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Aires MM, Pereira I FY, Silva CD, Pedroso JEDS, Biase NGD, Haddad L. Predictive factors of frozen section in transoral microlaryngeal surgery for suspicious glottic lesions. Braz J Otorhinolaryngol 2024; 90:101434. [PMID: 38848629 DOI: 10.1016/j.bjorl.2024.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Frozen biopsy may guide surgical intraoperative decisions. We evaluated the accuracy of frozen biopsy for diagnosing benign, dysplastic and malignant laryngeal lesions, compared to paraffin section (gold standard). METHODS Retrospective review of the charts of all patients presenting with laryngeal lesions suspicious of malignancy, who underwent laryngeal microsurgery with frozen biopsy in our institution, between 2015 and 2020. Results of frozen biopsy and paraffin section examinations were compared. RESULTS Among 113 samples of 89 patients, paraffin section diagnosed 23 benign, 31 dysplastic and 59 malignant lesions. The accuracy of the frozen biopsy in identifying dysplasia or malignancy was 80.5% (91/113), and greater for lesions >5 mm (78.8% × 51.5%; p = 0.009). The positive and negative predictive values, sensitivity and specificity were 95.9%, 51.3%, 78.9% and 86.9%, respectively. CONCLUSIONS Frozen section is a reliable tool when malignancy is detected, but almost half of benign results exhibit dysplasia or malignancy in paraffin section. Other clinical parameters should be considered in intraoperative decisions to prevent undertreatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mateus Morais Aires
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de Pernambuco (UPE), Faculdade de Ciências Médicas, Recife, PE, Brazil
| | - Fábio Yukio Pereira I
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Camilla Diacópulos Silva
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - José Eduardo de Sá Pedroso
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Noemi Grigoletto de Biase
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Pontifícia Universidade Católica de São Paulo (PUC), São Paulo, SP, Brazil
| | - Leonardo Haddad
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
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Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024:S0012-3692(24)00396-9. [PMID: 38508333 DOI: 10.1016/j.chest.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
TOPIC IMPORTANCE Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. REVIEW FINDINGS The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. SUMMARY Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology & Voice Disorders Center, University of Utah, Salt Lake City, UT
| | - Michael J Morris
- Pulmonary & Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
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Zhou P, Yu W, Xia Q, He C. Tracheobronchial mucosal keratosis: A literature review of this rare disorder. Heliyon 2024; 10:e23701. [PMID: 38187287 PMCID: PMC10767502 DOI: 10.1016/j.heliyon.2023.e23701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Background Tracheobronchial mucosal keratosis (TBMK) is a rare airway disease that may cause refractory cough and airway stenosis. The characteristics of this disease remain unknown. In the present study, we describe this disorder based on a review of the current literature, emphasizing its diagnostic and therapeutic aspects. Methods A comprehensive search of TBMK was performed in Medline, Google Scholar, Web of Science, Cochrane Library (UK), Embase, China National Knowledge Infrastructure (CNKI) (China), and Wan Fang Med Online (China). The following data were collected: patient characteristics, chest imaging findings, bronchoscopy, histopathologic findings, pathogen testing, treatment, and prognosis. Results As of 2023, eighteen cases of TBMK have been reported. The main clinical manifestations were cough and expectoration. Chest imaging findings were non-specific. The main bronchoscopy findings were nodular protrusion of airway lumen and yellow-white purulent moss above the nodular lesion. The lesions were mainly located in the trachea and mainstem bronchus. The main pathological manifestations include keratinocytes or keratinocyte beads, squamous metaplasia, and mucosal inflammatory changes. The treatments that were administered include antibiotics, symptomatic treatment, and glucocorticoids. All methods were ineffective except for bronchoscopy-guided high-frequency electric knife and recombinant human epidermal growth factor treatment. Conclusions TBMK is a rare respiratory disease with atypical clinical manifestations and chest computed tomography findings. Bronchoscopy revealed that nodular hyperplasia of the airway and purulent fur-covered lesions are typical manifestations. The final diagnosis needs to be confirmed by histopathological examination. There is a lack of effective treatment for this disease, and bronchoscopy-guided intervention therapy may be a candidate treatment.
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Affiliation(s)
- Pengcheng Zhou
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan province, PR China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, PR China
| | - Wei Yu
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, PR China
| | - Qianming Xia
- Department of Respiratory Medicine, AVIC 363 hospital, Chengdu,Sichuan province, PR China
| | - Chengshi He
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan province, PR China
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4
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Olson C, Alexander R, Stinnett S. Dysplastic Lesions of the Larynx. Otolaryngol Clin North Am 2023; 56:233-246. [PMID: 37030937 DOI: 10.1016/j.otc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
There have been many advancements in the clinical and histologic diagnosis of laryngeal dysplasia (LD), but diagnosis still necessitates invasive histologic evaluation. Furthermore, despite improved histologic identification of dysplastic lesions, the exact details of pathophysiologic progression and the risk of malignant transformation is still uncertain. These unknowns create a barrier to establishing an ideal grading and classification system, which prevents the establishment of a precise and consistent treatment paradigm. Identifying these gaps in knowledge serves to highlight where further studies are warranted, ideally focusing on a better understanding of the biological behavior of LD. This would ultimately allow for the creation of a reliable grading and classification system and for the formalization of management and treatment guidelines for LD.
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Botini DS, Rodrigues SA, Castilho GL, Mercuri G, Martins RHG. Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment. Int Arch Otorhinolaryngol 2022; 27:e97-e103. [PMID: 36714893 PMCID: PMC9879634 DOI: 10.1055/s-0042-1742767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.
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Affiliation(s)
- Dayane Silvestre Botini
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | | | - Gustavo Leão Castilho
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | - Gustavo Mercuri
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | - Regina Helena Garcia Martins
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil,Address for correspondence Regina H. G. Martins, MD, PhD Ophthalmology, Otorhinolaryngology and Head Neck Surgery Department, Botucatu Medical School – Universidade Estadual Paulista Júlio de Mesquita FilhoDistrito de Rubião Junior s/n, 18618-970; Botucatu, SPBrazil
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Lungova V, Wendt K, Thibeault SL. Exposure to e-cigarette vapor extract induces vocal fold epithelial injury and triggers intense mucosal remodeling. Dis Model Mech 2022; 15:275857. [PMID: 35770504 PMCID: PMC9438930 DOI: 10.1242/dmm.049476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Vaping has been reported to cause acute epiglottitis, a life-threatening airway obstruction induced by direct epithelial injury and subsequent inflammatory reaction. Here, we show that we were able to recapitulate this phenomenon in vitro. Exposure of human engineered vocal fold (VF) mucosae to 0.5% and 5% electronic cigarette (e-cigarette) vapor extract (ECVE) for 1 week induced cellular damage of luminal cells, disrupting homeostasis and innate immune responses. Epithelial erosion was likely caused by accumulation of solvents and lipid particles in the cytosol and intercellular spaces, which altered lipid metabolism and plasma membrane properties. Next, we investigated how the mucosal cells responded to the epithelial damage. We withdrew the ECVE from the experimental system and allowed VF mucosae to regenerate for 1, 3 and 7 days, which triggered intense epithelial remodeling. The epithelial changes included expansion of P63 (TP63)-positive basal cells and cytokeratin 14 (KRT14) and laminin subunit α-5 (LAMA5) deposition, which might lead to local basal cell hyperplasia, hyperkeratinization and basement membrane thickening. In summary, vaping presents a threat to VF mucosal health and airway protection, thereby raising further concerns over the safety of e-cigarette use. This article has an associated First Person interview with the first author of the paper. Editor's choice: Exposure of vocal fold mucosae to e-cigarette vapor extract induces lipid-mediated epithelial injury that disrupts vocal fold mucosal homeostasis and innate barrier function and triggers intense mucosal remodeling.
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Affiliation(s)
- Vlasta Lungova
- Department of Surgery, University of Wisconsin Madison, 5105 WIMR, Madison, WI, USA
| | - Kristy Wendt
- Department of Surgery, University of Wisconsin Madison, 5105 WIMR, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, 5103 WIMR, Madison, WI, USA
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Hellquist H, Ferlito A, Mäkitie AA, Thompson LDR, Bishop JA, Agaimy A, Hernandez-Prera JC, Gnepp DR, Willems SM, Slootweg PJ, Rinaldo A. Developing Classifications of Laryngeal Dysplasia: The Historical Basis. Adv Ther 2020; 37:2667-2677. [PMID: 32329013 PMCID: PMC7467449 DOI: 10.1007/s12325-020-01348-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 12/12/2022]
Abstract
During the last 60 years numerous significant attempts have been made to achieve a widely acceptable terminology and histological grading for laryngeal squamous intraepithelial lesions. While dysplasia was included in the pathology of the uterine cervix already in 1953, the term dysplasia was accepted in laryngeal pathology first after the Toronto Centennial Conference on Laryngeal Cancer in 1974. In 1963 Kleinsasser proposed a three-tier classification, and in 1971 Kambic and Lenart proposed a four-tier classification. Since then, four editions of the World Health Organisation (WHO) classification have been proposed (1978, 1991, 2005 and 2017). Several terms such as squamous intraepithelial neoplasia (SIN) and laryngeal intraepithelial neoplasia (LIN) are now being abandoned and replaced by squamous intraepithelial lesions (SIL). The essential change between the 2005 and 2017 WHO classifications is the attempt to induce a simplification from a four- to a two-tier system. The current WHO classification (2017) thus recommends the use of a two-tier system with reasonably clear histopathological criteria for the two groups: low-grade and high-grade dysplasia. Problems with interobserver variability apart, subjectivities and uncertainties remain, but to a lesser degree. Ongoing and additional molecular studies may help to clarify underlying events that will increase our understanding and possibly can facilitate our attempts to obtain an even better classification. The classification needs to be easier for the general pathologist to perform and easier for the clinician to interpret. These two objectives are equally important to provide each patient the best personalised treatment available for squamous intraepithelial lesions.
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Affiliation(s)
- Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Faro, Portugal.
- Department of Biomedical Sciences and Medicine, Faro, Portugal.
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Center (ABC), Faro, Portugal.
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| | - Antti A Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Douglas R Gnepp
- Department of Pathology, Alpert Medical School at Brown University, Providence, RI, USA
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Slootweg
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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8
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Laryngeal Dysplasia: Persisting Dilemmas, Disagreements and Unsolved Problems-A Short Review. Head Neck Pathol 2020; 14:1046-1051. [PMID: 32141027 PMCID: PMC7669915 DOI: 10.1007/s12105-020-01149-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
We present the historical review and current state of the histopathological classifications and terminology of laryngeal precursor lesions. Attention to recent genetic findings is also presented; although in need of additional confirmation, these raise possibility for early detection of patients at risk of dysplasia progression. Although a number of identified genetic alterations with a promising diagnostic and prognostic value are emerging, none of the known genetic alterations can be currently implemented in clinical practice as a completely reliable diagnostic and/or prognostic marker. Regarding the terminology of precursor lesions, dysplasia remains the most frequently used term, but squamous intraepithelial lesion can be used as a synonym as well. Histological findings, in spite of certain degree of subjectivity, remain at present the most reliable method for an accurate diagnosis. The current 2017 WHO classification seems to successfully stratify risk of malignant progression, with a significantly different risk of malignant progression between low-grade dysplasia and high-grade dysplasia. In case of pronounced architectural disorders, severe cellular and nuclear atypias, and an increased number of mitoses, also atypical form, the high-grade dysplasia and carcinoma in situ can be separated. The Slovenian tertiary centers have a policy of surgical removal of high-grade SILs and life-long close follow-up. Radiotherapy is reserved for more pronounced intraepithelial lesions classified as carcinoma in situ and invasive cancer. Such a distinction can facilitate clinical decision to use radiotherapy if complete surgical removal is not possible.
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Lungova V, Chen X, Wang Z, Kendziorski C, Thibeault SL. Human induced pluripotent stem cell-derived vocal fold mucosa mimics development and responses to smoke exposure. Nat Commun 2019; 10:4161. [PMID: 31551422 PMCID: PMC6760204 DOI: 10.1038/s41467-019-12069-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/15/2019] [Indexed: 01/27/2023] Open
Abstract
Development of treatments for vocal dysphonia has been inhibited by lack of human vocal fold (VF) mucosa models because of difficulty in procuring VF epithelial cells, epithelial cells' limited proliferative capacity and absence of cell lines. Here we report development of engineered VF mucosae from hiPSC, transfected via TALEN constructs for green fluorescent protein, that mimic development of VF epithelial cells in utero. Modulation of FGF signaling achieves stratified squamous epithelium from definitive and anterior foregut derived cultures. Robust culturing of these cells on collagen-fibroblast constructs produces three-dimensional models comparable to in vivo VF mucosa. Furthermore, we demonstrate mucosal inflammation upon exposure of these constructs to 5% cigarette smoke extract. Upregulation of pro-inflammatory genes in epithelium and fibroblasts leads to aberrant VF mucosa remodeling. Collectively, our results demonstrate that hiPSC-derived VF mucosa is a versatile tool for future investigation of genetic and molecular mechanisms underlying epithelium-fibroblasts interactions in health and disease.
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Affiliation(s)
- Vlasta Lungova
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institute for Medical Research, Madison, WI, USA
| | - Xia Chen
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institute for Medical Research, Madison, WI, USA
| | - Ziyue Wang
- Department of Biostatistics & Medical Informatics, University of Wisconsin Madison, Madison, WI, USA
| | - Christina Kendziorski
- Department of Biostatistics & Medical Informatics, University of Wisconsin Madison, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institute for Medical Research, Madison, WI, USA.
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10
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Ali SA, Smith JD, Hogikyan ND. The White Lesion, Hyperkeratosis, and Dysplasia. Otolaryngol Clin North Am 2019; 52:703-712. [PMID: 31078307 DOI: 10.1016/j.otc.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Laryngeal mucosal precursor lesions represent a challenging clinical entity. Updated classification systems allow for grade-based categorization. Multiple management options exist, with treatment decisions made jointly by physician and patient and focused on both appropriate lesion treatment and preservation of laryngeal structure and function. Traditional methods include cold steel and CO2 laser excision, with newer modalities using angiolytic lasers for lesion ablation. Both operating room-based and office-based treatment options exist, and there are advantages and disadvantages to each approach. Research is ongoing to advance the understanding of lesion biology, and to optimize prevention and treatment.
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Affiliation(s)
- S Ahmed Ali
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Norman D Hogikyan
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA.
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11
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Braut T, Krstulja M, Marijić B, Maržić D, Kujundžić M, Brumini G, Vučinić D, Oštarijaš E. Immunohistochemical analysis of vocal cord polyps applying markers of squamous cell carcinogenesis. Pathol Res Pract 2019; 215:144-150. [DOI: 10.1016/j.prp.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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12
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Haney JT, McCant D, Honeycutt ME, Lange S. Development of an inhalation reference concentration for diethanolamine. Regul Toxicol Pharmacol 2018; 92:55-66. [DOI: 10.1016/j.yrtph.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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13
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Chen M, Cheng L, Li CJ, Chen J, Shu YL, Wu HT. Nonsurgical Treatment for Vocal Fold Leukoplakia: An Analysis of 178 Cases. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6958250. [PMID: 28695129 PMCID: PMC5488165 DOI: 10.1155/2017/6958250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/07/2017] [Accepted: 05/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the effectiveness and identify vocal fold leukoplakia types appropriate for nonsurgical treatment. METHODS The vocal fold leukoplakia in 178 patients was divided by gross appearance into three subtypes: flat and smooth, elevated and smooth, and rough. All patients received nonsurgical treatment including smoking and drinking cessation, voice rest, omeprazole, and Chinese medication therapy. The clinical response of three subtypes was assessed after a 6-month follow-up. RESULTS Vocal fold leukoplakia subtypes included flat and smooth (n = 66; 37.1%), elevated and smooth (n = 103; 57.9%), and rough (n = 9; 5.0%). The rate of complete response was 80.3%, 66.0%, and 0.0% for the 3 lesion types, respectively (rough versus flat and smooth, P < 0.001; rough versus elevated and smooth, P < 0.001, Fisher's exact test). The incidence of carcinoma in rough leukoplakia was significantly higher than that in smooth leukoplakia (44.4% versus 2.4%, P = 0.002, Fisher's exact test). Clinical type was the only significant factor for clinical response of nonsurgical treatment (P = 0.005, ordinal logistic regression). CONCLUSIONS The effectiveness of nonsurgical treatment for smooth vocal fold leukoplakia is better in comparison to rough vocal fold leukoplakia. Smooth leukoplakia could be managed with nonsurgical treatment; more aggressive treatments should be considered for rough leukoplakia.
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Affiliation(s)
- Min Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Cheng
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Chang-jiang Li
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Jian Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Yi-lai Shu
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Hai-tao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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14
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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15
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van Hulst AM, Kroon W, van der Linden ES, Nagtzaam L, Ottenhof SR, Wegner I, Gunning AC, Grolman W, Braunius W. Grade of dysplasia and malignant transformation in adults with premalignant laryngeal lesions. Head Neck 2015; 38 Suppl 1:E2284-90. [DOI: 10.1002/hed.24185] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Annelienke M. van Hulst
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Wouter Kroon
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Evi S. van der Linden
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Lily Nagtzaam
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Sarah R. Ottenhof
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Amy C. Gunning
- Department of Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; Utrecht, Utrecht The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Weibel Braunius
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Head and Neck Surgical Oncology; University Medical Center Utrecht; Utrecht The Netherlands
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16
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Kum RO, Ozcan M, Baklaci D, Kum NY, Yilmaz YF, Gungor V, Unal A. Elevated Neutrophil-to-Lymphocyte Ratio in Squamous Cell Carcinoma of Larynx Compared to Benign and Precancerous Laryngeal Lesions. Asian Pac J Cancer Prev 2014; 15:7351-5. [DOI: 10.7314/apjcp.2014.15.17.7351] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Gale N, Blagus R, El-Mofty SK, Helliwell T, Prasad ML, Sandison A, Volavšek M, Wenig BM, Zidar N, Cardesa A. Evaluation of a new grading system for laryngeal squamous intraepithelial lesions-a proposed unified classification. Histopathology 2014; 65:456-64. [DOI: 10.1111/his.12427] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nina Gale
- Institute of Pathology; Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics; Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Samir K El-Mofty
- Department of Pathology and Immunology; School of Medicine; Washington University; St Louis MO USA
| | - Tim Helliwell
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - Manju L Prasad
- Department of Pathology; Yale University School of Medicine; New Haven CT USA
| | - Ann Sandison
- Department of Histopathology; Charing Cross Hospital; London UK
| | - Metka Volavšek
- Institute of Pathology; Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Bruce M Wenig
- Department of Pathology; Beth Israel Medical Center; New York NY USA
| | - Nina Zidar
- Institute of Pathology; Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Antonio Cardesa
- Department of Pathology; Hospital Clinic; University of Barcelona; Barcelona Spain
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18
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Panwar A, Lindau R, Wieland A. Management of premalignant lesions of the larynx. Expert Rev Anticancer Ther 2014; 13:1045-51. [DOI: 10.1586/14737140.2013.829643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Abstract
Objective This study was to analyze the interobserver histopathological variability and carcinoma transformation of laryngeal premalignant lesions. Study Design A historical cohort study. Setting Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China. Subjects and Methods κ-statistics analysis was performed to estimate interobserver histopathological variability among pathologists by reassessment of 237 cases with laryngeal premalignant lesion according to 2005 WHO classification system. A retrospective follow-up of 237 patients over 8-year duration was carried out, and the carcinoma transformation of laryngeal premalignant lesions was analyzed using Kaplan-Meier survival curve estimation. Results κ-values of 0.5989 concerning interobserver variability indicated a moderate agreement among 3 pathologists. Major source of intergrade diagnostic disagreement between the original and the consensus diagnoses involved 2 grade pairs, namely, mild and moderate dysplasia, severe dysplasia, and carcinoma in situ. In addition, follow-up study showed that 20 of 237 (8.44%) laryngeal premalignant lesion cases developed into invasive carcinoma. Carcinoma transformation in severe dysplasia group exhibited a similar risk compared to that in carcinoma in situ group ( P = .232). Conclusion Severe dysplasia shows the same carcinoma transformation potential as the carcinoma in situ does. Clinically, more attention to severe dysplasia is needed in comparison with mild and moderate dysplasia.
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Affiliation(s)
- Yanping Hu
- Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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20
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Luers JC, Sircar K, Drebber U, Beutner D. The impact of laryngeal dysplasia on the development of laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 271:539-45. [DOI: 10.1007/s00405-013-2670-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
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21
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Differentiated dysplasia is a frequent precursor or associated lesion in invasive squamous cell carcinoma of the oral cavity and pharynx. Virchows Arch 2013; 462:609-17. [PMID: 23588556 DOI: 10.1007/s00428-013-1412-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 10/27/2022]
Abstract
The source of precursor lesions of squamous cell carcinoma (SCC) of the oral cavity and pharynx, their classification, and grading are controversial. In contrast, vulvar and penile cancer precursor lesions are known to be related to human papillomavirus or chronic inflammation and can be described using the vulvar intraepithelial neoplasia (VIN) classification system (VIN 1-3) or as differentiated vulvar intraepithelial neoplasia (dVIN), respectively. Oral and pharyngeal SCC precursor lesions are more etiologically diverse, and the spectrum of lesions may thus be wider. No international consensus exists regarding the histological types of precursor lesions or the significance of individual types. We therefore reviewed resection specimens and preceding biopsies of 155 patients with SCC of the oral cavity and pharynx (excluding tonsils) and identified five basic patterns of SCC-associated or precursor lesions: (1) pleomorphic (22/155), (2) basaloid (5/155), (3) differentiated (63/155), (4) mixed (42/155), and (5) verrucous (12/155). Keratinization was a common but variable feature in differentiated, mixed, and verrucous dysplasia. In 11/155 patients, no precursor lesion could be identified. Progression of isolated differentiated dysplasia (ranging from months to years) was documented in 13/155 (8 %) of patients. Our data suggest that full-thickness epithelial dysplasia of pleomorphic or basaloid type is present in <20 % of oral and pharyngeal SCC, and differentiated dysplasia is a frequent precursor or associated in situ lesion. Failure to recognize differentiated dysplasia results in the underdiagnosis of many patients at risk for invasive carcinoma. These results indicate a need to refine criteria to distinguish differentiated dysplasia from morphologically related lichenoid lesions.
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22
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Wong TS, Gao W, Li ZH, Chan JYW, Ho WK. Epigenetic dysregulation in laryngeal squamous cell carcinoma. JOURNAL OF ONCOLOGY 2012; 2012:739461. [PMID: 22645613 PMCID: PMC3356733 DOI: 10.1155/2012/739461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 12/17/2022]
Abstract
Laryngeal carcinoma is a common head and neck cancer with poor prognosis. Patients with laryngeal carcinoma usually present late leading to the reduced treatment efficacy and high rate of recurrence. Despite the advance in the use of molecular markers for monitoring human cancers in the past decades, there are still no reliable markers for use to screen laryngeal carcinoma and follow the patients after treatment. Epigenetics emerged as an important field in understanding the biology of the human malignancies. Epigenetic alterations refer to the dysregulation of gene, which do not involve the alterations of the DNA sequence. Major epigenetic changes including methylation imbalance, histone modification, and small RNA dysregulation could play a role in the development of human malignancies. Global epigenetic change is now regarded as a molecular signature of cancer. The characteristics and behavior of a cancer could be predicted based on the specific epigenetic pattern. We here provide a review on the understanding of epigenetic dysregulation in laryngeal carcinoma. Further knowledge on the initiation and progression of laryngeal carcinoma at epigenetic level could promote the translation of the knowledge to clinical use.
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Affiliation(s)
- Thian-Sze Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
| | - Wei Gao
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
| | - Zeng-Hong Li
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
| | - Jimmy Yu-Wai Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
| | - Wai-Kuen Ho
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
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23
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Biomarkers predicting malignant progression of laryngeal epithelial precursor lesions: a systematic review. Eur Arch Otorhinolaryngol 2011; 269:1073-83. [DOI: 10.1007/s00405-011-1831-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/30/2011] [Indexed: 01/02/2023]
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