Laryngeal Tumors Research Articles

Evaluation of advanced protein oxidation and RAGE gene variants in the risk of laryngeal cancer

Laryngeal tumours with multifactorial etiopathogenesis constitute ∼1% of all body cancers. The imbalance between oxidative and antioxidative systems affects redox-homeostasis. The oxidative stress generated by the continuous formation of reactive oxygen species results in the oxidation of cellular molecules. The present study investigated the protein oxidation levels and the distribution of receptors for advanced glycation end products (RAGE) variants in the risk of laryngeal carcinoma (LC). RAGE gene polymorphisms were determined by restriction endonuclease-based assay in 120 controls and 120 LC patients. Spectrophotometric methods were used to determine oxidant and antioxidant parameters including protein-carbonyl-groups (PCO), advanced-oxidation-protein-products (AOPP), lipid-hydroperoxides (LPH), thiol-fractures, superoxide-dismutase (SOD) activity. The distributions of rs1800624 and rs2070600 genotypes differed non-significantly among the study groups, however, the rs2070600-Ser allele had a higher frequency among the patients. While rs1800624-A allele carriers had higher frequency of perineural and lymphatic invasion, rs2070600-Ser allele frequency was higher in advanced-stage patients and in patients with muscle and perineural invasion. PCO, AOPP, LPH levels, and SOD activity were significantly higher in the patients. According to AUCs all of them are of diagnostic importance, therefore, cut-off values were determined. The analysis of the combined effects of RAGE polymorphisms and the oxidative stress parameters showed that LPH, thiols, and SOD activity differ among RAGE variants. Our results suggest that high levels of serum PCO, AOPP, LPH, and SOD activity and rs2070600-Ser allele may have effects on LC risk individually and both polymorphisms of RAGE may affect the progression of the disease by interacting with the oxidant–antioxidant system.

Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform

Objective: To explore the feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform for pharyngolaryngeal tumors. Methods: A retrospective analysis was performed on 55 consecutive cases with resection of pharyngolaryngeal tumors by transoral robotic surgery with da Vinci Xi platform from July 27, 2020 to October 31, 2021 in the Department of Head and Neck Surgery, Fudan University Eye, Ear, Nose and Throat Hospital, including 44 males and 11 females, aged 25-79 years. There were 41 cases of oropharyngeal tumors, 9 cases of parapharyngeal space tumors, 2 cases of laryngeal tumors, 2 cases of hypopharyngeal tumors and 1 case of retropharyngeal space tumor. Operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheotomy, nasal feeding, hemorrhage and other complications were analyzed. Results: Of the 55 patients, 54 received resection of pharyngolaryngeal tumors by da Vinci robot through oral approach, and only 1 case of pyriform sinus carcinoma underwent a conversion to open surgery due to poor exposure of lower margin. The average surgical time for the patients with transoral robotic surgeries was 64.4 min, the average blood loss was 24.8 ml, the average postoperative hospital stay was 6.9 d, and the average oral feeding time was 11.1 d. Seventeen patients (30.9%) underwent preventive tracheotomy during surgery. Among 38 cases of laryngeal cancer, 28 underwent simultaneously neck dissection. No serious complications occurred in all patients during and after operation. The follow-up time was 1-15 months. Aside from 1 patient had a relapse 10 months after surgery, other patients had no recurrence or metastasis. Conclusion: Transoral robotic surgery with da Vinci Xi is safe, effective and minimally invasive for resection of pharyngolaryngeal tumors under reasonable indications.

Association of histological features with laryngeal squamous cell carcinoma recurrences: a population-based study of 1502 patients in the Netherlands

BackgroundRecurrences remain an important problem in laryngeal squamous cell carcinoma. Little has been described about histological characteristics of the primary laryngeal tumor that may be associated with recurrences. Identifying risk factors for recurrences might help in adapting treatment or follow-up. Using real-life population-based data, we aimed to identify histological features of the primary tumor associated with recurrences and overall survival.Material and methodsDemographic, clinical and treatment information on all first primary invasive laryngeal tumors diagnosed in 2010–2014 (N = 3705) were extracted from the population-based nationwide Netherlands cancer registry (NCR) and linked to PALGA, the nationwide Dutch pathology registry, to obtain data on histological factors and recurrences. For a random 1502 patients histological information i.e., keratinization, perineural invasion (PNI+), vascular invasion (VI+), growth pattern, degree of differentiation, extracapsular spread (ECS+), cartilage- and bone invasion and extralaryngeal extension, was manually extracted from narrative pathology reports and analyzed for locoregional recurrence and overall survival using cox regression analysis.ResultsIn total, 299 patients developed a locoregional recurrence and 555 patients died. Keratinization (HR = 0.96 (95%CI: 0.68–1.34) p = 0.79), two or three adverse characteristics (PNI+, VI+, non-cohesive growth) (HR = 1.38 (95% CI: 0.63–3.01) p = 0.42), and ECS+ (HR = 1.38 (95% CI: 0.48–4.02) p = 0.55) were not associated to recurrence. For death, also no significant association was found.ConclusionIn this population-based real-life dataset on laryngeal carcinoma in the Netherlands, histological factors were not associated with locoregional recurrences or overall survival, but future studies should investigate the role of these features in treatment decisions.

Fibreoptic Laryngoscopic Assessment of Patients with Hoarseness: A Cross-sectional Analysis.

Background:Hoarseness is a common clinical manifestation of laryngeal diseases. The cause of hoarseness may not always be a simple inflammatory disease, but it can be from other serious life-threatening conditions such as laryngeal cancer, for which a delay in diagnosis of such condition may compromise treatment, resulting in poor prognosis and a decreased survival rate. Against this background, we evaluated the causes of hoarseness using fibreoptic laryngoscopy in our environment.Materials and Methods:This was a cross-sectional study of patients with hoarseness attending ENT clinic of our institution. Ethical clearance and consent were obtained. A questionnaire was used to collect relevant clinical data, fibreoptic laryngoscopy was carried out, and the data was analysed using the Statistical Products and Service Solution version 20.0.Results:The study recruited 90 patients with hoarseness. The age of the patients ranged between 18 and 70 years with a mean of 40.1 ± 14.8 years. There were 51 (56.7%) males and 39 (43.3%) females. About 46 (51.2%) of the patients had intermittent hoarseness, whereas 44 (48.8%) had persistent hoarseness. Most of the patients, 49 (54.4%), had hoarseness for less than 6 months before presentation. The fibreoptic laryngoscopic findings were non-specific laryngitis 49 (54.5%), laryngeal tumor 20 (22.2%), vocal cord polyp 7 (7.7%), laryngeal papilloma 6 (6.7%), vocal cord palsy 5 (5.6%), and others 3 (3.3%).Conclusion:Laryngeal tumour constituted a significant percentage of fibreoptic laryngoscopic findings in patients with hoarseness after nonspecific laryngitis. Therefore, fibreoptic laryngoscopy is recommended for all patients with hoarseness in order to detect sinister pathology early.

FABNet: Fusion Attention Block and Transfer Learning for Laryngeal Cancer Tumor Grading in P63 IHC Histopathology Images.

Laryngeal cancer tumor (LCT) grading is a challenging task in P63 Immunohistochemical (IHC) histopathology images due to small differences between LCT levels in pathology images, the lack of precision in lesion regions of interest (LROIs) and the paucity of LCT pathology image samples. The key to solving the LCT grading problem is to transfer knowledge from other images and to identify more accurate LROIs, but the following problems occur: 1) transferring knowledge without a priori experience often causes negative transfer and creates a heavy workload due to the abundance of image types, and 2) convolutional neural networks (CNNs) constructing deep models by stacking cannot sufficiently identify LROIs, often deviate significantly from the LROIs focused on by experienced pathologists, and are prone to providing misleading second opinions. So we propose a novel fusion attention block network (FABNet) to address these problems. First, we propose a model transfer method based on clinical a priori experience and sample analysis (CPESA) that analyzes the transfer ability by integrating clinical a priori experience using indicators such as the relationship between the cancer onset location and morphology and the texture and staining degree of cell nuclei in histopathology images; our method further validates these indicators by the probability distribution of cancer image samples. Then, we propose a fusion attention block (FAB) structure, which can both provide an advanced non-uniform sparse representation of images and extract spatial relationship information between nuclei; consequently, the LROI can be more accurate and more relevant to pathologists. We conducted extensive experiments, compared with the best Baseline model, the classification accuracy is improved 25%, and It is demonstrated that FABNet performs better on different cancer pathology image datasets and outperforms other state of the art (SOTA) models.

CT and MRI Based Gross Tumor Volume Comparison in Pharyngeal and Laryngeal Carcinoma

Background: Different other imaging modalities help in accurate gross tumor volume delineation. Studies have shown conflicting results for intermodality GTV comparison. Since in our institute we routinely take planning CT and planning MRI for laryngeal and pharyngeal tumors treated with definitive radiotherapy, with this study we intent to compare the gross tumor volume (GTV) with these modalities in these tumors. Materials & Methods: Study population included pharyngeal and laryngeal carcinoma patients treated. Planning CT and planning MRI images of these patients were retrieved. Gross tumor volume (GTV) was delineated by a Radiation Oncologist in both these image sets and GTVs were documented. Results: Out of 87 patients analysed, the overall median GTV with planning CT and planning MRI were 20.4 cc & 18.2 cc respectively. Median GTV with planning CT & MRI for different sites like Nasopharynx, Oropharynx, Larynx and Hypopharynx were 32.85 & 27.75 cc, 22.1 & 20.9 cc, 8.25 & 10.35cc and 20.55 & 20.6 cc respectively with no statistically significant difference. Median GTVs with CT & MRI for different primary tumor stages like T2, T3, T4a, T4b were 14.3 & 14.3 cc, 20.45 & 19 cc, 16.55 & 27.45 cc and 50.75 & 52.4 cc respectively. Analysis showed 94.6 % correlation between GTVs with CT & MRI. Conclusion: This study showed comparable median GTVs with planning CT & MRI for pharyngeal and laryngeal carcinomas. Subset analysis did not show any significant difference in GTVs with two modalities for different primary tumor site. As expected there was good correlation between GTVs of two modalities. Even though the results does not show significant intermodality variation for GTV delineation. With the results of this study we cannot question the use of multiple modalities for GTV delineation as subtle variation in GTV can result in differences in target volumes resulting in differences in toxicity profile.

Outcomes of Patients With Adenosquamous Carcinoma of the Head and Neck after Definitive Treatment

<h3>Purpose/Objective(s)</h3> Adenosquamous carcinoma of the head and neck (ASC-HN) is a rare and aggressive variant of squamous cell carcinoma (SCC). Limited data suggests inferior outcomes compared to conventional SCC. We report one of the largest single institutional experiences of this disease in patients treated definitively to further elucidate oncologic outcomes. <h3>Materials/Methods</h3> Patients with non-metastatic ASC-HN treated definitively between 2003 and 2021 were identified retrospectively from an IRB approved database with histology verified by head and neck pathologists. All tumors of the oropharynx were tested for p16 and/or HPV to document HPV associated disease. For non-oropharyngeal lesions, a designation of HPV positivity required the presence of HPV DNA/RNA per FISH. Actuarial analyses were performed for PFS and OS. <h3>Results</h3> 29 patients with ASC-HN (72.4% male, 93.1% Caucasian) with median age of 66 (range 34-91) and a median follow up of 33 months (range 6.6-126.7) were identified. The most common primary tumor sites were: oropharynx (27.6%), oral cavity (20.7%), nasal cavity (17.2%), and larynx (17.2%). 3 patients had primaries in the hypopharynx, nasopharynx and parotid gland respectively. 11 patients (37.9%) were HPV positive of whom 8 had oropharyngeal primaries. The majority (n=23, 79.3%) were treated with primary surgery of whom 19 (82.6%) received adjuvant radiation (RT) to a median dose of 60 Gy (range 36-70 Gy) with 7 receiving concurrent chemotherapy. 6 patients were treated with definitive RT to a median dose of 70 Gy with two receiving concurrent chemotherapy. There were 10 recurrences (34.5%) which occurred at a median of 14.3 months (range 5.4-28) after diagnosis including 8 loco-regional and 2 distant recurrences. Recurrences were documented in patients with primary salivary gland, oral cavity, laryngeal, hypo-pharyngeal, and oropharyngeal tumors. 3 of the 10 recurrences were in patients with HPV positive disease. Among the 6 patients treated with definitive radiation or chemo-radiation no failures were observed. 9 patients (31%) were deceased at the time of analysis. Overall 3 year PFS and OS were 54.2% and 72.9% respectively. 3 year PFS and OS were 45.6% and 69.6% for primary surgery and 83.3% and 83.3% in the definitive RT group. 3 year PFS was 50% and 75% for HPV negative and positive patients respectively. <h3>Conclusion</h3> In our single institutional experience of 29 patients with adenosquamous carcinoma of the head and neck there was a 34.5% recurrence rate. Loco-regional recurrence was the primary mode of failure.

Factors Affecting the Lifetime of Third-Generation Voice Prosthesis After Total Laryngectomy.

The study aimed to evaluate the impact of different variables on the longevity of Voice Prosthesis (VP) in patients after total laryngectomy. This retrospective cohort study is based on data about a continuous series of 328 third-generation VP, which were implanted between 2016 and 2020. Data about the VP users' age, sex, place of residence, laryngeal tumor stage, neck irradiation, VP size, and the use of Heat and Moisture Exchanger (HME) were obtained and analyzed. The effect of these variables on VP lifetime was determined. The median lifetime of VPs in patients 65 years old and above was 182 days (95% CI 168-196), versus 146 days (95% CI 130-162) (P=0.033) in patients younger than 65. Neck irradiation was associated with a longer VP median lifetime of 161 days (95% CI 142-180) compared to 126 days (95% CI 100-152) with no prior neck irradiation (P=0.046). HME usage was associated with significantly increased longevity of VPs: 182 days (95% CI 156-208) with HME and 149 days (95% CI 132-166) without HME usage (P=0.039). The results of the present study suggest that neck irradiation, and routine use of use of HME are positively associated with the longevity of VPs.

Photothermolysis Mediated by Gold Nanorods Conjugated with Epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Induces Apoptosis via the Mitochondrial Apoptosis Pathway in Laryngeal Squamous Cell Cancer.

Gold nanorods (AuNRs) have unique optical properties and biological affinity and can be used to treat tumors when conjugated with other protein molecules. Our previous studies have shown that EGFR monoclonal antibody (EGFRmAb)-modified AuNRs exert strong antitumor activity in vitro by inducing apoptosis. In this study, we tested the effects of EGFRmAb-modified AuNRs on laryngeal squamous cell cancer (LSCC) in vitro and in vivo. The in vitro results showed that EGFRmAb-modified AuNRs inhibited NP-69, BEAS-2B and Hep-2 cell growth and induced mitochondria-dependent apoptosis. The mitochondrial membrane potential was reduced, leading to the release of cytochrome C (Cyt C) and consequent activation of the intrinsic mitochondrial apoptosis pathway. Moreover, we observed that the occurrence of mitochondrial apoptosis is related to the destruction of the lysosome-mitochondria axis. To verify the effects in vivo, we also established a laryngeal tumor model in nude mice by subcutaneous transplantation. In model mice treated with EGFRmAb-modified AuNRs and irradiated with an NIR laser, tumor cell apoptosis and tumor growth were inhibited. These results suggest that EGFRmAb-modified AuNRs induced apoptosis through the intrinsic mitochondrial apoptotic pathway and are a potential candidate for cancer therapy.

АНАЛИЗ ВОЗРАСТНЫХ ПОКАЗАТЕЛЕЙ ЗАБОЛЕВАЕМОСТИ НАСЕЛЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ ГОРТАНИ

Objectives. To analyze the main age-specific data of the incidence of malignant neoplasms of the larynx in the Republic of Belarus during 2000-2019. Material and methods. The age indicators of the incidence were compared for the entire population and differentiated by sex and area of residence in 2000-2004 and 2015-2019. The distribution according to the stages was studied during 2000-2019 for the entire population and differentiated by sex and area of residence, as well as separately for people of working age. Results. The highest incidence was observed in age groups from 55 to 74 years for the entire population both in 2000-2004 and in 2015-2019. The peak incidence was noted in the age groups from 60 to 64 years both in 2015-2019 (23.3 per 100,000) and in 2000-2004 (19.8 per 100,000). The increase of the incidence occurred in the age groups 55 years and older. The largest increase of the incidence was 1.3 in the group of people aged 60-64 years in 2015-2019 compared to 2000-2004. The growth rate was more pronounced among rural residents in comparison with the urban ones. The average age of patients in 2000-2004 was 60.1 years, whereas in 2015-2019 it was 61.2 years. The average proportion of cases of malignant larynx neoplasms diagnosed at stages I-II made up 46% with some regional fluctuations. Conclusions. The age-specific distribution of the incidence of malignant neoplasms of the larynx in the Republic of Belarus did not undergo any significant changes during 2000-2019. The highest incidence rates were noted in the age groups from 55 to 74 years. An increase of the incidence was noted in people aged 55 and over. The proportion of cases of malignant neoplasms of the larynx of stage III-IV exceeded that of cases of stage I-II throughout the whole study period.

Prevalence of human papillomavirus types in head and neck cancer sub-sites in the Indian population.

Although a subset of head and neck cancers (HNC) has been associated worldwide with mucosal high-risk human papillomaviruses (HPV), information on the prevalence of HPV-positive HNC in India is limited. In this study, we examined the prevalence of 21 subtypes of HPV in sub-sites of HNC (n = 175) in the western region of India. Type-specific multiplex genotyping assay was conducted at the Centre for Cancer Epidemiology, Tata Memorial Centre, to determine the prevalence of HPV subtypes. The HPV prevalence was observed to be 28.43%, 41.67%, 38.89% and 15.79% in the oral cavity, oropharynx, hypopharynx and larynx tumour tissues, respectively. The HPV 16 genotype was most common in all HNC tumour tissues (30.29%), followed by HPV 58 (0.57%).

Role of CSE1L expression in determining recurrence and survival of laryngeal tumors.

The correlation of CSE1L (human chromosomal segregation 1-like) staining intensity with disease-free survival, disease recurrence and development of distant metastases in Advanced Laryngeal Tumors. Specimens of patients with advanced glottic larynx cancer (T3, T4) were evaluated for nuclear CSE1L staining intensity. According to mild, moderate and severe CSE1L staining, patients were compared in terms of disease-free survival, disease recurrence and development of distant metastases. 17 of the 57 patients died within 5years, distant metastases developed in 5 patients, and recurrence in 5 patients. Of the 17 patients who died within 5years, 10(%59) showed severe staining with CSE1L, 6 (%35) showed moderate staining, and only 1 (%6) patient showed mild staining. 4 (%80) out of 5 patients who developed distant metastases were those with moderate staining with CSE1L. Metastases did not develop in any patient who stained poorly with CSE1L. 2 (%40) of the 5 patients who developed relapse were patients with severe staining with CSE1L, while 3 (%60) were patients with moderate staining with CSE1L. No recurrence was observed in any patient with mild staining with CSE1L. CSE1L will help in demonstrating the increased risk of distant metastasis, increased recurrence probability and shortened life expectancy of advanced laryngeal carcinoma.

Markers of tumor cell proliferation in cancerous tumors of the larynx

The cell proliferative process in the larynx cancer is studied. Contrary to the classical mitotic index the Ki-67 and PCNA indices are reliable and reproducible on the clinical material by the proliferative cell activity indices of the larynx tumors. There is a reverse connection between the proliferation index in cells of the squamous larynx cancer and the tumor differentiation. The direct correlation of the cell proliferation index of the squamous laxynx cancer with the disease stage is revealed. The preoperative radiation therapy significantly decreases the cell proliferation rates of the squamous larynx cancer.

Research Progress Of Scrna-seq In The Field Of Laryngeal Cancer And Other Tumors

The scRNA-Seq has become a powerful tool for unbiased and systematic characterization of cells in a given tissue. Indeed, the application of scRNA-Seq in patient tumors has identified multiple cell subpopulation and highlighted intercellular connections in the tumor microenvironment. In this paper, we review the progress of research on scRNA-Seq in the field of laryngeal cancer and other tumors in the last decade, which is of interest to explore the pathogenesis of laryngeal cancer and other malignancies.

Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study.

Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research. Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center. Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery.

Paclitaxel Promotes Oxidative Stress-Mediated Human Laryngeal Squamous Tumor Cell Death through the Stimulation of Calcium and Zinc Signaling Pathways: No Synergic Action of Melatonin.

The paclitaxel (PAX) and melatonin (MLT)-mediated mitochondria reactive free oxygen radical (miROS) generations via the influx of excessive Ca2+ and Zn2+ induce tumor cell death and apoptosis. However, a presence of resistance was demonstrated against thePAX treatment in the tumor cells. The stimulation of TRPM2 may increase the anticancer action of PAX after the treatment of MLT. We investigated the stimulating role of PAX with/without MLT on the excessive Ca2+ influx and miROS generation-mediated human laryngeal squamous cancer (Hep2) cell death through the stimulation of TRPM2. The Hep2 cells were divided into four groups as control, MLT (1mM for 2h), PAX (50μM for 24h), and PAX + MLT. In some experiments, we induced additional subgroups such as PAX+ACA and PAX+2APB.The stimulation of TRPM2 induced the increase of TRPM2 current densities, lipid peroxidation, cytosolic ROS, miROS, cytosolic Ca2+, and Zn2+ values in the Hep2 cells after the treatment of PAX, although their values were decreased by the treatment of MLT and TRPM2 antagonists (ACA and 2APB). In addition, the PAX induced apoptosis and cell death via upregulation of caspases and downregulation of antioxidant glutathione peroxidase and glutathione in the cells. The treatment of PAX increased protein band expression values of TRPM2, PARP-1, and caspase 3 and 9 in the Hep2. The increased expression, apoptotic, and cell death values were not affected by the treatment of MLT. In conclusion, PAX induced the increase of Hep2 cell death via upregulations of TRPM2andZn2+, although its downregulation via the treatment of MLT did not change the antitumor action of PAX.

Incorporation of Core Biopsy and FNAB in the Diagnostic Algorithm for Endophytic and Submucosal Laryngeal Malignancies: A Technical Note.

Endophytic and submucosal laryngeal tumours pose as diagnostic as well as management challenges to the head and neck surgeon. Identifying the tumour location and extent of disease is crucial for the surgeon to determine the treatment options and the potential outcomes. Persistent laryngeal edema following radiotherapy also presents with a diagnostic dilemma, as distinguishing between recurrent laryngeal carcinoma and radiotherapy sequels; which include fibrosis, oedema and soft tissue and cartilage necrosis, can be confusing and punch biopsies performed in such cases would more than often yield inadequate or superficial tissue. Using a core biopsy gun for acquiring biopsy specimen is known to have more cellular material, less damage to the surrounding structure depth control, immediate analysis with higher accuracy rates. Patients with suspected laryngeal malignancy are initially evaluated with flexible endoscopy with Narrow band imaging (NBI) and appropriate imaging. These patients are subjected to Microlaryngoscopic under general anaesthesia. A core biopsy gun is used to obtain samples from the suspicious area. Simultaneously, with the aid of microlaryngeal forceps, an FNAC is also done and sent for rapid processing. Trucut biopsy is a novel diagnostic tool that can be commonly used in early laryngeal malignancies especially in those cases where there is strong suspicion of malignancy and the lesion is found to be submucosal. we noted that a routine DL scopy and Biopsy in submucoal disease often results in a acquiring a non-representative sample as well as causing inadvertent trauma to the surrounding mucosa. We encourage Laryngeal surgeons to routinely use Core biopsies and FNAC during routine microlaryngeal Examination for better yield, faster diagnosis and faster planning of treatment protocols.

A Case of Large Cell Neuroendocrine Carcinoma in Posterior Supraglottis

Neuroendocrine carcinoma (NEC) is a rare form of hormone-secreting tumor. NECs originate from the epithelial cells of the larynx and account for less than 1% of the laryngeal neoplasm. Most cases of NECs are diagnosed by pathological confirmation after surgery. The terminology of laryngeal NEC has been a source of confusion. In 2017, World Health Organization newly categorized laryngeal NEC; as a result, the large cell type, which has been the main target of disagreement, was finally included into a subtype of poorly differentiated NEC. We report a case of a 58-year-old male with a growing granulomatous mass in the posterior supraglottis. The granuloma was removed by surgical excision when the size of the mass increased. He was diagnosed with the large cell type laryngeal NEC by pathological confirmation. He underwent postoperative radiotherapy and is currently being followed up in our outpatient clinic without evidence of recurrence.

Supraglottic Schwannoma: Dilemma and Challenges in Management.

Laryngeal schwannomas are rare lesions that represent less than 1.5% of all benign laryngeal tumors. Its slow and submucosal growth may cause a delay in consultation and management. Herein, a case of right supraglottic schwannoma is diagnosed in a 34-year-old lady who was unconcerned about hoarseness for 10years. She was referred to otorhinolaryngology clinic for assessment when hoarseness was detected during consultation for a gynecology surgery. Apart from hoarseness, there were no noisy breathing, shortness of breath or aspiration symptoms. Flexible nasopharyngolaryngoscopy showed a submucosal bulge at the right vestibular fold obscuring the vocal fold causing an airway concern. Computer tomography scan of the neck revealed a heterogenous enhancing mass centered at the right supraglottis measuring 2.6 × 2.7 × 2.7cm. There were no erosions of the adjacent thyroid and arytenoid cartilages. Subsequently, complete excision of the lesion was done endoscopically. Definitive diagnosis of schwannoma was obtained via histopathology examination. This paper presents our approach and operative steps in the excision of this lesion using microlaryngoscopy with cold instruments.

Application of Voice Handicap Index score and flexible laryngoscopy in the evaluation of patients with laryngeal disorders

Background: Laryngeal disorders are common in our environment, and a number of studies have been carried out. However, there is a paucity of literature with regard to the evaluation of voice-related handicap, and Voice Handicap Index (VHI) score for specific laryngeal disorders. Aim: The aim of this study was to apply the VHI score and flexible laryngoscopy in the evaluation of patients with laryngeal disorders and to determine the mean VHI score for specific laryngeal disorders in our environment. Methodology: A cross-sectional study was conducted among patients with the clinical diagnosis of laryngeal disorder who presented at the otolaryngology clinic of our institution. Patients who had previous laryngeal surgery or tracheostomy were excluded. Data was collected on sociodemographic variables, clinical history, and flexible laryngoscopic findings. The VHI score, which comprised of functional, physical, and emotional subscales was also collected and analyzed. Results: A total of 90 patients completed the study; 56.7% of them were males, whereas 43.3% were females. The mean VHI was highest in patients with laryngeal tumor (68.8 ± 14.8) followed by patients with vocal cord palsy (58.2 ± 5.7), but it was lowest in patients with acute laryngitis (27.1 ± 5.3). There was a statistically significant difference in mean VHI for each laryngeal disorder (P = 0.000). Conclusion: The patients with laryngeal tumor and those with vocal cord palsy had the highest VHI score, which affected their functional and emotional well-being. Therefore, applying VHI score and flexible laryngoscopy is important in the holistic evaluation of patients with laryngeal disorders.