Differential diagnosis of laryngeal spindle cell carcinoma and inflammatory myofibroblastic tumor – report of two cases with similar morphology

BACKGROUND: Spindle cell tumors of the larynx are rare. In some cases, the dignity is difficult to determine. We report two cases of laryngeal spindle cell tumors. CASE PRESENTATION: Case 1 is a spindle cell carcinoma (SPC) in a 55 year-old male patient and case 2 an inflammatory myofibroblastic tumor (IMT) in a 34 year-old female patient. A comprehensive morphological and immunohistochemical analysis was done. Both tumors arose at the vocal folds. Magnified laryngoscopy showed polypoid tumors. After resection, conventional histological investigation revealed spindle cell lesions with similar morphology. We found ulceration, mild atypia, and myxoid stroma. Before immunohistochemistry, the dignity was uncertain. Immunohistochemical investigations led to diagnosis of two distinct tumors with different biological behaviour. Both expressed vimentin. Furthermore, the SPC was positive for pan-cytokeratin AE1/3, CK5/6, and smooth-muscle actin, whereas the IMT reacted with antibodies against ALK-1, and EMA. The proliferation (Ki67) was up to 80% in SPC and 10% in IMT. Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information. After resection, the patient with SPC is free of disease for seven months. The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery. CONCLUSION: Differential diagnosis can be difficult without immunohistochemistry. Therefore, a comprehensive morphological and immunohistochemical analysis is necessary, but markers of cell cycle (apart from the assessment of proliferation) do not help

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 1: study population, injury specification and classification

Objectives The objective of the first part of this retrospective multicentre study was to identify and classify common calcaneal tendon (CCT) injuries in a study population of 66 cats. Methods The medical records of five different small animal referral centres and veterinary teaching hospitals between 2010 and 2020 were reviewed. In addition to patient-specific data, CCT injuries were characterised in detail. Diagnostic modalities and further comorbidities were recorded. Results Sixty-six cats met the inclusion criteria. The mean age of the cats was 7.5 years (range 0.5–16.3) and their mean body weight (BW) was 4.6 kg (range 1.5–9.0). Thirty-four spayed females (51.5%), five intact females (7.6%) and 27 castrated males (40.9%) were included. Most cases involved closed injuries of the CCT (69.7%). Twenty-one of 46 cats had closed atraumatic injuries (45.7%). Open injuries (30.3%) were most commonly lacerations (65%). Twenty-one injuries were classified as atraumatic (31.8%), whereas 25 were traumatic (37.9%). With every year of age, the odds of having an atraumatic injury increased by a factor of 1.021. Cats with atraumatic injuries had a higher mean BW than cats with traumatic injuries, but the difference was not statistically significant. Acute injuries were recorded in 40.9% of cases, whereas 51.5% of cats had a subacute CCT injury and 7.6% had chronic lesions. Most acute lesions were Meutstege type I injuries (55.6%). Subacute and chronic lesions were more commonly Meutstege type IIc injuries (58.8% and 60%, respectively). Considering all CCT injuries, a Meutstege type IIc injury was most common (53%). Conclusions and relevance The most common type of injury was Meutstege type IIc. Cats with atraumatic injuries had a higher mean BW than cats with traumatic injuries, but the difference was not statistically significant. Older cats more commonly presented with atraumatic CCT injuries

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes

Objectives The aims of the second part of this retrospective multicentre study were to describe the surgical techniques used in the treatment of common calcaneal tendon (CCT) injuries, and evaluate the short- and long-term outcomes and complications. Methods The medical records of five different small animal referral centres and veterinary teaching hospitals between 2010 and 2020 were reviewed. Surgical vs conservative treatment was evaluated. Treatment type, type of postoperative immobilisation, and short- and long-term outcomes and complications were recorded. Minor complications were defined as not requiring surgical intervention. Long-term outcome was evaluated by an owner questionnaire. Results Sixty-six cats met the inclusion criteria. Mean time to surgery was 9.6 days (range 0–185). Most cats (83.3%) were treated surgically. Regardless of treatment modality, all limbs were immobilised for a mean time of 48.2 days (range 2–98). For 63 cats that had the temporary tarsal joint immobilisation technique recorded, a transarticular external skeletal fixator (ESF; 57.1%) or a calcaneotibial screw (33.3%) were used most commonly. The method of immobilisation had a notable, although non-significant, influence on the occurrence of short-term complications, with most complications being reported for the transarticular ESF group. The total short-term complication rate was 41.3%, the minor complication rate was 33.3% and the major complication rate was 7.9%, with pin tract infections being the most commonly occurring minor complication. Three cats (6%) had a total of four major complications over the long term. Most cats (86%) were free of lameness at the long-term evaluation, with an overall successful clinical long-term outcome of 84.9%, according to the owner questionnaire. Cats with traumatic injuries and injuries treated surgically had higher questionnaire scores than those with atraumatic injuries and those treated conservatively. Conclusions and relevance Outcome was generally good in cats with CCT injury, irrespective of the type of treatment. Complications included a high proportion of minor complications associated with the technique of tarsal joint immobilisation. ESF frames were more commonly involved in complications than other techniques. Surgically treated cats had a slightly better long-term outcomes

Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?

<p>Abstract</p> <p>Background</p> <p>In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries.</p> <p>Methods</p> <p>Seventy patients with acute Quebec Task Force (QTF) grade II whiplash injuries were randomized to two therapy groups and received either active (APT) or passive (PPT) physical therapy. Patients were compared with regard to pain and range of motion with data obtained in an earlier study from a group with grade II whiplash injuries in which the therapy recommendation had been "act as usual" (AAU; n = 20). The above-mentioned parameters were assessed at 24 hours and two months after the injury. Furthermore patients' period of disability was documented after two months.</p> <p>Results</p> <p>After two months, patients in both the APT and PPT groups showed significant improvement in the median period of disability (active: 14 days; passive: 14 days) compared to the AAU group (49 days). No group difference was observed with regard to median improvement in range of motion (active: 120°; passive: 108°; activity as usual: 70°). The median pain reduction was significantly greater in the APT group (50.5) than in the PPT (39.2) or AAU group (28.8).</p> <p>Conclusion</p> <p>Our data show that active physical therapy results in enhanced pain reduction and shortening of post-injury disability. Therefore, active physical therapy should be considered the treatment of choice in patients with QTF grade II whiplash injuries.</p> <p>Trial registration</p> <p>The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.</p

Perioperative changes in osteopontin and TGFβ1 plasma levels and their prognostic impact for radiotherapy in head and neck cancer

Background: In head and neck cancer little is known about the kinetics of osteopontin (OPN) expression after tumor resection. In this study we evaluated the time course of OPN plasma levels before and after surgery. Methods: Between 2011 and 2013 41 consecutive head and neck cancer patients were enrolled in a prospective study (group A). At different time points plasma samples were collected: T0) before, T1) 1 day, T2) 1 week and T3) 4 weeks after surgery. Osteopontin and TGFβ1 plasma concentrations were measured with a commercial ELISA system. Data were compared to 131 head and neck cancer patients treated with primary (n = 42) or postoperative radiotherapy (n = 89; group B1 and B2). Results: A significant OPN increase was seen as early as 1 day after surgery (T0 to T1, p < 0.01). OPN levels decreased to base line 3-4 weeks after surgery. OPN values were correlated with postoperative TGFβ1 expression suggesting a relation to wound healing. Survival analysis showed a significant benefit for patients with lower OPN levels both in the primary and postoperative radiotherapy group (B1: 33 vs 11.5 months, p = 0.017, B2: median not reached vs 33.4, p = 0.031). TGFβ1 was also of prognostic significance in group B1 (33.0 vs 10.7 months, p = 0.003). Conclusions: Patients with head and neck cancer showed an increase in osteopontin plasma levels directly after surgery. Four weeks later OPN concentration decreased to pre-surgery levels. This long lasting increase was presumably associated to wound healing. Both pretherapeutic osteopontin and TGFβ1 had prognostic impact

Lymphangiosis carcinomatosa in squamous cell carcinomas of larynx and hypopharynx – value of conventional evaluation and additional immunohistochemical staining of D2-40

<p>Abstract</p> <p>Background</p> <p>Recent studies revealed a predictive value of lymphatic vessel invasion (L1) for the nodal metastasizing and poor prognosis in malignant tumors at different sites. The monoclonal antibody D2-40 (podoplanin) stains specifically endothelial cells of lymphatic vessels and improves the search for L1. However, the importance of this immunohistochemical staining was not investigated in squamous cell carcinomas (SCC) of larynx and hypopharynx.</p> <p>Aim</p> <p>This study was performed to compare the diagnostic potential of convential and immunohistochemical determination of L1 in SCC of larynx and hypopharynx with special respect to the predictive value for nodal metastasizing and prognosis.</p> <p>Methods</p> <p>119 SCCs of the larynx (n = 70) respectively hypopharynx (n = 49) were investigated. The lymphatic vessel invasion was assessed by conventional method (HE stain) and immunohistochemical staining with an antibody against D2-40 (DAKO, Germany). Immunohistochemistry was performed in accordance with manufacturer's protocol. L1 was searched microscopically in a standardized magnification (×200) in serial sections of tumor samples (1 section per cm tumor diameter).</p> <p>Results</p> <p>The immunohistochemical investigation did not show significant advantages for the prediction of regional nodal metastases. Despite a low sensitivity (< 50%) in both methods, the specifity can reach 80%. The negative predictive value in both methods seems acceptable (up to 80%), whereas the positive predictive value is not higher than 64%. Cases with L1 detected either conventionally or immunohistochemically did not show a significant shorter survival than cases with L0. However, a non-significant shorter survival was found. Only in SCC of hypopharynx, a combination of both methods revealed patients with a significant worse prognosis.</p> <p>Conclusion</p> <p>The status of lymphatic vessel invasion should be documented in standardized tumor reports. A benefit of an additional immunohistochemical investigation was not found, for the daily routine HE-stain seems sufficient.</p

Elektromyographische Veränderungen im Therapieverlauf bei Patienten mit funktionellen Störungen der Muskulatur nach akuter HWS-Beschleunigungsverletzung (QTF II°)

Einleitung: Im Zeitalter des ständig zunehmenden Individualverkehrs stellt die HWS-Distorsion nach Beschleunigungsunfällen eine sehr häufige Verletzung dar. Sie ist aus therapeutischer, diagnostischer und versicherungswirtschaftlicher Sicht von großer Bedeutung. Mittels konventioneller bildgebender Diagnostik lassen sich morphologische Schäden schnell ausschließen, diese liegen jedoch lediglich bei 5 - 7 % der Patienten vor. Methoden: 35 Patienten mit akuten HWS-Beschleunigungsverletzungen (QTF II°) wurden untersucht. Anhand der klinischen Parameter "Bewegungseinschränkung" und "Neck-Pain-and-Disability-Scale" wurden die Patienten als gesund oder krank eingestuft. Es wurde ein intramuskuläres Fine-Wire-EMG des m. semispinalis capitis während Flexion / Extension abgeleitet und als "normal" oder "pathologisch" klassifiziert. Nach 8 Wochen Physiotherapie wurden die Patienten nach dem gleichen Schema nachuntersucht. Die klinische und die elektromyographische Klassifikation wurden miteinander verglichen und die Spezifität und Sensitivität bestimmt. Ergebnisse: Direkt nach dem Unfall lagen "pathologische" Veränderungen bei 30 von 35 klinisch kranken Patienten vor (Sensitivität 86 %). Nach 8 Wochen Therapie zeigten 7 von 10 klinisch kranken Patienten ein "pathologisches" EMG (Sensitivität 70 %). Von den 20 gesunden Patienten nach Therapie zeigten 12 ein "normales" und acht ein "pathologisches" EMG (Spezifität 60 %). Zusammenfassung: Veränderungen muskulärer Aktivitätsmuster treten direkt nach einer Beschleunigungsverletzung der HWS mit großer Konstanz auf und entsprechen den muskulären Veränderungen, wie sie bei chronischen HWS-Patienten beobachtet wurden. 8 Wochen nach dem Unfall stehen muskuläre Aktivitätsmuster in einem geringeren Zusammenhang mit der klinischen Symptomatik als initial. Zur Beurteilung dieser Situation müssen daher außer biologischen auch soziale und psychologische Faktoren der Schmerzverarbeitung herangezogen werden

Surgical management of lateral neck abscesses in children: a retrospective analysis of 100 cases

Cervical abscesses are relatively common infections in pediatric patients. There is an ongoing debate about the necessity and time point of surgical drainage. The identification of a focus of infection might play an important role in facilitating a therapeutic decision. In a retrospective study, 100 pediatric patients aged 1–18 years who underwent incision and drainage of a lateral cervical abscess at our institution were analyzed. Patients were divided into two groups based on whether a focus of infection could be identified or not. Data collection included patient characteristics, microbiological results, antibiotic regimen, and clinical course. A focus of infection was found in 29% (29/100) of the patients, most frequently in the tonsils. A causative microorganism was found in 75% (75/100) of all patients, with Staphylococcus aureus and Streptococcus pyogenes being the most common pathogens. All patients received an empiric antibiotic therapy in addition to surgery. Antibiotic medication was changed in 31% in both groups (9/29 with a focus of infection and 22/71 without a focus of infection) during therapy. Children without an identified focus of infection generally were younger and had more comorbidities reducing immune response while also showing differences in the pathogens involved. There were no complications associated to surgery or antibiotic therapy in any of the patients involved. Conclusion: Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding the microorganisms involved. But the focus of infection seems not to have an impact on patient’s outcome. What is Known: • Neck abscesses are a relatively common disease in the pediatric population and may cause serious complications. • Therapy in general consists of intravenous antibiotics with or without surgery. What is New: • The focus identification has no impact on patient’s outcome. • Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding their medical history, age, and the microorganisms involved