Filippo Carta

Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx.

Image‐enhanced endoscopy, such as narrow band imaging and the Storz Professional Image Enhancement System, have been increasingly used in patients with suspect lesions of the larynx and hypopharynx during preoperative and intraoperative assessment.

Endoscopic management of adult-type rhabdomyoma of the glottis: case report and review of the literature.

while glottic lesions are extremely rare, and only22 cases have been reported up to now. With this article we anadditionalcaseofglotticadult-typerhabdomyoma reviewthepertinentliterature,withtwoaims:(I)assess standard ofcare this pathology, to avoid inadequate and (II) increase its knowledge among surgeons pathologists.

Salivary Gland Pathology in IgG4-Related Disease: A Comprehensive Review

IgG4-related disease (IgG4-RD) is a rare fibroinflammatory condition that can affect almost any organ, characterized by swollen lesions and often by eosinophilia and elevated serum IgG4 concentrations. The diagnosis of IgG4-RD is a challenging task: in fact, single or multiple organs can be affected and clinical, serological, and histological findings can be heterogeneous. In IgG4-RD, the involvement of salivary glands is observed in 27% to 53% of patients. Several organ-specific conditions, now recognized as different manifestations of IgG4-related sialadenitis (IgG4-RS), were viewed in the past as individual disease entities. The study of salivary glands may sometimes be complex, because of the number of pathological conditions that may affect them, often with overlapping clinical pictures. Integration of different imaging techniques is often required in the case of swelling of salivary glands, even though biopsy remains the gold standard for a definite diagnosis of IgG4-RS. Thus, in this review, we discuss new insights in the pathogenesis of IgG4-RD, focusing on its clinical aspects and the tools that are currently available for a correct differential diagnosis when the salivary glands are involved.

Rhabdomyomatous mesenchymal hamartoma presenting as a polypoid lesion of the nasal skin in a child: answer

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital lesion of the dermis and soft tissue, first described in 1986 as a striated muscle hamartoma. It has been reported under various names: striated muscle hamartoma, congenital midline hamartoma, hamartoma of cutaneous adnexa and mesenchyme. Etiology of this lesion is unknown; it has been hypothesized that be due to an abnormal migration of mesodermal stem cells during embryiogenesis or to right genetic defects. Patients with RMH occasionally have other congenital defects. RMH usually presents as a polypoid or papular cutaneous lesion that ranges in size from a few millimeters to 1-2 cm and occurs in areas where there is a superficial striated muscle, as the nose, chin, periorbital and anterior neck areas. Here we report a case of RMH in a 2-year-old child presenting with a congenital polypoid mass on the nasal skin.

CO2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma

The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan–Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3–4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Three months after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery of swallowing is significantly worsened after total resection of the arytenoid. Modified type IVb procedure leaving intact, when possible, the inferior third of the arytenoid and consequently the glottic competence, improves functional outcome.

Atypical pleomorphic adenoma with chronic sialoadenitis of the submandibular gland: a case report in a child

A 12-year-old girl presented with an oval swelling in the left submandibular region. The tumor had gradually increased in size, during the last 9 months. Preoperative ultrasonography evidenced an hypoechoic oval mass, 14 x 12 mm in size. Submandibulectomy was performed. At macroscopy, the tumor was surrounded by a fibrous capsule, and appeared tan-white in color. At histology, an admixture of epithelial and mesenchymal cell components characterized the tumor. Epithelial cells showed large polymorphous atypical nuclei, with irregular nuclear membranes. The mesenchymal cells were embedded in a myxoid matrix, with focal areas of chondroid differentiation. The tumor showed pushing margins, focally extending into the fibrous capsule. Occasionally, some scattered foci of capsular pseudo-infiltration were detected. The proliferative index of tumor cells, detected by Ki67 immunostaining, reached levels around 10% in some tumor areas characterized by the highest frequency of atypical tumor cells. On these bases, a diagnosis of atypical pleomorphic adenoma was performed. A lymphocytic infiltrate, sometimes organized in lymphoid nodules, was observed in the surrounding submandibular gland. After 1 year of follow-up, the patient is in good health, in the absence of any recurrence. The case here reported confirms that tumors of the salivary gland occurring in children are characterized by a higher aggressive potential, here represented by the atypical tumor cells associated with the high proliferative index and with the pressure on the tumor capsule, and deserve the complete resection of the affected salivary gland, in order to prevent their potential malignant transformation. The association of the salivary gland tumor presenting in our patient with lymphocytic nodular sialoadenitis confirms previous reports of this peculiar association, and reinforces the hypothesis that the two conditions might share a common etiology.

Congenital remnants as a cause of neonatal respiratory impairment

Neonatal respiratory distress is a potentially life-threatening condition, representing a diagnostic and therapeutic challenge for physicians, especially when it is caused by rare pathologies. Head and neck remnants are benign congenital neoplasms rarely observed in newborns. Teratoma is the most common congenital tumor in childhood, while head and neck epithelial and mesenchymal hamartomas are uncommon. We report three cases of pharyngeal congenital remnants presenting with neonatal airway obstruction. We observed a 9-month-old, 35-day-old, and 15-hour-old patients, who have been referred to our Department of Otorhinolaryngology with acute airway distress. All the patients showed a pharyngeal benign lesion, since teratomas originated from the left lateral wall of the pharynx in two cases and one “fibrovascular” hamartoma originated from the base of the tongue. Timely surgical excision through transoral CO 2 laser microsurgery was curative in all the cases. Dyspnoea in newborns is a challenging condition and must be managed, when possible, by a well-trained paediatric team. When clinicians face obstructive airway congenital remnants, a timely and radical surgical excision is necessary to avoid potentially lethal asphyxia.

Metabolomic analysis of urine with Nuclear Magnetic Resonance spectroscopy in patients with idiopathic sudden sensorineural hearing loss: A preliminary study

OBJECTIVE Idiopathic sudden sensorineural hearing loss is a frequent emergency, with unknown aetiology and usually treated with empiric therapy. Steroids represent the only validated treatment but prognosis is unpredictable and the possibility to select the patients who will not respond to steroids could avoid unnecessary treatments. Metabolomic profiling of the biofluids target the analysis of the final product of genic expression and enzymatic activity, defining the biochemical phenotype of a whole biologic system. METHODS We studied the metabolomics of the urine of a cohort of patients with idiopathic sudden sensorineural hearing loss, correlating the metabolic profiles with the clinical outcomes. Metabolomic profiling of urine samples was performed by 1H Nuclear Magnetic Resonance spectroscopy in combination with multivariate statistical approaches. RESULTS 26 patients were included in the study: 5 healthy controls, 13 patients who did not recover after treatment at 6 months while the remaining 8 patients recovered from the hearing loss. The orthogonal partial least square-discriminant analysis score plot showed a significant separation between the two groups, responders and non-responders after steroid therapy, R2Y of 0.83, Q2 of 0.38 and p value <0.05. The resulting metabolic profiles were characterized by higher levels of urinary B-Alanine, 3-hydroxybutyrate and Trimethylamine N-oxide, and lower levels of Citrate and Creatinine in patients with worst outcome. CONCLUSION Idiopathic sudden sensorineural hearing loss is a specific disease with unclear systemic changes, but our data suggest that there are different types of this disorder or patients predisposed to effective action of steroids allowing the recover after treatment.

Parotid Masson's tumor: case report

Masson’s tumor, also known as ‘Masson’s vegetated intravascular hemangioendothelioma’, is a papillary hyperplasia of the endothelial vascular cells that generally develops in medium-sized veins, but may also be observed in all-sized veins and, less frequently, in arteries.1 Pierre Masson in 1923 first described this tumor in inflamed hemorrhoidal plexus and explained its pathogenesis as a primary endothelial proliferation of endothelial cells into the vessel lumen due to obstructive thrombosis, followed by degeneration and necrosis.2 Currently, it is considered a reactive vascular proliferation secondary to vascular stasis3 that can develop in tendons, head and neck, skin, intracranial, aero-digestive tract, intra-abdominal areas, genital tract, and fallopian canal; it is generally endovascular, but Pins et al.4 reported 13 patients presenting with a rare extravascular form. Corio et al. in 19825 reported 14 cases of head and neck Masson’s tumor, only one found in the parotid gland; clinical features were not detailed. To the best of our knowledge, this is the first well documented reported case of a Masson’s tumor of the parotid gland. The authors want ENT surgeons and pathologists to be aware of this entity.

Congenital dacryocystocele: case report

RESUMO: Introdução: A dacriocistocele congênita é uma coleção do fluido amniótico ou muco no saco lacrimal causada pela imperfuração da válvula de Hasner. A apresentação clínica é perinatal, apresentando-se como uma tumoração azulada na região cantal medial ou abaixo dela, acompanhada de epífora. Objetivo: Relatar os aspectos clínicos, acompanhamento e tratamento de um caso referente à Dacriocistocele congênita. Metodologia: Consiste em uma pesquisa de campo de caráter exploratório, tipo relato de caso com uma abordagem qualitativa. A população-alvo foi uma única paciente (recém-nascido) com história de Dacriocistocele congênita, por meio de sua genitora, procedente e residente na cidade de Cajazeiras (PB). O local do estudo foi a residência da mãe da criança, localizada nessa cidade. A coleta de dados foi realizada por meio de um roteiro de entrevista contendo perguntas objetivas e subjetivas com ênfase nos objetivos desse estudo. A pesquisa obedeceu de maneira integral os princípios éticos, de acordo com a Resolução 466/12 do Conselho Nacional de Saúde, que trata de pesquisas e testes envolvendo seres humanos. Resultados obtidos: O estudo realizou a análise da efetividade da implementação da massagem de Crigler no tratamento dessa afecção em crianças.