NEUROENDOCRINE CARCINOMA OF THE LARYNX WITH LAMBERT-EATON MYASTHENIC SYNDROME: A RARE CASE REPORT.

Neuroendocrine carcinomas (necs) of the larynx are varied and heterogeneous tumours of rare observation in clinical practice. The WHO classification of 2017 divides them into: (i) well differentiated neuroendocrine carcinomas (WD-NEC); (ii) moderately differentiated neuroendocrine carcinomas (MD-NEC); and (iii) poorly differentiated neuroendocrine carcinomas (PD-NEC), which includes (a) small cell neuroendocrine carcinoma (smcc) and (b) large cell neuroendocrine carcinoma (LCNEC)

Strategies and Controversies in the Treatment With Carbon Dioxide Laser of Laryngeal Hemangioma: A Case Series and Review of the Literature

The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness

Neuroendocrine carcinoma of the larynx with Lambert-Eaton myasthenic syndrome: a rare case report and literature review

This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated 'morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation' (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient's medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin-etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended

Subglottic Mass as Isolated Manifestation of Relapsing Polychondritis at Presentation

Relapsing polychondritis (RP) is a rare systemic disease that is characterized by recurrent episodic inflammation of the cartilaginous structures of the body, resulting in their progressive destruction and subsequent replacement with fibrotic scar. We present a case of RP that initially manifested with subglottic involvement and we propose an innovative strategy for the treatment for laryngeal RP in phase of active inflammation. A multidisciplinary approach (rheumatologist, otolaryngologist, immunologist, internist, cardiologist, etc) and adequate follow-up are essential. The timeliness of the diagnosis is fundamental to contain the destructive effects on the cartilages involved

New Therapeutic Strategies in the Treatment of Stomal Recurrence After Total Laryngectomy: Role of Immunotherapy

Objective: The aim of this study was to investigate the incidence of stoma recurrence and the therapeutic strategy outcomes in relation to survival that have been adopted over the past few decades using a monoclonal antibody, specifically nivolumab. Methods: This study included a total of 487 patients diagnosed with laryngeal carcinoma undergoing either a laryngectomy or salvage surgery after conservative interventions at the ENT Unit of Federico II University in Naples, Italy, between 2011 and 2021. Following a minimum 2.5-year follow-up and a maximum 21-year follow-up, the results revealed that only 38 patients suffered a stomal recurrence. Results: Despite various adopted treatment strategies, the literature reports lower patient survival rates. Following a total laryngectomy, stomal recurrence represents a therapeutic management challenge due to a poor prognosis for nearly every treated case. According to the literature, in fact, despite a low incidence (ie, 0.8–31.3%), the overall mortality rate increases from 77% to 100% after three years. Nevertheless, introducing immunotherapy into cancer treatment has resulted in an observable revolution in the treatment of different types of cancers over the years. Conclusion: In light of recorded data on survival following the use of the nivolumab, the case presented in this study allows a new perspective of successfully treating recurrences of squamous carcinoma of the head and neck. © The Author(s) 2022

Postoperative infectious complications in head and neck cancer surgery

Aim: In our work we have considered the problems related to the post-operative hospitalization in patients admitted to our ENT's department in the last 4 years. Material of study: Our observations refer to a sample of 155 patients suffering from head and neck tumors. Results: Regarding therapy, some drugs have been less effective to prevent post-operative infection: the ceftriaxone at the level of the oral cavity/oropharynx and ceftriaxone/pefloxacin at the level of the hypopharynx/larynx. Discussion: Post-operative infections in cancer surgery can compromise not only the surgical outcome but also be responsible for delays for any adjuvant treatments. Post-operative infections risk in head-neck cancer surgery drops from 30- 80 % to 20 % with perioperative antibiotic prophylaxis. Despite the introduction of pre-operative prophylaxis , according to guidelines, the number of post-surgical infections still remains high (40/61% of cases). It is important to know the intrinsic risk factors (related to the patient) and extrinsic (related to the external environment and the same procedure) to better understand how to prevent infections. Prolonged hospitalization can expose patients to the risk of hospital pathogens. Conclusion: We tried to outline a profile of head-neck cancer patients more likely to contract post-operative infections. We also compared the effects of various antibiotics administered before and after the onset of complications to suggest a therapeutic protocol. Key words: Antibiotics therapy Post-operative infectious, Prophylaxis in head and neck surgery

Small-Cell Carcinoma of Nasopharynx: A Case Report of Unusual Localization

Neuroendocrine tumors are a spectrum of rare and highly heterogeneous neoplasms with distinct functional and biological behavior in relation to location, tumor size, and histological differentiation. Neuroendocrine tumors arise from the neuroendocrine cells of the diffuse neuroendocrine system located in almost every organ. Neuroendocrine tumors in the head and neck district are usually reported in sinonasal cavities and larynx. We present the case of a nasopharyngeal small-cell neuroendocrine carcinoma, which, as far as we know, is the 16th case reported in literature

Intralabyrinthine Schwannoma of the Intravestibular Subtype: A Difficult Diagnosis

Intralabyrinthine schwannoma is a rare, slow-growing, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. It can be located in the vestibule, cochlea, or semicircular canals. In 2004, Kennedy et al proposed a classification system which recognized 7 subtypes of intralabyrinthine schwannoma; in 2013, Abel et al1 modified the Kennedy classification,2 which included intracochlear, intravestibular (IV), intravestibulocochlear, transmodiolar, transmacular, transotic, and tympanolabyrinthine, to also include translabyrinthine, tumors extending into the CPA, and tumors not otherwise specified. They also proposed to rename intralabyrinthine schwannoma as primary inner ear schwannoma to permit clear subsite categorization. Patients usually have nonspecific symptoms, including hearing loss, tinnitus, and only single episode of vertigo. Among the resulting symptoms, the most frequent is hearing loss, which affects 95% of the patients. Most times, this loss is slow and progressive, but it may be sudden or fluctuating. Less common symptoms include tinnitus (51%), imbalance (35%), vertigo (22%), and ear fullness (2%), which may be present alone or in combination.3-7 We report a rare case of a patient with hearing loss and single episode of vertigo secondary to the intralabyrinthine schwannoma of the IV subtype

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Objective: The objective of our study was to compare our experience of intracapsular tonsillotomy performed with the help of a microdebrider usually used for adenoidectomy with results obtained from extracapsular surgery through dissection and from adenoidectomy in cases of people affected with OSAS, linked to adeno-tonsil hypertrophy, observed and treated in the last 5 years. Methods: 3127 children with adenotonsillar hyperplasia and OSAS-related clinical symptoms (aged between 3 and 12 years) underwent tonsillectomy and/or adenoidectomy. A total of 1069 patients (Group A) underwent intracapsular tonsillotomy, while 2058 patients (Group B) underwent extracapsular tonsillectomy, from January 2014 to June 2018. The parameters considered in order to evaluate the effectiveness of the two different surgery techniques taken into consideration were as follows: the presence of possible postoperative complications, represented mainly by pain and perioperative bleeding; the level of postoperative respiratory obstruction compared with the original obstruction through night pulse oximetry, performed 6 months before and after the surgery; tonsillar hypertrophy relapse in Group A and/or the presence of residues in Group B with clinical evaluation performed 1 month, 6 months, and 1 year after the surgery; and postoperative life quality, evaluated through submitting to parents the same survey proposed before the surgery 1 month, 6 months, and 1 year after the surgery. Results: Regardless of the technique used (extracapsular tonsillectomy or intracapsular tonsillotomy), there was a clear improvement in both the obstructive respiratory symptomatology and quality of life in both patient groups, as highlighted by the pulse oximetry and the OSA-18 survey submitted later. Conclusions: Intracapsular tonsillotomy surgery has improved in terms of a reduction in postoperative bleeding cases and pain reduction, with an earlier return to patients’ usual lifestyle. Lastly, using a microdebrider with the intracapsular technique seems to be particularly effective in removing most of the tonsillar lymphatic tissue, leaving only a thin border of pericapsular lymphoid tissue and preventing lymphoid tissue regrowth during one year of follow-up