Laryngology

Synovial sarcoma of the larynx treated by supraglottic laryngectomy: Case report and literature review

July 21, 2013     Kuauhyama Luna-Ortiz, MD; Ana Maria Cano-Valdez, MD; Isabela Werneck da Cunha, MD; Adalberto Mosqueda-Taylor, DDS
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Abstract

We describe a case of synovial sarcoma of the larynx, and we discuss the use of fluorescence in situ hybridization (FISH) in confirming the diagnosis. The patient was a 21-year-old woman who presented with a recurrence of a previously resected supraglottic tumor of the aryepiglottic folds. A horizontal supraglottic laryngectomy was performed, and the 0.5-cm tumor was resected. Histopathologic study suggested that it was a biphasic malignant tumor compatible with a synovial sarcoma. The diagnosis of synovial sarcoma was confirmed by FISH immunohistochemistry with the use of an SYT break-apart probe. The patient recovered satisfactorily, but at follow-up 5 years and 4 months later, tumoral activity was evident in the left side of the neck. A biopsy found that 5 lymph nodes contained a metastasis of the synovial sarcoma. Again, a bilateral neck dissection was performed, and it revealed that 16 of 16 right-side nodes and 36 of 36 left-side nodes were negative. Two months later, the patient received 46 Gy of radiotherapy in 23 sessions. She remained free of disease during 2 more years of follow-up. Synovial sarcoma of the larynx is a rare entity. Organ preservation seems to be indicated in these cases. The histologic diagnosis may be difficult. In this case, the identification of a genetic mutation corroborated the diagnosis.

Spindle cell lipoma of the larynx

June 11, 2013     Antonio D'Antonio, MD, PhD; Giampiero Mottola, MD; Alessia Caleo, MD; Maria Addesso, MD; and Amedeo Boscaino, MD
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Abstract

Among the primary mesenchymal tumors of the hypopharynx and larynx, lipomas are rare. Macroscopically, they often resemble a retention cyst or laryngeal nodule. Spindle cell lipomas (SCLs) are an uncommon variant of lipoma. SCLs are extremely rare in the larynx; as far as we know, only 4 cases have been previously described in the literature. We present a new case of laryngeal SCL in a 65-year-old man who presented with a 1-year history of hoarseness, choking spells, stridor, and dyspnea. Examination revealed the presence of a large polyp on the left true vocal fold that had caused stenosis of the posterior glottis. The polyp was removed endoscopically, and the patient's stridor and dyspnea resolved. Histologically, the tumor was composed of bland, CD34-positive spindle cells with an abundant fibrous and myxoid stroma interspersed with mature fatty tissue. The patient was free of local recurrence at 2 years of follow-up.

Supraglottoplasty for airway obstruction

June 11, 2013     Nausheen Jamal, MD; Farhad Chowdhury, DO; Reena Gupta, MD; and Robert T. Sataloff, MD, DMA, FACS
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Supraglottoplasty may be helpful in a patient with tracheotomy-dependent  adult obstructive sleep apnea/hypopnea syndrome that is causally related to or aggravated by supraglottic obstruction.

Oropharyngeal squamous cell carcinoma metastatic to lower-extremity soft tissues: A case report and literature review

June 11, 2013     Jason M. Samuelian, DO; Brandon J. Fisher, DO; Larry C. Daugherty, MD; and Usha A. Babaria, MD
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Abstract

A 52-year old man was referred to our service for evaluation after being diagnosed with oropharyngeal squamous cell carcinoma. Contrast-enhanced computed tomography (CT) revealed a mass in the left tonsillar pillar, as well as submental lymphadenopathy. The extent of tumor infiltration was assessed by fluoro-2-deoxyglucose positron emission tomography scans, which showed increased uptake in the tumor bed and a suspicious-looking lymph node near the right hilum. No other signs or symptoms of distant metastasis were evident at that time, and the patient was treated with induction chemotherapy followed by chemoradiation. Several weeks after treatment completion, the patient returned, complaining of right medial foot edema. CT of the right lower extremity revealed multiple high-attenuation masses in the soft tissues of the right leg and foot, including a mass in the medial plantar region of the foot. Approximately 15 to 20% of patients with oropharyngeal squamous cell carcinoma develop distant metastasis throughout the course of the disease. Soft-tissue metastases from oropharyngeal cancers are rare, however, particularly when they present in the absence of widespread metastasis. A review of the current head and neck tumor literature describes soft-tissue metastases in less than 10% of patients with known distant metastases. Metastasis to distal regions such as the lower extremities has rarely been observed but should be included in the differential diagnosis for patients presenting with lower-extremity pain or edema.

Letters to the Editor

June 11, 2013    
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Prolonged ulcerative laryngitis in an 18-year-old voice major

April 17, 2013     Brent L. Toland, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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Management of prolonged ulcerative laryngitis requires close observation with strobovideolaryngoscopy; therapy involves steroids, antibiotics, antifungal drugs, and antireflux treatment.

Subfreezing versus room-temperature balloon dilation of benign tracheal stenosis: A pilot study in rabbits

April 17, 2013     Benjamin J. Wycherly, MD; Matthew K. Steehler, MD; Hosai Hesham, MD; Kevin Burke, MD; Sonya Malekzadeh, MD
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Abstract

We conducted an experiment to compare collagen deposition in tracheal stenoses dilated with room-temperature balloons and stenoses dilated with balloons at a subfreezing temperature (-10°C). Six New Zealand white rabbits underwent endoscopic tracheal injury. Tracheal dilation was performed at 3 weeks postinjury with either a room-temperature balloon or a vascular cryoplasty balloon. Five surviving rabbits were sacrificed at either 2 weeks (n = 3) or 4 weeks (n = 2) postdilation (1 rabbit that was not able to tolerate dilation was euthanized during the procedure). A blinded pathologist graded histologic sections of the injured tracheas for collagen content. The tracheal collagen deposits in the 3 animals sacrificed at 2 weeks postdilation were all graded as moderate. However, at the 4-week postdilation examination, there was a marked difference in collagen deposition between the rabbit that underwent room-temperature dilation and the rabbit that underwent subfreezing dilation; while the former showed moderate collagen deposition, the deposition in the latter was only mild. In conclusion, this pilot study showed that tracheal dilation with balloon cryotherapy decreased collagen deposition in the injured airway of 1 animal. Larger studies are required to determine whether balloon cryotherapy improves the long-term patency of immature tracheal stenosis.

Hemorrhagic vocal process granuloma

April 17, 2013     Farhad R. Chowdhury, DO; Kevin Hsu, DO; Robert T. Sataloff, MD, DMA, FACS
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Most small vocal process granulomas will resolve spontaneously if the primary insult is removed, but these lesions have a very high tendency to recur.

A false-positive FDG uptake in Teflon granuloma: A case report

April 17, 2013     Munir Demir Bajin, MD; Ali Sefik Hosal, MD
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Abstract

Positron emmision tomography (PET) is successfully used to monitor malignancies. Unfortunately it is not tumor specific. We present a case with history of rectum cancer and lentigo maligna who underwent PET-CT which revealed an increased uptake in the larynx. What was first considered as a third pirmary turned out to be a Teflon granuloma.

World Voice Day 2013

April 17, 2013     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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 Vocal health is critical to our communication-oriented society, but the voice does not receive the public recognition and appreciation it deserves.

Propranolol in the treatment of upper airway hemangiomas

April 17, 2013     Lauren C. Anderson de Moreno, MD; Bruce H. Matt, MD; Gregory Montgomery, MD; Young-Jee Kim, MD
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Abstract

Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.

Systemic sclerosis and reflux

April 17, 2013     John J. Petronovich, BS; Jonathan M. Bock, MD
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MII-pH testing with impedance-based symptom association may improve diagnostic accuracy in patients with systemic sclerosis and reflux.

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