Endolaryngeal microsurgery in vocal cord carcinomas. Indications and results.
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Carcinoma↗
Biomedical subjects
O Kleinsasser
Publications and source records attributed to O Kleinsasser.
What's new in tumours of the nasal cavity? Adenocarcinomas arising after exposure to wood dust.
Since the first observations have been published by Macbeth in England 1965 adenocarcinomas of the nose arising after exposure to wood dust have been considered as occupational diseases in a number of countries. As many questions concerning epidemiology, clinical course and pathology are still open, the Industrial Insurance Institute for the Wood Working Industry (Holz-Berufsgenossenschaft, Munich) has tried to collect all cases of nasal adenocarcinomas in the Federal Republic of Germany by requesting the clinical data from all Oto-Rhino-Laryngologic Clinics in West Germany and slides from the corresponding Institutes of Pathology. An extensive investigation concerning occupational exposure and other epidemiological aspects to wood dust was performed. The authors had the opportunity to review all clinical data and most of the histological material. Additionally some immunohistochemical and electron microscopical investigations were performed at the University Ear Nose Throat Clinic in Marburg. Finally we investigated cases of which we had the complete occupational, epidemiologic, clinical and histological data (further 34 cases with incomplete data are not discussed in this study).
Adenocarcinoma↗
[Treatment of carcinoma of the piriform sinus].
Sixty patients with carcinoma of the piriform fossa were treated with surgery and postoperative irradiation, and 22 other patients with incurable disease were irradiated. All but 2 patients primarily irradiated died within a year. 87% of the 60 patients who were treated by primary surgery had histologically proven lymph node metastases. Twenty six of these patients suffered a local recurrence, regional metastases or distant metastases within 18 months. They were all dead within 2 years of diagnosis of the primary tumor. 75% of patients in this group had shown capsular rupture by metastases. Thirty two of the patients operated on are now free of disease, 23 of them for more than 18 months. Eighteen patients had regional metastases, of whom 6 had caused capsular rupture. The tumor specific 3 year survival was 47.1%. Primary radical surgery followed by radiation therapy is the most effective form of treatment for cancer of the piriform sinus, and should always be advised if possible instead of less mutilating but also less effective forms of treatment.
Carcinoma, Squamous Cell↗
[2 cases of cancer following gunshot injuries of the larynx].
Two cases of laryngeal cancer following gunshot injury are presented, and the relation of trauma to the development of cancer is discussed. A correlation between the two is accepted in medicolegal reports if a number of requirements are met. Histomorphological examination shows that these criteria are insufficient to provide conclusive proof.
Aged↗
[The pathology and clinical picture of adenocarcinoma of the nose after wood dust exposure].
After longterm exposition (30.5 years) to beech and oak wood dust in woodworking, a formation of adenocarcinomas of the inner nose is possible in joiners, parquet layers and similar professions. They develop after a latency of 39 years on an average. These tumors appear generally in the area of the middle nasal concha and the ethmoid bone and invade continually into the orbit, the paranasal sinuses and the intracranial space. The incidence of regional and hematogenous metastases is low. Among the various forms of adenocarcinomas of the nose only those adenocarcinomas which are very similar to gastrointestinal carcinomas have been developed after an exposition to dust of wood. The most frequent tumors are adenocarcinomas of cylindrical cells with a papillary tubular structure. Alveolar goblet cell carcinomas with much mucous secretion and carcinomas of the signet ring cells are less frequent. There are evident correlations between the differentiation degree and the development of these tumors. In some of them polypeptide hormones have been demonstrated by histochemical and electron-optical methods. This report is based on 177 cases compiled by the professional association of woodworkers in the Federal Republic of Germany.
Adenocarcinoma↗
[Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University].
The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.
Carcinoma in Situ↗
Adenocarcinomas of the inner nose after exposure to wood dust. Morphological findings and relationships between histopathology and clinical behavior in 79 cases.
We present the results of light microscopic, available electron microscopic and immunohistochemical investigations of 79 adenocarcinomas occurring in the noses of wood workers following exposure to beechwood and oakwood dust. Three types of adenocarcinomas can be differentiated. The most frequently occurring form is the papillary tubular cylinder cell adenocarcinoma, while the mucus-producing alveolar goblet cell adenocarcinoma and signet ring cell adenocarcinoma are rarer types. Transitional stages suggest the common origin of these tumors from mucus-secreting cylinder cells of the respiratory epithelium. The grade of differentiation and the tumor type are definitely related to the prognosis of these tumors. Similar to the tumors of the gastrointestinal tract, electron microscopy and immunohistochemistry prove the existence of a number of various polypeptide hormones, the significance of which has not yet been clarified.
Adenocarcinoma↗
[Therapy of adenoid cystic carcinoma with cisplatin, etoposide and vindesine].
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Adult↗
[Congenital cysts of the larynx].
Based on our own observation of one case of congenital laryngeal cyst of the newborn and a review of 48 cases presented in literature, this congenital anomaly is described. The clinical picture is demonstrated and the genesis of these cysts is discussed.
Airway Obstruction↗
[Endoscopic surgery of vocal cord cancers].
Controversy began in the last century as to whether endoscopic surgery for vocal cord carcinoma carries an unnecessary risk for the patient. This controversy has been renewed since microlaryngoscopy offered the possibility of precise endoscopic resection of a vocal cord carcinoma. The most decisive prerequisites are careful assessment and adherence to strict indications. We only remove small carcinomas arising on freely mobile vocal cords by endoscopy, if the tumour is fully visible through a larger calibre operating laryngoscope. We prefer to use conventional microsurgical instruments rather than the laser. The specimen should be taken in one piece and be subjected to histological examination. Every patient must be closely followed up. A total of 76 patients with carcinomata in situ (Tis a, Tis b) and microinvasive carcinomas (T 1a, T 1b) have been followed for up to 8 years. So far not a single patient has lost his life, his larynx or his voice, or needed an additional external operation or irradiation. The results of endolaryngeal microsurgery for smaller vocal cord tumours are achieved with a minimum cost in time and money, and the least possible burden for the patient. They are scarcely inferior to primary irradiation with respect to the voice and are definitely better with respect to cure. However such results are only achieved in very carefully selected cases.
Adult↗
Stenosis of the larynx following Teflon injection.
Teflon is commonly used to adduct immobile vocal cords in cases of unilateral recurrent nerve paralysis. However, its use can lead to considerable chronic inflammation at the site of the injection. Since Teflon is not encapsulated, particles can also be carried off and disseminated through the lymphatic system. This occurrence was found following Teflon injection in a 48-year-old man, resulting in laryngeal stenosis with tissue histology showing an impressive diffuse distribution of the Teflon particles and severe chronic inflammation. Our experiences have caused us to prefer the implantation of autologous materials in cases of unilateral recurrent nerve paralysis, particularly when patients have a long life expectation.
Humans↗
Verrucous carcinoma of the larynx--a misnomer.
A serie of our observations of so-called "verrucous carcinomas" of the larynx show that these peculiar lesions do not develop true infiltrating growths or metastases, and do not fulfill the criteria of a true carcinoma. Our experiences indicate that these cases can be treated successfully by repeated endoscopic resections. We have found that no aggressive radical treatment - either by surgery or irradiation - is necessary in managing these lesions. Although the etiology of "Ackerman's tumor" of the larynx is still uncertain, we suggest that the lesions develop as the result of a virus infection and propose again the term "verrucous acanthosis" instead of verrucous carcinoma for this disease.
Carcinoma, Papillary↗
Immunohistological reaction patterns of cervical lymph nodes in patients with laryngeal carcinomas.
An attempt was made to assess the immunological importance of regional lymph node histology in relation to the survival of 107 patients with carcinoma of the larynx, operated on from 1973 to 1982 at the ENT-Clinic in Marburg. A total of 2765 sections of lymph nodes removed during neck dissections were examined microscopically to evaluate the morphological patterns of response. Microscopically, four distinct patterns were defined. Patients whose lymph nodes demonstrated immunological responses according to patterns I and II in the form of either expanded inner cortices or increased numbers of germinal centers had a greater 5-year survival rate than those patients whose lymph nodes showed an unstimulated pattern. Eight patients whose lymph nodes showed a depleted pattern, IV, did not survive more than 3 years. Morphological assessment of immunological activity in lymph nodes draining malignant tumors seems to be of value in predicting survival. The evaluation of the reaction pattern and difficulties in methodology, however, set definite limitations to our study.
Age Factors↗
[Operative management of hypopharyngeal cancer].
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Female↗
Terminal tubulus adenocarcinoma of the nasal seromucous glands. A specific entity.
A distinctive species of adenocarcinoma arising in the region of the middle turbinate and ethmoid is described. While these tumors generally behave rather benignly, some lesions are capable of invading the cranial cavity as well as metastasizing. Histologically the cells and the structure of these tubular-papillary cystadenocarcinomas show such a striking similarity to the terminal tubules of the seromucous glands that the term "terminal tubulus adenocarcinoma" is proposed. As similar glands can be found in all portions of the upper and lower aerodigestive tracts, it is also possible that these tumors may occur throughout this entire area.
Adenocarcinoma↗
[New and controversial concepts in the treatment of laryngeal cancer].
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Combined Modality Therapy↗
[Invasion of thyroid gland tumors in the larynx and trachea].
Intraluminal involvement of larynx or trachea in thyroid cancer causes extraordinary therapeutical problems. Surgical or medical treatment fails in most of these advanced tumours. Only carcinomas of low-grade malignancy--especially follicular and papillary type--can be cured by operation if involved parts of larynx or trachea are resected with the tumour. Surveying 85 cases reported in literature and 9 observations of our own we present the clinical, diagnostical and therapeutical aspects of this disease.
Adult↗
[Intranasal extradural meningiomas. Case report and review of the literature].
Report on an extradural meningioma of the left nasal cavity and ethmoid sinus with secondary extension into the subfrontal region in an 18-year old male. Review of 37 similar cases reported in literature. These slowly growing non-infiltrating tumours cause nasal obstruction and sinusitis but have no characteristical clinical symptoms. The origins of these tumours are obviously arachnoideal meningocytes which accompany the olfactory filaments through the lamina cribrosa to the extradural site.
Adolescent↗