1/25. Inflammatory cutaneous metastasis from laryngeal carcinoma.The authors report the case of a 64-year-old man who presented with erythematous infiltrating plaques sited on his right supraclavicular and infraclavicular regions. Five years before a laryngeal epidermoid carcinoma had been surgically removed. After two years the patient underwent lymphadenectomy and radiotherapy for the presence of metastasis in his right cervical lymph nodes. He was disease free until two months before our examination when small red spots appeared on his right supraclavicular region, slightly enlarging. A skin biopsy was performed and histological examination showed the presence of metastatic cells inside dilated lymphatic vessels. Immunohistochemical markers showed only positive staining of atypical cells with monoclonal anti-cytokeratin antibodies (cytokeratin B-ORTHO=34betaE12) confirming the epithelial origin of metastastic cells. A diagnosis of inflammatory cutaneous metastasis from laryngeal epidermoid carcinoma was given. This type of metastasis has been frequently observed in patients with breast carcinoma and it has also been described during the course of other malignant tumours. Malignant tumour of the larynx generally spreads to regional lymph nodes or, through blood, to the lungs. skin metastasis have rarely been described, and always as multiple or solitary nodules. According to our knowledge this is the first case of inflammatory cutaneous metastasis from laryngeal epidermoid carcinoma reported in the literature.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/25. A diagnostic and therapeutic approach to paragangliomas of the larynx.BACKGROUND: Differentiating paragangliomas from moderately differentiated neuroendocrine carcinoma in the larynx is a difficult management problem. As the biological behavior of these 2 entities is different, we developed an algorithm for the preoperative diagnosis and treatment of this disease. DESIGN: The sample case from which the algorithm was developed consisted of a 69-year-old man who was transferred to us after tracheostomy and an attempt at biopsy for airway obstruction secondary to a vascular mass. biopsy resulted in substantial bleeding. Flexible laryngoscopy showed a vascular mass of the supraglottis. A computed tomographic scan showed 2 vascular masses at the carotid bifurcation and in the larynx. An arteriogram confirmed synchronous vascular tumors. RESULTS: The arteriogram showed the superior thyroid artery to be the major feeder vessel to this mass, a situation commonly seen in paragangliomas but not other neuroendocrine tumors. The presence of synchronous lesions and a vascular mass based on the superior thyroid artery helped differentiate paraganglioma from the other neuroendocrine tumors. As the biological behavior of paragangliomas is relatively benign, we performed a conservative supraglottic laryngectomy and excision of the carotid body tumor. Histologic diagnosis and immunohistochemical analysis confirmed the diagnosis of paraganglioma. CONCLUSIONS: The vascular nature of neuroendocrine tumors prevents preoperative pathological diagnosis. Radiologic features demonstrating a vascular mass with a dominant feeder vessel by the superior or inferior thyroid artery may help in the clinical diagnosis of paragangliomas of the larynx. Since paragangliomas are rarely malignant, a conservative surgical procedure should suffice.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/25. Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: a case report.BACKGROUND: radiation-induced damage to small and medium-sized vessels has been observed in both animals and humans. Changes may appear in the immediate postradiation period or many years later. In this case, we report an unusual presentation of bilateral radiation-induced carotid artery stenoses associated with pseudoaneurysms, and a previously unreported application of a recently established treatment. CASE DESCRIPTION: A 72-year-old African-American male presented with recurrent right hemispheric transient ischemic attacks (TIA) and neck pain. Thirteen years previously, the patient had received radiation therapy for laryngeal carcinoma. Diagnostic carotid angiography demonstrated moderate radiation-induced bilateral carotid artery stenosis and associated common carotid pseudoaneurysms. The patient was treated with bilateral endovascular stents and electrolytically detachable coils in staged procedures. At his most recent follow-up, there is no evidence of re-stenosis and the patient remains asymptomatic. CONCLUSIONS: This case illustrates a novel and successful treatment for the endovascular repair of post-radiation bilateral carotid artery stenosis and pseudoaneurysms. In our practice, we have seen three such cases of radiation-induced vasculopathy. Therefore, patients with a previous history of radiation therapy for head and neck neoplasms merit cautious monitoring and judicious use of stents and secondary coils, when necessary.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/25. myofibromatosis-like hemangiopericytoma metastasizing as differentiated vascular smooth-muscle and myosarcoma. Myopericytes as a subset of "myofibroblasts".A thyroid hemangiopericytoma that was resected in a 5-year-old boy recurred insidiously in the larynx 8 years later. Marked cicatricial mucosal inflammation prevented a definitive pathologic diagnosis of recurrence until a nodule grew to obstruct the airway 15 years after initial surgery. After excision of the nodule, a larger sarcomatous metastasis was discovered in the upper esophagus and resected, but the patient eventually succumbed to widespread disease at the age of 20 years. The original tumor contained atypical pericytes and bundles of hyalinizing smooth muscle abutting on "staghorn vessels," a pattern similar to infantile myofibromatosis. desmin immunostaining was negative in the pericytes but positive in smooth-muscle cells dispersed singly as well as in bundles. Both elements reacted strongly for vimentin and the alpha-isoform of actin (alpha-SMA) found in normal smooth muscle and pericytes. A third cell type showing dendritic processes and immunoreactivity for all three antigens was interpreted as a myopericyte. Spindled cells in multiple subsequent mucosal biopsy specimens stained retrospectively also positive for these antigens. Large bundles of vascular smooth muscle surrounded by radiating myocytes characterized the occluding laryngeal nodule. In the esophageal metastasis, which showed no histologic features typical of hemangiopericytoma, numerous mitotically active, small, vimentin , desmin , alpha-SMA cells often maintained shortened processes and tended to form nodular aggregates about capillaries. Single rows of pericytes accreted to endothelial tubes. Ultrastructurally, some cells contained myofilaments and irregular dense material or showed rare cell junctions and variable investment by a basal lamina.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/25. Extended latissimus dorsi musculocutaneous flaps for extremely wide cervical skin defects involving the cervical esophagus.Two cases using island distally and anteriorly extended latissimus dorsi musculocutaneous flaps for one-stage reconstruction of pharyngoesophageal defects of the entire front of the neck are reported. The advantage of this flap is its extremely large skin territory, which provides a reliable vascular supply. This flap is suitable for extremely wide cervical defects where the recipient vessels are damaged after severe infection and irradiation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/25. Limited Wegener's disease presenting as pharyngolaryngeal tumor.Wegener's disease (WD) which is mostly a systemic illness rarely presents as isolated, monoorganic, limited disease. Limited pharyngolaryngeal WD is thus a very rare occurrence. We report the case of a 29 years old man who developed a pharyngolaryngeal tumor with clinically benign evolution, histologically showing granulomatous inflammation and small vessel vasculitis, with no signs of: tuberculosis, sarcoidosis, fungal disease, Hodgkin's disease or foreign body aspiration. p-ANCA's were positive. He was considered a limited form of WD and treated with moderate doses of corticoids and cotrimoxazole. One month later, the lesion diminished significantly. The finding of a pharyngolaryngeal tumor with granulomatous inflammation and vasculitis, in the context of p-ANCA positivity and without any evidence for another systemic granulomatous disease, suggested the diagnosis of limited WD. The response to treatment favoured this presumption. Limited pharyngolaryngeal WD is a rare disease, with a potential for life-threatening (even fatal) complications. It should be recognized early and treated promptly. Remissions can be achieved (even without the use of cyclophosphamide).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/25. Extravascular papillary endothelial hyperplasia of the larynx: a case report and review of the literature.Papillary endothelial hyperplasia (PEH), a tumor that falls along the spectrum of reactive to neoplastic vascular lesions, must be diagnosed carefully because it can resemble an angiosarcoma. PEH is generally considered to be the result of an unusual form of thrombus organization, exhibiting excessive papillary endothelial proliferation that is usually confined to the lumen of preexisting vessels or vascular malformations. Most cases of PEH are of the intravascular type; extravascular PEH is rare. We describe what we believe is the first reported case of an extravascular PEH in the larynx.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/25. Laryngeal repair after resection of advanced cancer: an optimal reconstructive protocol.Tracheal autotransplantation allows for reconstruction of extended hemilaryngectomy defects after resection of laryngeal cancer. With this technique, optimal functional results were obtained after a learning curve of more than 50 patients. The objective of this paper is to present the final reconstructive concept with the typical indications. Unilateral glottic cancer and lateralized chondrosarcomas of the cricoid cartilage are resected with a hemilaryngectomy including one-half of the cricoid cartilage. After tumor resection, a radial forearm flap with a skin paddle and a fascial paddle are taken. The skin paddle restores the laryngeal defect temporarily, and the fascial paddle wraps the upper 4 cm of cervical trachea. A 'tracheostomy' is preserved in the area between the reconstructed larynx and the fascia-wrapped trachea. The radial forearm vessels are sutured to the neck vessels. After 4 months, the skin island of the radial forearm flap is removed from the defect and the revascularized, fascial enwrapped trachea is transplanted to the laryngeal defect. The tracheal continuity is re-established with preservation of a tracheostoma. The tracheotomy can be closed after 6 weeks. Two case reports are presented: a unilateral T3 glottic cancer and a chondrosarcoma of the cricoid cartilage. The two patients showed normal oral feeding 1 week after the operation. hand-free speaking was possible after closure of the tracheostomy. Tracheal autotransplantation after vascular induction of the trachea with the radial forearm flap leads to optimal repair of extended hemilaryngectomy defects.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/25. Reconstruction of a circular defect of the hypopharynx and cervical part of esophagus by a free jejunal flap (case report).patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx closure in an oncology patient with a larynx carcinoma. The patient is a 60-year-old male diagnosed in 2002 with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy and chemotherapy. In 2003 the patient underwent pharyngo - laryngectomy for relapse of the larynx carcinoma. Postoperatively the patient developed pharyngo - cutaneous fistula, which was reconstructed at the otorhinolaryngology department by a muscle - cutaneous flap from the pectoralis major muscle. During the course of healing the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended. The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to restart peroral intake.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/25. Surgical importance of highly located innominate artery in neck surgery.Massive hemorrhage is an unusual complication of tracheotomy, and the most common causes are injury to the anterior jugular veins and the thyroid isthmus, or unrecognized variations of the vascular structures, such as the arteria thyroidea ima. We present a case of high-running innominate artery that ascends until the third tracheal ring and courses horizontally anterior to the trachea in a patient with laryngeal carcinoma. If not noticed during tracheolaryngeal surgery, trauma to this vessel and subsequent hemorrhage may be fatal. In this report, the case is presented and the surgical significance of this anomaly is emphasized.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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