Biomedical subjects
Publications and source records attributed to A Ferlito.
A case report of pleomorphic rhabdomyosarcoma of the larynx is presented. It is the first case in which the diagnosis is supported by immunohistochemical investigation. A critical review of the literature follows, evaluating the clinicopathologic features of this rare malignancy.
Adenoid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. The lesion is histologically distinctive and it is usually localized on the skin of the head and neck region; it only rarely involves the mucosal sites. The differential diagnoses include adenosquamous carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, basaloid squamous cell carcinoma, and metastatic adenocarcinoma. Surgery is the treatment of choice. The biologic behavior of this neoplasm is more aggressive when it involves mucosal areas, and the prognosis seems worse than that of conventional squamous cell carcinoma.
Head and neck manifestations of human immunodeficiency virus (HIV) infection include lymph nodal and extranodal localization of non-Hodgkin's lymphoma (NHL). A histopathologic characteristic common to head and neck NHLs and to all the other systemic lymphomas in HIV patients is the frequent occurrence of cases displaying pleomorphic features and some overlap between established histologic subtypes. This article highlights the difficulties in defining HIV-related NHLs correctly, and proposes a specific pathologic categorization of these disorders accounting for their pathogenic aspects as gathered from molecular data.
Extranodal lymphomas account for as many as 40% of non-Hodgkin's lymphomas, and most arise in the gastrointestinal tract, but other mucosal organs may be involved, especially the upper aerodigestive tract. Low-grade B-cell lymphomas arising in the gastrointestinal tract and other mucosae have been found to recapitulate the structure and cytologic features of mucosa-associated lymphoid tissue (MALT). Histologically low-grade MALT lymphomas are characterized by centrocyte-like B-cells with a phenotype similar to that of so-called marginal zone B-cells. Tumors evolving from MALT are generally rare among lymphomas of the upper aerodigestive tract, but a few cases of laryngeal lymphomas derived from MALT have been reported. Primary MALT lymphoma of the larynx should always be considered in tumors with histopathologic features of low-grade B-cell lymphoma, or so-called pseudolymphoma.
The diagnosis of Hodgkin's disease (HD) is still primarily based on the histopathologic criteria presented by Lukes et al in 1965. Over the past three decades, however, advances in immunohistochemistry, molecular studies, and virologic findings have provided evidence that HD exhibits significant heterogeneity. Whereas the nodular sclerosis subtype is the major subset of the "classic" disease, it has become evident that the nodular, lymphocytic predominance subtype may represent a minor distinct subset, and possibly a distinct disease entity. Furthermore, there is strong evidence that the mixed cellularity subtype may be an Epstein-Barr virus-related disorder. Finally, based on phenotypic and genotypic features, the existence of a "continuum" between a fraction of HD cases, including the lymphocytic depletion subtype, and CD30-positive anaplastic large cell lymphomas has been suggested.
Both otolaryngologists and surgical pathologists are involved in the diagnosis and treatment of lesions of the larynx that are best diagnosed as invasive squamous cell carcinomas of some specified degree of differentiation, not further subclassified (that is, conventional squamous cell carcinomas). On occasion, however, a patient will present with an invasive tumor that on histologic examination diverges from the expected pattern of a squamous cell carcinoma of the usual type and so raises the question of proper classification (on the part of the pathologist) and, following classification, a consideration of the prognostic and therapeutic implications of such a classification (on the part of the clinician). While some of these unconventional squamous cell carcinomas are rather indolent lesions (as, for example, the hybrid verrucous squamous cell carcinoma), others behave in a fashion similar to conventional squamous cell carcinomas (such as the adenoid squamous cell carcinomas), and yet others seem to behave more aggressively than do conventional squamous cell carcinomas of a similar size and stage (examples include the basaloid squamous cell carcinomas and adenosquamous carcinomas). Finally, the possibility exists within the larynx, as elsewhere in the body, that a nonepithelial lesion such as malignant melanoma may mimic a tumor more commonly encountered in that vicinity- namely, a squamous cell carcinoma- and so receive inappropriate treatment if such mimicry is not recognized.
Paraganglioma and atypical carcinoid tumor of the larynx are two neuroendocrine neoplasms that have often been confused in the past, and even in the present, in the literature. The clinicopathological profile of the two lesions is presented and the differential diagnosis is discussed. A correct diagnosis is of paramount importance, since treatment and prognosis depend on diagnostic accuracy and differ for the two lesions. Paraganglioma of the larynx is usually benign, whereas atypical carcinoid tumor is malignant and has an aggressive clinical course.
Cartilaginous tumors of the larynx, while rare, will on occasion be encountered by the otolaryngologist in routine daily practice. True laryngeal chondromas are exceedingly rare, and as a consequence, a putative diagnosis of chondroma should be viewed with suspicion. On pathologic examination, laryngeal chondromas usually prove to be small lesions (less than 2 cm in maximum dimension) and may arise in children or adults. Laryngeal chondrosarcomas, by contrast, usually prove to be larger lesions (exceeding 3 cm in greatest dimension) and are typically found in adults. While high-grade chondrosarcomas are readily identifiable on light microscopic study, the distinction between a chondroma and a low-grade chondrosarcoma is often not so clear-cut. Some low-grade chondrosarcomas may show a slight increase in both cellularity and cytologic atypia when compared with chondromas, but the two patterns often overlap. When faced with a limited biopsy specimen of a laryngeal cartilaginous lesion in which neither increased cellularity nor recognizable cytologic atypia is found, a diagnosis of "cartilaginous tumor without obvious evidence of malignancy--further classification dependent on examination of the lesion in its entirety," or words to this effect, is recommended.
Immunohistochemistry is important in the diagnosis of neuroendocrine neoplasms of the head and neck, particularly in the differential diagnosis of the various neuroendocrine neoplasms, although the results of staining should never be interpreted alone, but together with conventional histopathologic findings. It is emphasized that there are currently no markers capable of distinguishing between benign and malignant tumors. A correct diagnosis is of paramount importance, since treatment depends on the diagnostic accuracy and prognosis is naturally related substantially to the phenotype.
Malignant laryngeal tumors include a variety of oncotypes with differing biologic connotations, each calling for a different therapeutic approach and giving rise to a different prognosis. But the oncotype can only be accurately identified histologically by means of a technically adequate, representative biopsy specimen. Intrinsic malignancy varies with the structure of the neoplasm, so the choice of surgery, radiotherapy, chemotherapy, or laser therapy depends largely on tumor type. Most malignant laryngeal neoplasms are squamous cell carcinomas, but the rare cases of nonsquamous tumor include a wide array of oncotypes of which the true incidence is difficult to assess. Diagnosis is based on light microscopy, but may be supported by histochemical, immunocytochemical, and ultrastructural investigations that improve the accuracy of categorization of the specific tumor type. A precise histologic diagnosis, based on representative biopsy material, will lead to a better understanding of the tumor's likely behavior, and consequently to more effective treatment.
All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.
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Pure "early cancer" is an intramucosal lesion, but does not include carcinoma in situ or dysplasia in which the malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. The term is often erratically used to describe lesions with invasion of the muscle or cartilage structures and such a careless terminology adds confusion to the nomenclature for these neoplastic lesions. Malignant tumour development involves complex interactions between several factors, both environmental (or exogenous) and endogenous (i.e. genetic, hormonal, etc.). The natural history of neoplastic disease coincides with three chronologically distinct stages: initiation and promotion (the sub-clinical latency period), and progression (when the tumour usually becomes clinically visible). Early vocal cord cancer may be asymptomatic and more advanced than it seems. It has a high cure rate with various treatments: there is no treatment of choice for early cancer, but a choice of treatments. As it is obviously difficult, or even impossible, to control far-advanced laryngeal cancer, it is essential to concentrate efforts on study the initial steps in tumour development to facilitate early detection and timely therapy.
This study details the clinicopathologic features of 62 cases of laryngeal paraganglioma (LP), including 54 acceptable cases identified in the literature (although clinical information is lacking on 7 of these) and 8 previously unpublished cases identified from the Registry of Otolaryngic-Endocrine Pathology at the Armed Forces Institute of Pathology. Demographic findings show that the overwhelming majority of cases affect women (41:14), mainly in the fourth to sixth decades of life (age range, 14 to 83 years; median, 44 years), with a prevalence in the supraglottic larynx. These neoplasms are treated by surgical resection and are benign. Despite the characteristic pathologic features associated with LP, it is sometimes confused with other neoplasms, particularly neuroendocrine carcinomas of the larynx, and this confusion leads to unfortunate designations such as malignant paraganglioma and metastasizing paraganglioma of the larynx. Judging from the cases reported in this study and those identified in the literature, we conclude that malignant biologic behavior associated with LP is extraordinarily rare (< 2%). Because of the misdiagnoses of LP, the prognosis associated with this entity has been skewed to suggest that LP may behave aggressively. This has led to the inappropriate classification of LP among the malignant categories of laryngeal neuroendocrine neoplasms. The goal of this study is to detail the features diagnostic of LP and to discuss the appropriate treatment, prognosis, and classification of these neoplasms.
Despite a considerable amount of discussion and research in the course of many years, aural cholesteatoma has remained a matter of controversy. This review concerns only the definition, terminology and pathology of this common and severe disease.
A second edition of the Histological Typing of Upper Respiratory Tract Tumours in the WHO series International Histological Classification of Tumours was published in 1991. The new edition has been entitled Histological Typing of Tumours of the Upper Respiratory Tract and Ear. The task of revising the first edition, which was published in 1978, was undertaken at the WHO Center for Upper Respiratory Tract Tumours by K. Shanmugaratnam in collaboration with L. H. Sobin and pathologists in 8 countries. Several tumour types have been added to the classification, and some have been redefined in light of current knowledge. This presentation outlines the changes in the revised WHO classification as regards tumours of the larynx, hypopharynx, and trachea and discusses the grounds for said revisions.
This is a case report of recurrent bilateral parotid swelling with intraglandular gaseous bubbles in a 14-year-old boy, together with a review of the literature on this condition, which is usually called pneumoparotitis. The disorder has been reported as an occupational hazard in wind instrument players and glass-blowers and also as a rare non-occupational disease, mainly in adolescents and often associated with psychological problems.
Between 1979 and 1988, 432 cases of previously untreated laryngeal cancers were histologically diagnosed at the Institute of Pathological Anatomy of the University of Trieste. Of these cases, 192 were supraglottic and 182 glottic cancers. The overall crude incidence was 31.06 0/0000 in males and 2.29 0/0000 in females, with a male/female ratio of 10.2:1 for supraglottic cancers vs. 20.4:1 for glottic cancers. Our incidence values for laryngeal cancer, and supraglottic lesions in particular, are similar to those recorded in France, Spain and other areas of Italy, i.e. in nations where wine production and consumption is very high. The 3-year adjusted survival rate was 45.7% for supraglottic and 83% for glottic cancer patients. Subjects with supraglottic cancer often had a poor prognosis because of the high frequency of cervical lymph node involvement, recurrences and visceral metastases; cancers of the aryepiglottic folds presented the worst clinical evolution.