additional surgical margins on permanent section. Positive additional surgical margins on permanent section were related to 37.5% of recurrences and negative additional surgical margins with 0% of recurrences (p=0.006). All patients spent at most 1 day at the hospital.

Neuroendocrine neoplasms of the larynx. Importance of the correct diagnosis and differences between atypical carcinoid tumors and small-cell neuroendocrine carcinoma

Findings in the present study have confirmed that the diagnosis of neuroendocrine tumors of the larynx (NETL) requires that a panel of neuroendocrine markers and electron microscopy be performed. This means that the clinician must be aware of the clinical presentations of such patients and should send fresh biopsy specimens to the clinical laboratory for optimal tissue studies. As shown in this study, the possibility of misdiagnosis of an atypical carcinoid tumor (ACT) is rather high. In establishing a diagnosis, a part of the material should be fixed for conventional histology, a part for immunohistochemistry and a part for electron microscopy. The correct diagnosis of NETL is obviously of great importance for subsequent treatment and prognosis. Patients with the diagnosis of ACT of the larynx require surgical treatment. Our findings also show that small-cell neuroendocrine carcinomas of the larynx should be considered to be a disseminated disease at initial presentation. A metastatic workup is necessary, but radical surgical procedures should be avoided. The combination of radiotherapy and chemotherapy is always indicated.