Henrique Olival Costa

Granular cell tumor of the larynx in children: a case report

The granular cell tumor (GCT) is an uncommon neoplasm, with slow progression, usually benign, that can be found in any organ. The most common region for GCT involvement is in the head and neck. Laryngeal involvement is uncommon and accounts for 6 to 10% of all cases reported. Among the major theories of origin and based on the strongest evidence, the most accepted one is that the tumor stems from neuronal tissue. The GCT has a higher incidence in African-descendent patients, and most commonly in their 4th and 6th decades of life. The posterior larynx is the most common laryngeal site. Pediatric laryngeal GCT is rare, anterior subglottis involvement has been described and extensive glottic involvement may occur. Affected patients typically present with hoarseness, dysphagia, cough, haemoptysis, stridor and pain. The GCT presents as a small, firm nodule, sessile or polypoid, with intact mucosa, well outlined but not encapsulated. Cytoplasm granules are typically seen under light microscopy, and the cells are positive for S100 immunoperoxidase and neuron-specific enolase. Treatment of laryngeal GCT is based on surgical excision. This paper describes a pediatric patient with GCT and its clinical course before and after surgical treatment, stressing the importance of GCT diagnosis in the pediatric population. We review clinical course, pathology characteristics and treatment.

Infectious granulomatous laryngitis: a retrospective study of 24 cases.

The diagnostic and treatment of verrucous lesions of the larynx involves a high level of suspicion by the physician attending the patient. The causes may go from unspecific laryngitis to neoplasia and granulomatous diseases. This kind of lesion is uncommon and the presentation aspects may vary broadly. The lesions in larynx are significant source of morbidity. The onset of symptoms is insidious and the diagnosis is usually delayed. Symptoms include dysphonia, dyspnea, dysphagia and odynophagia. Proper treatment depends upon tissue biopsy, identification of the causative organism, and the appropriate pharmacotherapy. As there are few papers presenting the clinical features of infectious granulomatous laryngitis (IGL) as leishmaniasis, tuberculosis and paracoccidiodomycosis affecting the larynx, we considered important to show the experience of a big Brazilian Laryngology Service in dealing with this potential worldwide problem. We present a retrospective chart review showing our institution’s experience with IGL focusing in the diagnostic, treatment and prognosis aspects. Twenty-four patients were identified. Mycobacterium tuberculosis and Paracoccidiodis brasiliensis accounted for ten cases each, and Leishmania braziliensis the remaining four. Hoarseness was the most common symptom of infection. Up to one-third of patients with laryngeal involvement lacked laryngeal symptoms. The average delay from onset of symptoms to diagnosis was 7xa0months. All patients underwent direct laryngoscopy and biopsies. Caseating granulomas was the key histopathologic finding. Identification of the causative organism was uncommon. No evidence of concomitant malignancy was seen on biopsy. Despite treatment, almost 40% of patients had permanent sequelae of infection, including hoarseness, dyspnea, and dysphagia. Mycobacterium tuberculosis, P. brasiliensis, and L. braziliensis accounted for all cases of IGL. Patients may have laryngeal infection but lack laryngeal symptoms. Prompt diagnosis relies upon a high index of suspicion, especially when evaluating patients from endemic areas. Given the degree of tissue destruction, which accompanies infection, timely intervention may be important in the prevention of late sequelae. Despite appropriate therapy, a significant number of patients may have permanent sequelae of infection.

Experimental study of the tissue reaction caused by the presence of cellulose produced

Summary Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. Aim to study tissue reaction to cellulose in the dorsal nose of rabbits. Materials and Methods 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. Results The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. Conclusion The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Experimental study of the tissue reaction caused by the presence of cellulose produced by Acetobacter Xylinum in the nasal dorsum of rabbits

UNLABELLEDnSeveral materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose.nnnAIMnto study tissue reaction to cellulose in the dorsal nose of rabbits.nnnMATERIALS AND METHODSn22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate.nnnRESULTSnThe inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters.nnnCONCLUSIONnThe cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Tumor de células granulares da laringe na infância: relato de caso

The granular cell tumor (GCT) is an uncommon neoplasm, with slow progression, usually benign, that can be found in any organ. The most common region for GCT involvement is in the head and neck. Laryngeal involvement is uncommon and accounts for 6 to 10% of all cases reported. Among the major theories of origin and based on the strongest evidence, the most accepted one is that the tumor stems from neuronal tissue. The GCT has a higher incidence in African-descendent patients, and most commonly in their 4th and 6th decades of life. The posterior larynx is the most common laryngeal site. Pediatric laryngeal GCT is rare, anterior subglottis involvement has been described and extensive glottic involvement may occur. Affected patients typically present with hoarseness, dysphagia, cough, haemoptysis, stridor and pain. The GCT presents as a small, firm nodule, sessile or polypoid, with intact mucosa, well outlined but not encapsulated. Cytoplasm granules are typically seen under light microscopy, and the cells are positive for S100 immunoperoxidase and neuron-specific enolase. Treatment of laryngeal GCT is based on surgical excision. This paper describes a pediatric patient with GCT and its clinical course before and after surgical treatment, stressing the importance of GCT diagnosis in the pediatric population. We review clinical course, pathology characteristics and treatment.

Incidência de alterações estruturais das pregas vocais associadas ao pólipo de prega vocal

Phonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma. AIM: To prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP. MATERIAL AND METHODS: The charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions. RESULTS: Associated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement. DISCUSSION AND CONCLUSIONS: The high incidence of associated anatomical lesions to the VF (63%) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.

Determinação da prevalência de HPV em amostras de mucosa oral/orofaríngea em um distrito rural de São Paulo

UNLABELLEDnKnowledge about HPV infection in the oral cavity/oropharynx may contribute to the elucidation of the role it plays in Head and Neck Squamous Cell Carcinoma (HNSCC).nnnOBJECTIVEnTo determine the effectiveness of the methodology used for sampling the oral cavity and oropharynx mucosae and to determine the prevalence of HPV in the oral cavity and oropharynx of adults and children.nnnMETHODnThe study population was served by an assistance program in a rural district of São Paulo. The subjects were asked to donate samples regardless of complaints.nnnRESULTS AND CONCLUSIONnThe study included 47 men, 77 women and 22 children, of which the oral cavity samples were obtained by gargling with commercially-available antiseptic mouthwash. We found 3 positive samples (2.4%) in adults: 2 HPV 55 and one HPV 58. No positive results were found in children. Furthermore we concluded that the sampling method with the mouthwash proved effective and fast for the detection of HPV in the oral cavity and oropharynx in the general population.

The use of Maytenus ilicifolia to prevent cisplatin-induced ototoxicity

UNLABELLEDnMaytenus ilicifolia is a native plant from South America, with several medicinal properties including antioxidant effects.nnnAIMnusing an original cisplatin induced ototoxicity model, we evaluated a possible otoprotection caused by Maytenus ilicifolia extract.nnnMATERIALS AND METHODSnclinical and experimental study design with female albino guinea pigs divided in groups as follows: 9 animals receiving cisplatin only (three doses of 7.5mg/kg/day), 4 animals receiving the plant extract only, 10 animals receiving the cisplatin protocol and 1g/kg/day of extract for 8 days, 5 animals with cisplatin and 3g/kg/day of extract for 8 days, and 5 animals receiving extract for 3 weeks and cisplatin in the last week. The tests were distortion product otoacoustic emissions, brainstem auditory response, before and after medication and scanning electron microscopy.nnnRESULTSnthe animals receiving cisplatin plus plant extract, had alterations in all the tests, showing lesions on the basal cochlear region under electron microscopy.nnnCONCLUSIONSnDespite of the plant extracts antioxidant effect, it was not sufficient to protect the cochlea against cisplatin ototoxicity.

O uso de Maytenus ilicifolia na prevenção da ototoxicidade induzida pela cisplatina

Maytenus ilicifolia is a native plant from South America, with several medicinal properties including antioxidant effects. AIM: using an original cisplatin induced ototoxicity model, we evaluated a possible otoprotection caused by Maytenus ilicifolia extract. MATERIALS AND METHODS: clinical and experimental study design with female albino guinea pigs divided in groups as follows: 9 animals receiving cisplatin only (three doses of 7.5mg/kg/day), 4 animals receiving the plant extract only, 10 animals receiving the cisplatin protocol and 1g/kg/day of extract for 8 days, 5 animals with cisplatin and 3g/kg/day of extract for 8 days, and 5 animals receiving extract for 3 weeks and cisplatin in the last week. The tests were distortion product otoacoustic emissions, brainstem auditory response, before and after medication and scanning electron microscopy. RESULTS: the animals receiving cisplatin plus plant extract, had alterations in all the tests, showing lesions on the basal cochlear region under electron microscopy. CONCLUSIONS: Despite of the plant extracts antioxidant effect, it was not sufficient to protect the cochlea against cisplatin ototoxicity.

Incidence of structural vocal fold abnormalities associated with vocal fold polyps

UNLABELLEDnPhonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma.nnnAIMnTo prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP.nnnMATERIAL AND METHODSnThe charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions.nnnRESULTSnAssociated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement.nnnDISCUSSION AND CONCLUSIONSnThe high incidence of associated anatomical lesions to the VF (63%) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.