Laryngeal and hypopharyngeal cancer: Ten-year experience

Otolaryngology– Head and Neck Surgery Volume 131 Number 2

Scientific Posters

P214 Latex Allergy of Healthcare Workers Yusuke Suzuki,

MD

(presenter); Nobuo Ohta,

MD;

Shinichi

Sakurai, MD; Masaru Aoyagi, MD Yamagata Japan; Yamagata Japan; Germantown

MD;

Yamagata-Ken Japan

Objectives: Latex allergy has been recognized to be an important problem and to be associated with serological cross-reactivity to inhalant and plant food. We investigated specific IgE sensitization for latex allergen, inhalant allergens, and food allergens in health care workers. Methods: Serum samples of 6 health care workers were investigated: 3 doctors, 1 nurse, and 2 students. All had a history of latex allergy. Samples were analyzed for IgE antibodies against latex allergen, 2 common inhalant allergens (taxodiaceae and betula platyphylla), and 10 plant food allergens (corn, peach, banana, melon, orange, kiwi, avocado, tomato, carrot, and potato). Results: A specific IgE antibody for latex allergen and taxodiaceae allergen was found in 3 cases. One case presented specific IgE sensitization for betula platyphylla, corn, orange, tomato, carrot, and potato. Conclusion: Determination of specific IgE was not always a sensitive neither a specific test to establish the diagnosis of these allergies. And some health care workers suffer from a latex allergy which often associate inhalant and food allergies. So we as health care workers need to be concerned with not only latex, but also inhalant and food. And we should keep in the mind that health care workers use low protein, powder-free gloves to reduce the prevalence of latex allergy.

P215 Papillary Adenocarcinoma with Oncocytic Features Arising from the Ethmoid Sinus Brennan Thomas Dodson, MD (presenter); Bruce W Jafek, Sherif Said, MD PhD Denver CO; Denver CO; Denver CO

MD;

Objectives: We report a case of low-grade papillary adenocarcinoma with unique oncocytic features arising in the ethmoid sinus of a 72-year-old female. Methods: A review of the case history, pathological findings, and medical literature is performed. Results: A 72-year-old female presented with a 2-month history of progressive right-sided nasal obstruction. Preoperative nasal endoscopy showed a glistening, pink-red, soft mass arising from the middle meatus suspicious for inverting papilloma. Paranasal CT revealed a soft tissue density opacifing the right ethmoid sinus with ipsilateral maxillary and frontal sinus opacification. Complete endoscopic sphenoethmoidectomy was performed. Pathological examination of the surgical specimen revealed a low-grade papillary adenocarcinoma with oncocytic features. Special staining for MIB-1, p53, and Ki-67 was confirmatory. One year following surgical resection, nasal endoscopy revealed a recurrent mass in the surgical field; paranasal CT was confirmatory. A completion external and endoscopic ethmoidectomy was performed with complete removal of the neoplasm. Pathological examination revealed recurrent low-grade papillary adenocarcinoma. At 3 months postoperatively, the patient remains free from recurrent neoplasm. Conclusion: The management of ethmoid adenocarcinoma is dependent on the extent of disease and its pathological characteristics. Locally aggressive low-grade neoplasms, such as inverting papilloma, have been successfully treated with complete endoscopic resection with good rates of local control. Similarly, low-grade papillary adenocarcinoma has been successfully treated with endoscopic resection. In this case report, a rare oncocytic form of papillary adenocarcinoma is described that behaves similarly to other low-grade sinonasal papillary adenocarcinomas. Meticulous endoscopic surgical resection must be performed as local recurrence is common. P216 Laryngeal and Hypopharyngeal Cancer: Ten-Year Experience M Pia Vallejos, MD (presenter); Marcelo Pradenas, MD; Maritza Rahal, MD; Ariel Cisternas, MD; Wilma T Anselmo-Lima, PhD (presenter) Santiago Chile; Santiago Chile; Santiago LR Chile; San Miguel Chile; Sao Paulo Brazil

Objectives: Analize the data of our center in the 1990 –2001 period in terms of location, histology, treatment, and survival. Determine potential improvement areas from this data. Methods: This is a retrospective descriptive study. We

POSTERS

6-day-old newborn male with presumed meconium aspiration who underwent deep suctioning of the trachea at birth. The child subsequently developed inspiratory stridor soon after birth. Nasopharyngoscopy revealed a pale polypoid mass arising from the left laryngeal ventricle. Results: With a presumptive diagnosis of vocal cord granuloma, the patient was initially treated with steroids. There was no change in the mass size after several days of steroid treatment. The child underwent direct laryngoscopy and the mass was excised using cupped biopsy forceps. Pathological examination of the mass revealed herniated ventricular tissue into the larynx with central necrosis. Conclusion: From our review of the literature, this is the first reported case of ventricular mucosal herniation causing stridor in a newborn. The differential diagnosis of newborn stridor and treatment courses are discussed.

P309

Scientific Posters

searched our database to obtain the clinical records of patients admitted in the ENT department of Barros Luco Trudeau Hospital, Santiago, Chile, from 1990 to 2001. Selected information was extracted from this records and analized statistically. Results: A total of 86 records were completed and then selected for the study; 93% of patients were male and 7% female. The most frequent location was transglottic (32.6%) followed by the glottic location (31.4%). Smoking was found in 86% of the patients while alcohol consumption in 50%. The 5-year survival was 75% for the glottic location, 37.5% for supraglottic, 57.1% for transglottic, and 100% for hypopharyngeal tumors. Conclusion: The location frequency found in this study differs from that reported by most of the authors and we must confirm this with prospective protocols. Our survival rate is lower than reported in literature. That could be explained by the high proportion of advanced tumors that we admit in our center. Given the low percentage of complete records, we have to improve our registry system.

P217 Venous Malformation of the Sternomastoid Muscle: A Case Report and Review Erik H Waldman, MD (presenter); David Goldenberg, MD; Joseph Califano, MD; James J Sciubba, DMD, PhD; David E Tunkel, MD Perry Hall MD; Baltimore MD; Baltimore MD; Baltimore MD; Baltimore MD

Objectives: Intramuscular venous malformations occur rarely in the head and neck. Only 11 cases involving the sternomastoid muscle have been reported. Methods: We present a case involving a 12-year-old female. We review the literature and discuss diagnostic and therapeutic aspects of this unusual entity. Results: Definitive evaluation of venous malformations of the head and neck skeletal muscles is best accomplished with T1- and T2-weighted magnetic resonance imaging coupled with the clinical history and physical exam. Complete surgical excision is recommended and is usually curative, with little morbidity. Our patient first presented at the age of 4 with a nontender neck swelling within the sternomastoid muscle. The mass had enlarged dramatically by age 12, thereby necessitating surgical excision. Fine needle aspiration yielded gross blood. The mass was hyperintense on a T2-weighted magnetic resonance image consistent with a vascular malformation. Transcervical surgical excision was performed, dissecting the mass from feeding vessels within an envelope of attenuated sternomastoid muscle, preserving the spinal accessory nerve. Histologic evaluation revealed medium-sized and thin-walled channels that were lined with a flattened endothelial layer and surrounded by a poorly developed and variably evident smooth muscle sheath, consistent with a venous

malformation. She is doing well now 4 months after surgery without signs of recurrence or functional compromise. Conclusion: Venous malformations of skeletal muscle are frequently labeled as intramuscular hemangiomas. These are more accurately called intramuscular venous malformations based on clinical imaging and pathologic criteria. We add the twelfth case of a venous malformation of the sternomastoid muscle to the literature. P218 A Case of Radiation-Induced Spindle Cell Sarcoma of Tongue Masahiko Takeda, MD (presenter); Meijin Nakayama, MD; Kazuo Yao, MD; Makito Okamoto, MD Sagamihara Japan; Kanagawa Japan; Sagamihara Japan; Sagamihara Japan

Objectives: Sarcoma arising from tongue is rare. We have experienced a case of sarcoma possibly induced by previous radiation to the oral cavity. The clinical course and the management of this tumor is presented Methods: A 70-year-old male received chemoradiotherapy to his mesopharyngeal cancer (T3N1M0) in December 2000. The patient was well until July 2003 when he has had a rapidly growing mass lesion arising from the right edge of tongue. A couple of biopsies were done and the pathology showed granulation without malignancy. Because of the further rapidly growing tumor mass in October 2003, a radical excision of the tumor was done. Results: A 7 ⫻ 4 ⫻ 5.5 cm grayish elastic hard tumor was removed from his oral cavity. The tumor invaded deeply into the tongue and hence the right one third of the tongue was excised along with the tumor. Histopathologically, the tumor showed interwoven spindle-shaped cells with marked atypia. Part of the spindle cells infiltrated into the tongue tissues. Immunohistochemical stains showed AE1(-), CAM5.2(-), Vimentin(⫹), f¿-SMA(⫹). Radiation-induced spindle cell sarcoma was most suspected. Conclusion: We have experienced a case of spindle cell sarcoma possible induced by the previous radiation. Radical excision is crucial in the treatment of this tumor. P219 A Case of Primitive Neuroectodermal Tumor (PNET) of the Larynx Shunsuke Miyamoto, MD (presenter); Hisaya Nakadate, MD; Meijin Nakayama, MD; Kazuo Yao, MD; Makito Okamoto, MD Saitama Japan; Sagamihara Japan; Kanagawa Japan; Sagamihara Japan; Sagamihara Japan

Objectives: PNET (Primitive neuroectodermal tumor) is a malignant neoplasm that originates from the cells of the primitive neural crest. PNET mainly occurs in the brain, extremities, pelvis, and the chest wall. PNET in the cerebellum is also called medulloblastoma. The peripheral PNET is part of the Ewing’s

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Otolaryngology– Head and Neck Surgery August 2004