Multiple amyloid lesions in the lateral pharyngeal wall: a case report

<p class="abstract">Amyloidosis represents a diverse group of disorders that have in common the deposition of amyloid protein in various extracellular tissues. Its clinical presentation may be systemic or localised. However, regions in the head and neck are rarely affected. This report discusses the case of a 57 year old man with a history of 6 years of left ear non-pulsatile tinnitus, who at the physical examination presented a polilobulated, yellowish oropharyngeal lesion, behind the left posterior pillar of the tonsil. Biopsy of the lesion sustained the diagnostic of light chain amyloidosis and subsequent evaluation was significant for establishing the diagnosis of localised amyloidosis. While further investigations a second laryngeal lesion was encountered. We present a case report of double synchronous amyloidosis localization on head and neck and asymptomatic lesions and discuss the implications for diagnosis and treatment.</p>

COMPARISON OF PATIENTS WITH MALIGNANT OR BENIGN LARYNGEAL LESIONS AND HEALTHY INDIVDUALS IN TERMS OF HEMATOLOGICAL INFLAMMATORY PARAMETERS

Purpose: Recent studies have shown a relationship between cancer and inflammatory response. The aim of this study is to compare NLR and PLR values, which are inflammatory parameters, in precancerous and cancerous lesions and to determine whether there is a parameter that can be used in the early diagnosis of laryngeal squamous cell carcinoma. Methods:174 patients who were benign as a result of pathology, 122 patients who were malignant, 39 patients who were premalignant (335 patients in total) and 117 normal individuals were included in the study. Data groups were divided into 4 groups as Benign Laryngeal Lesion(BLL), Precancerous Laryngeal Lesion(PLL), Malignant Laryngeal Lesion(MLL) and Control Group(CG). In addition, the PLL group was subdivided into Mild Dysplasia(MiD), Moderate Dysplasia(MoD) and Severe dysplasia-carcinoma in situ (SeD/CIS). NLR, PLR and other parameters were calculated. Results: NLR and PLR values were significantly different between the groups. (p = 0.000, p = 0.002) The mean NLR was higher in the MLL and PLL groups, and was lower in the BLL and control groups. The mean PLR was also higher in the MLL and PLL groups. When the groups were compared in pairs, there was a significant difference between BLL and MLL (p = 0.001) and MLL and CG.(p = 0.006) The PLL group was subdivided into MiD, MoD and SeD / CIS. There was a significant difference in NLR when CG and other subgroups were compared.(p = 0.027) Significant differences were found between CG and SeD when the groups were compared in pairs.(p = 0.007) There was no significant difference between the groups in terms of PLR and dysplasia.(P = 0.516) Conclusion: As revealed in this study, these rates were low in the CG and BLL groups and high in the MLL group, so they could be used as markers to differentiate malignant lesions.

Bifid epiglottis with midline laryngeal hamartoma: a rare presentation of Pallister Hall syndrome

Bifid epiglottis is a rare laryngeal anomaly that can be an isolated occurrence or as part of malformation syndromes, commonly the Pallister Hall syndrome (PHS). PHS presents with hypothalamic hamartomas, polysyndactyly, bifid epiglottis, imperforate anus and genitourinary abnormalities. We report a case of a 22 months old male child with features of PHS and Hirschsprung's disease. The presentations are with a hypothalamic mass, a bifid epiglottis and a midline mass in the larynx with symptoms of respiratory distress. The laryngeal lesion was endoscopically excised and its histology confirmed as hamartoma (laryngeal). The importance of an early diagnosis of PHS, genetic counselling and prompt management of a compromised airway and endocrine abnormalities is emphasized to have a better outcome.

Coblation of paediatric cystic laryngeal lymphovascular malformations: a safe and effective alternative to tracheostomy

We describe the case of a 12-hour-old, full-term newborn girl referred to the Ear, Nose and Throat emergency team with increased work of breathing and stridor present at birth. Flexible nasendoscopy revealed a cystic laryngeal lesion obstructing the glottis that prompted securing of the airway with intubation and transfer to a tertiary paediatric centre. On further investigation with MRI and direct visualisation, the lesion was identified as a mixed macro/microcystic laryngeal lymphovascular malformation. The patient successfully underwent a series of microlaryngo–bronchoscopy and coblations of the laryngeal lesion with the aim of avoiding a tracheostomy. We describe the presentation, diagnosis and management of this rare condition in a paediatric case, along with a literature review of the subject.

Laryngeal Lesion Classification Based on Vascular Patterns in Contact Endoscopy and Narrow Band Imaging: Manual Versus Automatic Approach

Longitudinal and perpendicular changes in the vocal fold’s blood vessels are associated with the development of benign and malignant laryngeal lesions. The combination of Contact Endoscopy (CE) and Narrow Band Imaging (NBI) can provide intraoperative real-time visualization of the vascular changes in the laryngeal mucosa. However, the visual evaluation of vascular patterns in CE-NBI images is challenging and highly depends on the clinicians’ experience. The current study aims to evaluate and compare the performance of a manual and an automatic approach for laryngeal lesion’s classification based on vascular patterns in CE-NBI images. In the manual approach, six observers visually evaluated a series of CE+NBI images that belong to a patient and then classified the patient as benign or malignant. For the automatic classification, an algorithm based on characterizing the level of the vessel’s disorder in combination with four supervised classifiers was used to classify CE-NBI images. The results showed that the manual approach’s subjective evaluation could be reduced by using a computer-based approach. Moreover, the automatic approach showed the potential to work as an assistant system in case of disagreements among clinicians and to reduce the manual approach’s misclassification issue.

CT Study of the Arytenoid Cartilage in Patients with Laryngeal Contact Granuloma

Objective To explore high-resolution computed tomography (HRCT) characteristics of arytenoid cartilage in patients with laryngeal contact granuloma (LCG). Setting Tertiary hospitals. Study Design Individual case-control study. Methods HRCT scans were obtained before treatment from 42 patients with LCG. Similar scans were obtained from 50 patients with glottic laryngeal cancer or vocal cord leukoplakia without vocal process involvement. Results Forty-two male patients with LCG were enrolled in the study. There were 41 patients with unilateral vocal cord lesions, and 1 patient had bilateral lesions. All 50 eligible patients in the laryngeal lesion group were men. There were 39 patients with unilateral lesions, and 11 had bilateral lesions. The rate of arytenoid cartilage sclerosis in the LCG group was 79.07% (34/43) on the lesion side and 7.32% (3/41) on the healthy side. In the laryngeal lesion group, the rate of arytenoid cartilage sclerosis was 13.11% (8/61) on the lesion side and 2.56% (1/39) on the healthy side. The rate of arytenoid cartilage sclerosis on the lesion side of patients with LCG was significantly higher than on the healthy side of patients with LCG and significantly higher than both the healthy and lesion sides of patients with laryngeal lesions ( P < .001). Conclusions Arytenoid cartilage sclerosis was observed on the lesion side in most patients with LCG, and the presence of sclerosis may support the diagnosis of LCG.

Novel characteristics identified in two cases of feline cowpox virus infection

Case series summary This case series discusses novel characteristics identified in two cases of cowpox. One presented with upper airway signs, and was identified to have a focal laryngeal lesion. The other had central neurological signs at the terminal stages, with intracytoplasmic inclusion bodies identified within the cerebral hemispheres on histopathology. Relevance and novel information Currently, cowpox would be an unlikely consideration in patients with neurological signs or upper respiratory noise. These cases both document novel presentations of cowpox infection, which clinicians should be aware of and consider as differential diagnoses in patients with these atypical presentations.