Lucio Rucci

Carcinoma of the anterior commissure of the larynx: II. Proposal of a new staging system.

On the basis of embryology and clinical experience, we have defined here an anterior commissure (AC) subsite of the human larynx and have addressed the issue as to whether the degree of involvement of this subsite is related to the outcome of glottic cancer, in terms of local control within 5 years of therapy. Retrospective analysis of 534 patients included 1) classification of patients according to the TNM, 2) actuarial evaluation of the outcome, 3) reclassification of patients according to the involvement of the AC subsite, and 4) ree valuation of the outcome according to this latter classification. The results showed that the outcome was not well correlated with TNM classification, whereas patients with progressively heavier involvement of the AC subsite had a progressively worse outcome. On the basis of these data, we suggest that TNM classification of cancer involving the AC be implemented by an AC classification, in order to better forecast the prognosis and design specific conservative surgery.

CO2 laser therapy in Tis and T1 glottic cancer: Indications and results

Laser cordectomy for glottic cancer is still hampered by recurrence, which is more frequent upon anterior commissure (AC) involvement. Analysis of results may be a step to improve the efficacy of this therapy for early glottic cancer.

Vidian nerve resection, histamine turnover and mucosal mast cell function in patients with chronic hypertrophic non-allergic rhinitis

Parasympathetic innervation of the respiratory tract of nasal mucosa plays an important role in the pathogenesis of chronic hypertrophic non-allergic rhinitis (C.H.N.A.R.), the vidian nerve providing the main parasympathetic nerve supply to respiratory mucosa. The present study investigates the effect of vidian nerve resection in 22 patient with intractable C.H.N.A.R. on histamine content and formation and on the number of mast cells and their degranulation in the respiratory tract. Samples were taken from respiratory mucosa for histamine and histidine-decarboxylase assay, and for microscopic observations for mast cell density and degranulation index, before and 12–24 months after vidian nerve resection. Neurectomy of the vidian nerve completely cured the clinical symptomatology, evaluated by rhinoreomanometry, and also significantly decreased both the high histamine levels and histidine-decarboxylase activity in patients with C.H.N.A.R. The density and degranulation index of mast cells were also significantly lower after surgery. These data suggest a relationship between cholinergic activity and the secretory response of mast cells and indicates a correlation between the parasympathetic nerve supply and chronic hyperthrophic non-allergic rhinitis. The significant reduction in mast cell density, histamine levels and histidine-decarboxylase activity also lends support to the hypothesis that the parasympathetic nerve supply plays a role in the regulation of mast cell histamine.

Epidermal growth factor receptor and p53 expression in T1–T2 glottic cancer involving the anterior or posterior commissure

Objective We surveyed retrospectively the expression of epidermal growth factor receptor (EGFR) and p53 in cases of T1–T2 glottis cancer involving the anterior (AC) or posterior commissure (PC) subsites to check for differences possibly explaining the different prognoses of cancer at these subsites. Material and Methods Between 1970 and 1995, 15 patients with T1–T2 primary glottis cancer involving the PC, either partly or entirely, were treated. Thirty more cases were selected among 184 patients treated during the same time period for AC glottis cancer, to match the former cases with regard to age, sex, tumor stage, smoking habits and alcohol consumption. Results A significantly higher frequency of EGFR expression occurred in PC than in AC cancer. Conclusion These results, and the anatomy of the PC subsite, may explain the more frequent recurrence of T1–T2 PC compared to T1–T2 AC cancer and why radiotherapy achieves worse results in T1–T2 PC cancer than in AC cancer of comparable T grade.

Does the epithelium play a central role in the immune function of rhinopharyngeal tonsils? An immunocytochemical and ultrastructural study

Enlarged adenoids from 10 children with chronic rhinitis and otitis media with effusion have been studied immunocytochemically and ultrastructurally, to better define the possible role of the epithelium and the dendritic accessory cells in the immune activation of lymphoid cells, and provide further insight into the pathogenesis of the disease. The presence within the columnar epithelium of lymphocytes positive for CD8 antigen, and which electron microscopically have been found frequently apposed to degenerating epithelial cells suggests that the latter cells are targets for cytotoxic activity of intraepithelial lymphocytes, rather than being engaged in antigen presentation. Furthermore, the finding of typical dendritic accessory cells, recognized by their typical immunophenotypic and ultrastructural features, in the lamina propria, indicates that antigen presentation is more likely exerted by dendritic accessory cells. This is further supported by the fact that these cells express major histocompatibility (MHC) class II molecules, which are needed for antigen presentation, whereas epithelial cells do not. A possible relationship between epithelial damage and the pathogenesis of adenoidal enlargement is discussed.

TNM glottic : Role of the vocal muscle, arytenoid cartilage, and inferior paraglottic space in impaired vocal cord mobility (T2) : An embryological and clinical study

The TNM classification is unsatisfactory regarding the impaired mobility of the vocal cord and/or the arytenoid. The authors have studied the intrinsic laryngeal musculature, with particular attention to the medial thyroarytenoid muscle, the lateral thyroarytenoid muscle, and the inferior paraglottic space. The study was conducted on serial sections of 4 embryonal and 9 fetal larynges at different stages of development. The embryological observations showed that the lateral and medial thyroarytenoid muscles have different maturation times and probably different functions: phonatory and sphincteric. The authors have found that the inferior paraglottic space is situated between these 2 muscles. It would represent a path of diffusion for glottic cancer and play a central role in impaired vocal cord and/or arytenoid mobility, according to the degree of diffusion. Embryological observations have suggested the existence of laryngeal morphofunctional units belonging to the subsites of the glottic region and related to tumoral spreading.

Interdigitating Cells in the Peritumoral Infiltrate of Laryngeal Carcinomas: An Immunocytochemical and Ultrastructural Study

Interdigitating cells (IDCs) have been found in the peritumoral infiltrate of 18 patients with squamous cell carcinoma of the larynx. These cells have a dendritic shape and are characterized by the expression of S-100 protein and CD1a antigens. By electron microscopy, these cells are seen to establish intimate contacts with the apposed lymphocytes, which sometimes show signs of functional activation and proliferation. These findings indicate that IDCs may play a role in setting up a T-cell immune reaction against neoplastic cells, which may influence the biological behaviour and/or local growth of the tumour. Moreover, monocytes and cells with intermediate features between monocytes and IDCs are also found in the peritumoral infiltrate, thus suggesting that IDCs differentiate in situ from monocytic precursors, possibly under the influence of either tumour-derived factors or the local lymphoid microenvironment.