Background Prostate-specific membrane antigen (PSMA) expression is encountered in tumor-associated neovascularization.
Methods PSMA-antibody was applied to the paraffin blocks of 51 patients who were diagnosed with squamous cell carcinoma of the larynx and underwent laryngectomy and one who underwent lymph node dissection. The percentage of vascular expression in tumoral and extratumoral stroma and lymph nodes and intensity score in tumoral epithelium were evaluated and divided into groups according to the level of PSMA expression. Final PSMA expression was determined by multiplying intensity and percentage scores.
Results The mean age was 61±10 years. Patients with perineural invasion, cartilage invasion, and local invasion exhibited higher PSMA expression scores. Age, tumor differentiation, tumor diameter, perineural invasion, tumor localization, capsular invasion, depth of invasion, surgical margin status, local invasion, nodal metastasis, TNM classification, and stage were similar in high and low PSMA expression groups. There was no PSMA expression in extratumoral vascular stroma. Significantly higher PSMA expression was observed in the vascular endothelium of metastatic lymph nodes compared with reactive lymph nodes. Patients with advanced-stage disease exhibited higher PSMA vascular expression scores compared to those with earlier stages (p<.001). PSMA expression was not correlated with overall survival, disease-specific survival, or disease-free survival (p>.05).
Conclusions Our study suggests that higher PSMA expression is associated with cartilage invasion, local invasion, and advanced-stage of disease. PSMA expression can be utilized for detection of lymph node metastasis and has some predictive role in cases of neck metastasis.
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We describe herein a rare case of a laryngeal myxoma presenting as a nodule. Laryngeal myxomas involving the neck region, especially the laryngeal area, are quite rare. A 36-year-old male patient presented with a 2 month history of hoarseness. On laryngoscopic examination, there was a myxoid homogeneous transparent mass on the right vocal cord. On microscopic examination, the lesion was hypocellular and myxoid. The lesion showed stellate or spindle cells which were evenly dispersed in the poorly vascularized myxoid stroma. Although the incidence is extremely rare, a laryngeal myxoma should be considered in the differential diagnosis of laryngeal masses.
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Scleroma of the larynx is a rare specific granulomatous disease and is usually presented as alaryngeal extension of a primary rhinoscleroma. We report an unusual case of laryngeal scleromain a 64-year-old female patient whose presented with progressive upper respiratory obstructivesymptoms lasted for 2 years. Symptoms were acutely exaggerated during the course of one month.On physical examination, the nasal mucosa was atrophic and crusted, and septal perforationwas noted. The fiberoptic laryngoscopy revealed a yellowish granulated epiglottic mass with adirty surface mimicking laryngeal cancer. Histological sectioning showed the characteristic featuresof scleroma including Mikulicz cells with scattered plasma cells and some neutrophils.Warthin-starry stains and electron microscopy examination showed numerous short rods insidethe cytoplasm of the Mikulicz cells. After the diagnosis, the patient underwent an emergency tracheostomyfollowed by long-term antibiotic treatment, and her symptoms have slowly improved.
Atypical laryngeal carcinoid is a rare tumor with a poor prognosis, mostly occurring in the supraglottic larynx. It is a subtype of neuroendocrine carcinoma which should be separated from typical carcinoid and small cell carcinoma.
The histogenesis and standardized classification of laryngeal neuroendocrine carcinoma have not been clearly defined. In this report, we present two cases of atypical laryngeal carcinoid, one occurring in a 67 year old male and the other in a 54 year old female. Indirect laryngoscopy revealed a polypoid supraglottic mass, approximately 3 cm in diameter. Microscopically, each case showed a moderate degree of pleomorphism, tumor necrosis and frequent mitoses.
The immunohistochemistry revealed a strong positive reaction for chromogranin, neuron specific enolase and cytokeratin.
Each patient had distant metastasis, noted within 4 months after resection (liver and stomach), and died postoperatively at 5 and 20 months, respectively. A brief review of the literature concerning the biological behavior, histogenesis and pathology of atypical laryngeal carcinoid was performed.
Laryngeal atresia is a very rare congenital anomaly requiring immediate tracheotomy. We present a case of laryngeal atresia with tracheoesophageal fistula who showed immediate respiratory difficulty after ligation of umbilical cord and died of aspiration pneumonia at 8 days of age. The atretic portion of larynx is composed of irregulary arranged cartilaginous tissue, bundles of intrinsic muscle and soft tissue without epithelium-lined lumen. The lungs show normal development and evidences of aspiration pneumonia.
Spindle cell carcinoma of the upper aerodigestive tract mucosa was usually presented as polypoid mass and shows squamous cell carcinoma or dysplasia in the surface and underlying spindle cell proliferation. The spindle cell area discloses a variable pattern of sarcoma including rare osteosarcoma of 0~20% incidence. The histogenetic origin of the spindle cell component is now considered a metaplasia of squamous cell carcinoma. We experienced a case of spindle cell carcinoma of larynx showing massive underlying bone formation with proliferation of osteoclast-like cells in 75 year-old man. The immunohistochemical study demonstrates positive reaction with cytokeratin in area of squamous cells and with vimentin in area of spindle cells and osteoclasts.
There are very focal reactivity for high molecular weight cytokeratin in spindle cell area.
Verrucous carcinoma of the larynx is a distinct and uncommon variant of well-differentiated squamous cell-carcinoma. The authors hybridized in situ a case of laryngeal verrucous carcinoma with DNA prebes to humman papillomavirus (HPV) 6, 11, 16, 18, 31, 33 and 35. The DNAs from the verrucous carcinoma of larynx hybridized with mixed DNA probes HPV-16/18 and 31/33/35. In addition, there was an evidence of HPV infection based on hybridization with mixed DNA probe HPV-6/11 in the adjacent papilloma tissue. By in situ DNA hybridization techniques, we clearly demonstrated human papillomavirus (HPV-16/18, and 31/33/35) related sequences in this neoplasm. These findings suggest the role of HPV-6/11 in the development of laryngeal papilloma ad HPV-16/18 and 31/33/35 probably on the progression to verrucous carcinoma.