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Pugi J, Levin M, Gupta M. Supraglottic p16+ squamous cell carcinoma during pregnancy: a case report and review of the literature. J Otolaryngol Head Neck Surg 2019; 48:47. [PMID: 31615538 PMCID: PMC6794888 DOI: 10.1186/s40463-019-0378-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Head and neck cancer during pregnancy is uncommon. Specifically, laryngeal cancer in pregnancy has only been previously reported 10 times. HPV p16+ supraglottic cancer during pregnancy has never been described in the literature prior to this case report. This case is important to report to understand the most effective and safe diagnostic, treatment and follow-up options available for pregnant patients with laryngeal cancer. CASE PRESENTATION This report describes a case of a 33-year-old patient who was 24 weeks pregnant presenting with dysphonia and odynophagia. After laryngeal biopsy and MRI she was diagnosed with T3N1M0, stage three p16+ squamous cell carcinoma of the supraglottis. After inter-disciplinary consultation as well as extensive patient discussion, an awake tracheostomy, PEG tube placement and then elective C-section at 28 weeks' gestation was completed. This was followed by chemoradiotherapy. The patient has remained free from disease with a healthy child at four years post-treatment. CONCLUSION Supraglottic cancer during pregnancy is rare with only four previous cases reported in the literature. This case report elucidates the importance of including multiple specialities as well as patient preference in the decision-making process regarding treatment for patients with supraglottic cancer during pregnancy. Furthermore, diagnostic and treatment guidelines for pregnant patients with head and neck cancers should be established to promote the best possible oncological, obstetrical and neonatal care.
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Affiliation(s)
- Jakob Pugi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Marc Levin
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Michael Gupta
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
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2
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Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, Baujat B, Righini C, Jegoux F, Dufour X, Merol JC, Mauvais O, Lasne-Cardon A, Selleret L, Thariat J. Head and neck cancer during pregnancy. Head Neck 2019; 41:3719-3732. [PMID: 31329334 DOI: 10.1002/hed.25877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women. METHODS A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women. RESULTS Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified. CONCLUSION Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.
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Affiliation(s)
| | | | | | - Ludovic de Gabory
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Rangueil-Larrey, Toulouse, France
| | - François Janot
- Service de Chirurgie ORL, Centre Gustave Roussy, Villejuif, France
| | - Bertrand Baujat
- Service de Chirurgie ORL, Hopital Tenon, Université Paris-Est, Paris, France
| | - Christian Righini
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Franck Jegoux
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Xavier Dufour
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Claude Merol
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Mauvais
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Audrey Lasne-Cardon
- Service de Chirurgie ORL Centre François Baclesse, Normandie Université-Unicaen, Caen, France
| | - Lise Selleret
- Service de Gynécologie Obstetrique, Hopital Tenon, Paris, France
| | - Juliette Thariat
- Service de Radiothérapie, Centre François Baclesse, Caen, France
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3
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Ooi S, Ngo H. Cesarean section after abdominal mesh repair for pregnancy-related desmoid tumor: a case report. Int J Womens Health 2017; 9:497-499. [PMID: 28744163 PMCID: PMC5513847 DOI: 10.2147/ijwh.s135098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report the case of a 32-year-old gravida 2 para 1 woman with a background of partially resected desmoid tumor (DT) arising from the previous cesarean section (CS) scar. This case details the management of her DT by surgical resection and mesh repair and second pregnancy following this. Pregnancy-related DTs are a relatively rare entity, and there is a paucity of literature regarding their management during pregnancy. There are only five reported cases of DTs arising from CS scars. To our knowledge, this is the only report to illustrate that subsequent CS is possible after desmoid resection and abdominal mesh repair. It provides evidence that CS can be safely accomplished following abdominal wall reconstructions and further arguments against elective lower segment CS.
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Affiliation(s)
- Sara Ooi
- Obstetrics and Gynaecology Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - Harry Ngo
- Obstetrics and Gynaecology Department, Liverpool Hospital, Liverpool, NSW, Australia
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4
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Shinohara S, Suehiro A, Kikuchi M, Harada H, Kishimoto I, Imai Y. A case of desmoid tumor co-existing with recurrent squamous cell carcinoma in the larynx. Auris Nasus Larynx 2017; 44:365-369. [DOI: 10.1016/j.anl.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
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5
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de Bree E, Zoras O, Hunt JL, Takes RP, Suárez C, Mendenhall WM, Hinni ML, Rodrigo JP, Shaha AR, Rinaldo A, Ferlito A, de Bree R. Desmoid tumors of the head and neck: a therapeutic challenge. Head Neck 2014; 36:1517-26. [PMID: 24421052 DOI: 10.1002/hed.23496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/22/2013] [Accepted: 09/09/2013] [Indexed: 12/23/2022] Open
Abstract
Desmoid tumor, or aggressive fibromatosis, is a rare, histologically benign, fibroblastic lesion that infrequently presents in the head and neck. Desmoid tumors often grow locally, invasively, and may, in rare instances, be fatal secondary to invasion into critical structures, such as airway or major vessels. The most common treatment is surgery, but desmoid tumors are characteristically associated with a high local recurrence rate after resection. Although the margin status seems to be of importance, operations that avoid function loss and esthetic disfigurement should be the primary goal. The efficacy of postoperative radiotherapy is controversial. Its potential benefit should be carefully balanced against possible radiation-induced adverse effects. Alternative treatment modalities, such as primary radiotherapy and medical treatment or a wait-and-see policy, may be preferable to mutilating surgery. Considering all the aforementioned, it seems obvious that desmoid tumors of the head and neck present a therapeutic challenge and require an individualized approach.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
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6
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de Bree E, Dimitriadis E, Giannikaki E, Chryssou EG, Melissas J. A giant pregnancy-associated intra-abdominal desmoid tumour: not necessarily a contraindication for subsequent pregnancy. World J Surg Oncol 2013; 11:277. [PMID: 24131728 PMCID: PMC3852701 DOI: 10.1186/1477-7819-11-277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022] Open
Abstract
Desmoid tumours are rare mesenchymal tumours, often locally invasive and characteristically associated with a high local recurrence rate after resection. A potential aetiological role for female hormones is indicated. Pregnancy-associated desmoid tumours are almost exclusively located in the abdominal wall. An essential issue is how to counsel women who have had a pregnancy-associated desmoid tumour and subsequently wish to bear a child. A considerably rare case of a patient with a resection of a giant pregnancy-associated, 33 cm in diameter, intra-abdominal desmoid tumour is presented. After a subsequent pregnancy, the patient delivered healthy twins 26 months later. Fifty-four months after treatment, there are no signs of recurrent or second desmoid tumour. Although rarely located in the abdomen, pregnancy-associated desmoid tumours should be included in the differential diagnosis of intra-abdominal tumours detected during or shortly after pregnancy. Based on this case and a few others reported in the literature, subsequent pregnancy does not necessarily seem to be a risk factor for recurrent or new disease.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece.
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7
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Trigui K, Bouassida M, Kilani H, Mighri MM, Sassi S, Chebbi F, Touinsi H, Sassi S. Huge desmoid tumor of the anterior abdominal wall mimicking an intraabdominal mass in a postpartum woman: a case report. Pan Afr Med J 2013; 14:52. [PMID: 23593530 PMCID: PMC3626436 DOI: 10.11604/pamj.2013.14.52.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/11/2022] Open
Abstract
Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We report the case of anterior abdominal wall desmoid tumor in a female patient with previous history of cesarean section. Preoperative ultrasound and computed tomography demonstrated a large mass mimicking a large hematoma or an intraabdominal mass. The tumor was removed by wide excision with safe margins. The abdominal wall defect was reconstructed with polypropylene mesh. Subsequent histology revealed a desmoid tumor. Desmoid tumors in females are often associated with pregnancy or occur post-partum. The reasons behind this association are unclear. The most common sites are in the abdominal muscles.
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Affiliation(s)
- Khaled Trigui
- Department of surgery, MTM Hospital, Nabeul, Tunisia
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8
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Kiciński K, Skorek A, Stankiewicz C. [Managment of head and neck cancers during pregnancy]. Otolaryngol Pol 2012; 65:326-32. [PMID: 22078281 DOI: 10.1016/s0030-6657(11)70721-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/15/2011] [Indexed: 10/15/2022]
Abstract
The coincidence of malignant disease during pregnancy is uncommon. The incidence of cancer in pregnancy has increased, due to the tendency to postpone childbirth to an older age. Cancer complicates approximately 0.1% of all pregnancies. Managing head and neck cancers during pregnancy requires additional pregnancy-related understanding of the aetiological effect of pregnancy on cancer, knowledge of the direct and indirect effects of cancer on pregnancy, and the effect of diagnostic and treatment modalities on pregnancy. The timing of treatment is an important determinant on foetal wellbeing. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. Clinicians must be cognizant with the ethical dilemmas of treatment. In head and neck cancers, pregnancy has no effect on maternal prognosis when compared to non-pregnant patients matched by age, cancer stage and treatment.
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9
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Robinson WA, McMillan C, Kendall A, Pearlman N. Desmoid tumors in pregnant and postpartum women. Cancers (Basel) 2012; 4:184-92. [PMID: 24213235 PMCID: PMC3712680 DOI: 10.3390/cancers4010184] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/11/2012] [Accepted: 02/13/2012] [Indexed: 11/16/2022] Open
Abstract
We report here a review of the current medical literature on pregnancy associated desmoids, including 10 cases of our own. The pertinent findings are that a large percentage of desmoids in females arise in and around pregnancy. Most occur in the abdominal muscles, particularly the right rectus abdominus, perhaps related to trauma from abdominal stretching and fetal movement. While these tumors may regress spontaneously after delivery most can be surgically resected with low recurrence rates even with R1 resections and this is clearly the treatment of choice. Subsequent pregnancies do not appear to result in recurrence in either FAP or non FAP patients. It is not clear from currently available data whether pregnancy associated desmoids are molecularly distinct from other desmoids.
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Affiliation(s)
- William A. Robinson
- Department of Medicine, University of Colorado Denver, Denver, CO 80045, USA
- Authors to whom correspondence should be addressed; E-Mails: (W.A.R.); (N.P.); Tel.: +1-303-724-3872 (W.A.R.); Fax: +1-303-724-3889 (W.A.R.); Tel.: +1-303-724-2728 (N.P.); Fax: +1-303-724-7377(N.P.)
| | - Colette McMillan
- Department of Pharmacy, University of Colorado Denver, Denver, CO 80045, USA; E-Mails: (C.M.)
| | - Amy Kendall
- Department of the Tumor Registry, University of Colorado Denver, Denver, CO 80045, USA; E-Mails: (A.K.)
| | - Nathan Pearlman
- Department of Surgery, University of Colorado Denver, Denver, CO 80045, USA
- Authors to whom correspondence should be addressed; E-Mails: (W.A.R.); (N.P.); Tel.: +1-303-724-3872 (W.A.R.); Fax: +1-303-724-3889 (W.A.R.); Tel.: +1-303-724-2728 (N.P.); Fax: +1-303-724-7377(N.P.)
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10
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Liu Y, Guan GF, Jin CS, Yang JP. Aggressive Fibromatosis of the Larynx: Case Report and Brief Review. J Int Med Res 2011; 39:682-9. [PMID: 21672375 DOI: 10.1177/147323001103900239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aggressive fibromatosis is a rare, benign, fibroblastic neoplasm, characterized by local invasion and a relatively high rate of recurrence. Here a case of laryngeal aggressive fibromatosis in a 47-year old man is reported. The patient presented with worsening dyspnoea and hoarseness and was hospitalized for treatment with partial laryngectomy. Final pathological evaluation of the tumour confirmed a diagnosis of aggressive fibromatosis. The patient has remained disease-free without further treatment for 5 years. This study demonstrated that aggressive fibromatosis may occur around the larynx and can be managed by partial laryngectomy alone. It is, therefore, important to include this rare disease entity in the routine differential diagnosis of laryngeal masses.
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Affiliation(s)
- Y Liu
- Department of Otolaryngology/Head and Neck Surgery, Second Hospital, Jilin University, Changchun, Jilin Province, China
| | - G-F Guan
- Department of Otolaryngology/Head and Neck Surgery, Second Hospital, Jilin University, Changchun, Jilin Province, China
| | - C-S Jin
- Department of Otolaryngology/Head and Neck Surgery, Second Hospital, Jilin University, Changchun, Jilin Province, China
| | - J-P Yang
- Department of Otolaryngology/Head and Neck Surgery, Second Hospital, Jilin University, Changchun, Jilin Province, China
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11
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Desmoid tumors of the right rectus abdominus muscle in postpartum women. Arch Gynecol Obstet 2008; 279:869-73. [DOI: 10.1007/s00404-008-0830-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
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12
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Atabo A, Bradley PJ. Management principles of head and neck cancers during pregnancy: A review and case series. Oral Oncol 2008; 44:236-41. [PMID: 17475540 DOI: 10.1016/j.oraloncology.2007.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 02/17/2007] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
Head and neck cancers during pregnancy are rising in incidence. Clinicians need to be aware of the principles of managing these cases. This paper is a review of the literature of head and neck cancers during pregnancy with a short case series of six non-thyroid pregnancy-associated cancers treated by a head and neck oncology surgeon. The age range is 20-34 years. Tumour types include carcinoma of the tongue, nasopharynx, maxillary sinus, parotid gland, subglottic region, and the neck. Five patients were treated surgically and four were treated with either chemotherapy or radiotherapy. Both foetal and maternal death occurred in two cases. The range of follow-up is 15 months to 14 years. Managing head and neck cancers during pregnancy requires the addition of a pregnancy-related layer of understanding to the armoury of existing specialist knowledge, encompassing a triad of effects, (i) the aetiological effect of pregnancy on cancer, (ii) the direct and indirect effects of cancer on pregnancy, and (iii) the effect of diagnostic and treatment modalities on pregnancy. Consideration must also be given to the ethical dilemmas of decision making.
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Affiliation(s)
- Adigo Atabo
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, United Kingdom
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13
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Firoozmand E, Prager E. Pelvic Desmoid Tumor: Threat to Mother and Fetus. Am Surg 2001. [DOI: 10.1177/000313480106701221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Desmoid tumors (DTs) are well-recognized extracolonic manifestations of familial adenomatous polyposis. Surgical trauma and hormonal changes during pregnancy have been proposed as etiologic factors. We present a case of a rapidly growing pelvic DT arising from a J-pouch in a 27-year-old pregnant woman status postcolectomy with ileoanal J pouch anastomosis. The tumor interfered with the normal maturation and delivery of the fetus as well as the patient's ability to void or defecate prompting surgical intervention with resection of the tumor and adjacent J pouch at 23 weeks gestation. There are no other reports in the literature of pelvic DT requiring resection during pregnancy. Pelvic DTs in this scenario are potentially fatal to both mother and fetus secondary to uncontrolled bleeding. Surgical intervention should be limited to resection of tumor and when necessary the ileal pouch to minimize bleeding complications.
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Affiliation(s)
| | - Elliot Prager
- Santa Barbara Cottage Hospital, Santa Barbara, California
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14
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Mirra M, Calò S, Salviato T, Libera DD, Falconieri G. Aggressive fibromatosis of the larynx: report of a new case in an adult patient and review of the literature. Pathol Res Pract 2001; 197:51-55; discussion 56-8. [PMID: 11209817 DOI: 10.1078/0344-0338-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of aggressive fibromatosis of the larynx occurring in a 75-year-old man. The lesion manifested with voice hoarseness and swallowing difficulty. A computerized tomographic scan of the neck revealed distortion of the glottic profile. A malignant tumor was suspected. Although a laryngoscopy-driven biopsy was non-diagnostic, total laryngectomy was done, since the lesion was not deemed amenable to conservative therapy. Grossly, the glottic rim was infiltrated by a hard, grey-white tissue showing a tentacular outline. Tissue sections featured a moderately cellular lesion composed of spindle cells with bland, tapered nuclei, enmeshed in a variably collagenized ground substance. Delicate spindle cell fascicles surrounded the native submucosal seromucous glands and had invaded the thyroid cartilage and the thyroid gland as well. The spindle cells were immunopositive for actins and vimentin, and negative for keratins, epithelial membrane antigen, desmin, and S-100 protein. No further therapy was administered. Periodic follow-up visits were negative. The patient died 5 years after surgery of myocardial infarction with no clinical evidence of lesion recurrence. Based on the available literature, our data confirm that laryngeal fibromatosis in adult patients is a locally infiltrating and progressive disease. Total laryngectomy with clear margins is needed as to avoid the high risk of local recurrence.
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Affiliation(s)
- M Mirra
- Division of Anatomic Pathology, City Hospitals of Lodi, Italy
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