Piotr Wójtowicz

Laryngeal embryonal rhabdomyosarcoma in an adult - A case presentation in the eyes of geneticists and clinicians

1. AbstractBackgroundRhabdomyosarcoma is a solid tumor, resulting from dysregulation of the skeletal myogenesis program. For rhabdomyosarcomas (RMS) with a predilection for the head and neck, genitourinary tract, extremities, trunk, retroperitoneum, the larynx is still an unusual site. Till now only several cases of this laryngeal tumor have been described in world literature in the adult population. The entire spectrum of genetic factors underlying RMS development and progression is unclear until today. Multiple signaling pathways seem to be involved in ERMS development and progression.Case presentationIn this paper we report an interesting RMS case in which the disease was located within the glottic region. We report an embryonal rhabdomyosarcoma of the larynx in 33 year-old man. After unsuccessful chemotherapy hemilaryngectomy was performed. In follow up CT no signs of recurrence were found. Recently patient is recurrence free for 62 months.ConclusionsConsidering the histological diagnosis and the highly aggressive nature of the lesion for optimal diagnosis positron electron tomography (PET) and computerized tomography (CT) of the neck and thorax should be performed. At this time surgical treatment with adjuvant radiotherapy seems to be the treatment of choice for this disease. Rhabdomyosarcoma of the larynx has a better prognosis than elsewhere in the body, probably because of its earlier recognition and accessibility to radical surgery.

(99m)TC-octreotide scintigraphy and somatostatin receptor subtype expression in juvenile nasopharyngeal angiofibromas.

The main goal of the study was the analysis of somatostatin receptor (SSTR) expression on juvenile nasopharyngeal angiofibroma (JNA) cells and a subsequent analysis of the utility of SST analog‐based scintigraphy in JNA diagnostics.

Tracheal adenoid cystic carcinoma mimicking a thyroid tumor: A case report

At present, only eight cases of tracheal adenoid cystic carcinomas (ACCs) mimicking thyroid tumors have been reported. Since there are no guidelines available regarding their diagnosis and treatment, they present a significant clinical challenge. In the present study, patient treatment was analyzed to deliver the first concise summary of treatment options in patients with ACC mimicking a thyroid tumor. In addition, all available data regarding molecular abnormalities of this disease have been discussed. The current study presents a case of a 17-year-old patient with a tracheal ACC mimicking a thyroid tumor. The patient was diagnosed in 2007 with a pathological mass between the left lobe of the thyroid and the trachea, and underwent surgery and radiotherapy. In 2010, multiple lesions in the lungs were diagnosed and pulmonary metastasectomy was performed. Following surgery, the patient has been disease-free for almost 30 months. Thyroid tumor biopsy may reveal ACCs. This pathological report requires further investigation of the head and neck in order to confirm if the disease is of tracheal origin. Patients may present with a neck swelling, hoarseness of voice or dysphagia. Surgery must be considered as first-line therapy for all patients with local disease as it may be curative. For palliative treatment chemoradiotherapy based on cisplatin may be effective. The identification of cytogenetics, tumor suppressor genes, oncogenes, epigenetic alterations and mitochondrial abnormalities specific for ACCs is critical to the development of targeted therapies. Thus far, large studies have only reported the transcriptional activator Myb and mammalian target of rapamycin signaling pathway to be disrupted in ACCs.

Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis.

Vertical partial frontolateral laryngectomy with simultaneous pedunculated sternothyroid muscle flap reconstruction of the vocal fold – surgical procedure and treatment outcomes

PURPOSE OF THE STUDY The aim of the study was to present the treatment outcomes after vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction following the resection of neoplasm-infiltrated vocal fold. The procedure was used in a patient with glottic cancer. Oncological outcomes, morphology of neo-vocal fold and the act of swallowing were evaluated. MATERIAL AND METHODS 45 patients with T1-T2 glottic cancer were subjected to vertical partial laryngectomy with 26 patients undergoing a procedure with pedunculated sternothyroid muscle flap reconstruction and the remaining 19 patients undergoing a procedure without such a reconstruction. Two female and 43 male patients aged 35-82 years (mean age of 62.5 years) were enrolled in the study. Local tumor spread and the condition of reconstructed vocal fold were assessed in sequential videofiberoscopy examination conducted each month after surgery whereas the regional spread was assessed in ultrasound scans. Postoperative aspiration was graded according to the Pearsons scale. RESULTS Six patients experienced local recurrence while 2 patients experienced regional recurrence of the tumor. The pedunculated sternothyroid muscle flap neo-fold was structurally resemblant of the non-affected vocal fold. Episodic, daily dysphagia was observed in 1 patient while normal act of swallowing with no Pearsons scale symptoms was observed in the remaining 44 patients. No necrosis of pedunculated flap was observed. CONCLUSIONS Vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction is a good method for the treatment of low- or intermediate-stage glottic cancer, especially when endoscopic access to the tumor is limited and when CO2 laser cannot be used. No significant functional disorders were observed in operated larynges.

Extended Open Partial Laryngectomy with Titanium-Based Laryngeal Framework Reconstruction: Surgical Technique and Treatment Outcomes

Objective: To present surgical technique and treatment outcomes after extended open partial laryngectomy with titanium-based laryngeal framework reconstruction performed on 8 patients with T2-T3 squamous cell cancer of larynx. Method: To evaluate respiratory, phoniatric and swallowing function of larynx, titanium plate tolerance and cancer treatment outcomes 3 years after used operating procedure. Results: The procedure was uneventful and the airflow through the reconstructed part of the larynx was undisturbed in all cases. The titanium plate ensured airway patency and was well tolerated, except for one case, where it was explanted due to proliferation of granulation tissue on the skin over the plate. The anterior wall did not collapse following device explantation. Phoniatric evaluation demonstrated no social impact of patient vocal handicap. 5 patients reported mild vocal disability and 3 moderate vocal disabilities in the Voice Handicap Index. None of them developed dysphagia. Most patients reported high and very high swallowing-related quality-of-life in the M.D. Anderson Dysphagia Inventory (mean score of 79). Complete laryngectomy was performed in 2 patients due to local recurrence and cervical lymphadenectomy with subsequent radiotherapy was performed in 1 patient due to regional recurrence. Conclusion: Extended open partial laryngectomy with titanium-based laryngeal framework reconstruction may be one of way of treatment of intermediate-stage laryngeal cancer, especially with a limited endoscopic access to the tumor or suspected thyroid cartilage infiltration, which preserves physiological laryngeal function. This cancer stage is an indication for complete laryngectomy, so the procedure represents organ sparing approach

Usage of piezoelectric instruments in larynx surgery

OBJECTIVE The aim of the study was to estimate usability of the piezoelectric knife in larynx surgery. Prove that the piezoelectric staff can be used to do any different shape incision within the larynx cartilages. MATERIAL AND METHODS 35 patients hospitalized in our Department in 2014-2016 were enrolled in our study. 24 patients went vertical partial laryngectomy and 1 patient went horizontal partial laryngectomy because of larynx cancer. 5 patients went partial laryngectomy because of low stage of piriformis recess cancer. Piezoelectric staff was used to do thyroidectomy and resection of thyroid cartilage suspected of carcinomatosis infiltration. The rest 4 patients had done widening of larynx lumen due to larynx stenosis or slenderness. The piezoelectric tool was used to do different incision or resection within the larynx cartilages in case of widening lumen of the larynx. RESULTS The larynx cartilages, especially thyroid cartilage could be cut in different shapes using piezoelectric tools. The usage of this equipment causes the minimal loss and small destruction of local healthy tissues. CONCLUSIONS The Piezoelectric instrument is useful instrument suit to operate within larynx cartilages. Exchangeable tip available in different shapes enables different resections of cartilages. Using the piezoelectric staff we can remove pathological tissue with minimal local destruction. Our observation shows that larynx operation with a usage of the piezoelectric knife is safe and effective. Current English literature does not describe usage piezoelectric tools in larynx surgery. It is essential to do more observation about that type of operations.

Endoscopic Evaluation of the Local Complications after Radiotherapy and Radiochemotherapy for Nasal Cavity, Nasopharynx Neoplasms

Objectives: Determine complications of the radiotherapy or radiochemotherapy in patients with nasal cavity, pharynx and soft palate neoplasms in endoscopic examination. Methods: Out of 184 patients for nasal cavity, pharynx or soft palate neoplasm, 65 patients with previous surgical intervention were excluded from the study. Group of 119 patients (19-87 years old) were evaluated endoscopically in the Head and Neck Cancer Department of the Memorial Cancer Center in Warsaw between 2000 and 2012. Follow up was from 30 days up to 12 years. 115 patients were treated for cancer, 1 for sarcoma and 3 for melanoma. Nasopharynx was a primary localization in 74 cases, nasal cavity in 9 cases, soft palate in 4 cases. In 32 cases there were metastases to the regional lymph nodes without the primary focus. 31 patients were treated by radiotherapy, and 88 by radiochemotherapy. Results: The following complications were diagnosed: 47 skin and mucosal reactions, 23 permanent nasal cavity obturations, 11 hearing impairments, 6 ear leakages, 2 tinnituses, 2 vision impairments, 2 trismuses, 2 obturations of nasolacrimal canal, 2 Eustachian tube obturations, 2 palatal movement impairments 1 case of mandible bone exposition. There were also 3 cases of tissue necrosis and one case of bleeding. There were 13 cancer recurrences treated by 3 salvage surgeries, 1 brachytherapy, and 3 palliative chemotherapies. Conclusions: The regular endoscopic examinations allows to control negative aspects associated with radiotheraphy or radiochemotherapy. Complications and recurrence can be diagnosed easily by non-invasive, method. Endoscopic evaluation provide quick and precise assessment of treatment results.

Total Laryngectomy with Radiotherapy in Stage T3-T4

Objective: Evaluation of the result of treatment with total laryngectomy and complementary radiotherapy in patients with cancer of the larynx in stage T3- T4 N0M0. Analysis of the impact of the primary cancer localization, feature G and T, unradical result of the surgery treatment. Method: The study population included 136 patients with cancer of the larynx in stadium T3-T4 N0M0 treated with curative intent by total laryngectomy with complementary radiotherapy. T3 was in 61 patients, T4 was in 75 patients. Results: In coregression analysis of multivariate failure did not show the statistically related to the recurrence and death P > 0.1. Two- and 5-year disease-free survival was for all group adequately 83% and 76%. Two- and 5-year disease-free survival in cases T3 and T4 was adequately 88% and 76%. In patients with primary localization in glottis 2- and 5-year disease-free survival was adequately 81% and 73% in cases supraglottis 88% and 81%. Conclusion: The primary cancer localization, feature G and T, unradical result of the surgery does not statistically relate to the result of the treatment by laryngectomy with complementary radiotherapy. Total laryngectomy with complementary radiotherapy has high finish result of treatment cancer of the larynx in stage T3-T4 N0 M0.

Brodawczaki górnych dróg oddechowych – nowe metody leczenia

Summary Background Respiratory papillomatosis is caused by HPV. The most common location in head and neck is larynx, palatine tonsils and arches of palate, uvula and mucosa oral and nasal cavity. The disease is benign but recurrent. The aim of this study was to estimate new methods of treatment respiratory papillomatosis based on intralesional injection of cidofovir into sites where papillomas had just been excised. Methods The purpose of the study were 59 patients treating in Otolaryngology Clinic Stomatology Department Medical University of Warsaw. The treatment was based on surgical excision of papilloma and after it intralesional injection of cidofovir in after 4–5 weeks. Results We observed the patients during 28 months. 41 patients had 4 times intralesional injection of cidofovir. 18 patients had increased number of injection of ciodofovir because of recurrent papilloma. Rest of this group of the patients clinical studies showed remission disease. Conclusion Surgery with intralesional cidofovir injection in the place after removal of papilloma is very effective methods. We observed that this treatment caused long lasting remission of papilloma recurrence.