Undifferentiated laryngeal carcinoma with hyaline bodies in a cat

Background Primary laryngeal neoplasms are rare in cats, with lymphoma and squamous cell carcinoma being the most commonly diagnosed tumour types. These tumours are usually highly aggressive, difficult to treat, and have a poor prognosis. Here an undifferentiated laryngeal carcinoma with hyaline bodies in a cat is reported. Case presentation A 13-year-old cat was presented for progressive respiratory signs. Diagnostic procedures revealed a partially obstructive laryngeal mass. Cytology was compatible with a poorly differentiated malignant tumour, with neoplastic cells frequently containing large intracytoplasmic hyaline bodies. After 1 month the patient was euthanised due to a worsening clinical condition and submitted for post-mortem examination, which confirmed the presence of two laryngeal masses. Histopathology confirmed the presence of an undifferentiated neoplasm with marked features of malignancy. Strong immunolabelling for pancytokeratin led to a diagnosis of undifferentiated carcinoma, however, histochemical and immunohistochemical investigations could not elucidate the origin of the large intracytoplasmic hyaline bodies observed in tumour cells, which appeared as non-membrane bound deposits of electron-dense material on transmission electron microscopy. Conclusion This is the first report of primary undifferentiated laryngeal carcinoma in a cat. Our case confirms the clinical features and the short survival that have been reported in other studies describing feline laryngeal tumours. Moreover, for the first time in feline literature, we describe the presence of intracytoplasmic hyaline bodies in neoplastic cells that were compatible with the so-called hyaline granules reported in different human cancers and also in the dog.

Simultaneous double laryngeal tumours: a diagnostic and therapeutic challenge

Leiomyosarcomas are soft tissue tumours that rarely occur in the larynx. This case report describes the presentation and management of a 77-year-old man referred to the otolaryngology clinic with hoarseness who was found to have a large supraglottic leiomyosarcoma after panendoscopy and biopsies. He subsequently underwent laryngectomy for treatment of this tumour but, unexpectedly, the histological analysis of the laryngectomy specimen revealed a second primary tumour in the larynx—a squamous cell carcinoma (SCC). The patient had further treatment with neck radiotherapy. Three years after treatment, there are no signs of recurrence of either tumour. This case report discusses the very few similar cases of leiomyosarcoma coexisting with SCC in the larynx, collating the evidence surrounding the treatment of this rare presentation.

Localised laryngotracheal amyloidosis: a differential diagnosis not to forget

We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.

LARINGOPHARINGEAL REFLUX IMPACTS IMMUNE MICROENVIRONMENT OF LARYNGEAL CARCINOMA

The purpose of this study was to evaluate the effect of the laryngopharyngeal reflux (LPR) on the number of tumourinfiltrating T-lymphocytes in laryngeal cancer (LC). According to the results of pH monitoring, 87 patients with laryngeal tumours were subdivided into three groups: 1st group included patients with LC without LPR; 2nd group comprised LC patients with coexisting LPR, patients with benign neoplasms of the larynx with LPR were enrolled into 3d group. TIME was assessed immunohistochemically by counting T-lymphocytes (CD3+), T-cytotoxic cells (CD8+) and T-regulatory cells (Treg; FOXP3+) number within the tumour, in the peritumour stroma, and in the intact areas of the larynx. It was shown that LPR leads to chronic inflammation and affects TIME of laryngeal carcinomas. LC with coexisting LPR demonstrated a higher inflammatory infiltration of tumour area and intact mucosa. However, no statistically significant differences were found between a number of CD3+- and CD8+-cells in LC of the 1st and 2nd groups. In contrast, LPR was associated with higher number of immunosuppressive Treg-cells within tumour and in intact mucosa that could affect immune tolerance and efficacy of anti-tumour immunity facilitating LC progression.

Lateral Soft Tissue Neck X-ray a Tool for the Otorhinolaryngology Surgeon

Background: Management of aerodigestive emergencies can prove a challenge especially in this sub-Saharan region where there is a dearth of specialized equipment. In some areas, a plain radiograph may be the only investigative tool readily available to the surgeon. It is routinely done in most of these cases. In our environment health care is often financed by the patients through out of pocket expenses since most do not have health insurance. Affordability of a particular treatment becomes paramount. This study, therefore, is aimed at assessing the use of lateral soft tissue neck X-ray and its reliability as a diagnostic tool in aerodigestive emergencies. Objective: To determine the relevance or effectiveness of plain radiograph of the lateral soft tissue neck in patients with upper aerodigestive emergencies and therefore its use as a tool to the otorhinolaryngology (ORL) surgeon as the first-line investigation in these patients. Patients and Methods: It is a prospective study of all patients that presented to the ENT surgery department of UPTH from April 2018 to April 2019 with upper aerodigestive emergencies. Patients who presented in the ENT clinic, accident and emergency department, children`s emergency wards and the clinics with upper aerodigestive emergencies were recruited in this study. All the patients had X-ray lateral soft tissue of the neck done on presentation and the results were then compared with the final operative findings in the operation theatre. Some patients had also chest radiograph done however; the diagnosis was done based on the lateral soft tissue neck finding. Patients that had radiologic investigation other than radiograph of the lateral soft tissue neck as the main investigative tool were excluded from the study. The radiologist opinion was obtained for all the radiographs as a routine. The results were analyzed using the SPSS 20 and presented in simple statistical tables. Results: Sixteen patients were studied. Males were 14(87.5%) while females were 2(12.5%). Age range was from 1.5 to 77 years with children comprising only 31.25% of the study population. The commonest presenting complaint was voice change 68.75%. Positive findings on the x-ray neck were seen as soft signs in 62.5% and radio-opacity in 18.75%. In n=14(87.5%) the lateral neck x-ray positive findings were corroborated by the operative findings. The tool has a specificity of 100% for both foreign body inhalation/ingestion and laryngeal tumour but the sensitivity of 80% in laryngeal tumours but 100% for the foreign body. Conclusion: Study concludes that lateral soft tissue neck x-ray was found to be a good and useful tool in the diagnosis of a good number of upper aerodigestive emergencies such as foreign body ingestion/inhalation and patients with upper airway obstruction caused by laryngeal tumours and some infective conditions such as a retropharyngeal abscess.

Clinico-etiopathological and management profile of laryngeal tumours in a tertiary care centre

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Laryngeal tumours may be neoplastic or non-neoplastic. Our study aimed to analyze the incidence, clinico-etiopathological and management profile of laryngeal tumours. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This prospective study was performed on 90 cases of laryngeal tumours in the Department of Otolaryngology in a tertiary care hospital from Jan 2015 to June 2016. A detailed clinical history was taken, head &amp; neck examination done, and supplemented with necessary imaging when required. The data thus obtained was recorded and statistically analyzed. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The ratio of benign to malignant tumours was 1:4. Of the benign tumours, 59% were vocal nodules. They were most common in the third decade (23.5%) and presented with hoarseness. Most patients were housewives (29%) and were associated with vocal abuse. All cases were managed surgically. Ninety seven percent of malignant tumours were squamous cell carcinoma, and seen in the seventh decade (37%). Forty one percent were labourers, and smoking, alcohol and laryngopharyngeal reflux were the predominant risk factors. The supraglottis was the commonest site involved, and dysphagia was the predominant presenting symptom. Majority of patients (42.5%) presented with stage IV disease. Malignant tumours were treated with radiotherapy (55%), chemoradiation (44%) and surgery (1%). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Vocal nodule is the commonest benign tumour of the larynx and presents with hoarseness. The supraglottis is the main subsite to be involved in laryngeal cancer, and presents with dysphagia. Most patients present with stage IV disease. Laryngopharyngeal reflux is an important risk factor for carcinoma larynx.</span></p>