Róbert Paczona

Leiomyosarcoma of the larynx. Review of the literature and report of two cases.

Leiomyosarcoma of the larynx is an extremely rare malignancy. Until now, only 35 cases have been reported, and only 19 were reported in English. We present 2 new cases observed in the last 3 years at our department. Correct histologic diagnosis can only be made on immunohistochemical and electron microscopic grounds. A 65-year-old man previously treated for a premalignant vocal cord lesion and a 31-year-old woman who previously underwent operation on a benign vocal cord lesion are presented. Only surgical treatment (total laryngectomy and endolaryngeal laser resection) was performed. Thirty-six and 22 months after the initial surgical intervention, both patients are alive and well, with no evidence of local recurrence or distant metastasis.

Autofluorescence videoendoscopy for photodiagnosis of head and neck squamous cell carcinoma

The diagnosis of head and neck squamous cell carcinoma is usually made by visual identification. Searching for a non-invasive optical diagnostic method with the ability to detect the precancerous lesions or second primary tumors earlier in high-risk populations led to the development of photodiagnosis by autofluorescence (AF) endoscopy. The aim of the present study was to evaluate and discuss the diagnostic potential of autofluorescence videoendoscopy as a complementary visual aid in the routine endoscopic diagnosis of head and neck cancers. In a prospective study, 48 patients underwent white light (WL) videoendoscopy followed by AF technique at the Institute of Gustave-Roussy from November 2001 to August 2002. Of 48 patients, 30 had suspected precancerous or cancerous laryngeal lesions, 7 presented benign laryngeal lesions, while 8 showed pharyngeal and 3 oral tumors. All detected lesions were evaluated by histological examination. AF was induced by filtered blue light of a xenon short arc lamp and processed by a CCD camera system (D-Light AF System; Storz, Tuttlingen, Germany). Normal laryngeal mucosa displayed a typical green fluorescence signal. Moderate and severe epithelial dysplasia, carcinoma in situ and invasive carcinoma showed a diminished green fluorescence and presented a marked reddish-blue color. In case of hyperkeratosis a bright white color was detected. Some benign lesions, such as granulomas, polyps and papillomas also displayed altered green fluorescence. Autofluorescence videoendoscopy for photodiagnosis of head and neck squamous cell carcinomas has proved to be a method of high specificity and good sensitivity. Two additional precancerous lesions that were invisible at the WL examination but detected with the AF technique show its potential role in the regular screening procedure or follow-up examination in a high-risk population. It was a very helpful complementary visual aid for the intraoperative control of the surgical margins after per oral endoscopic resection.

Peroral Endoscopic Removal of a Regurgitated Giant Polisegmented Fibrovascular Polyp of the Esophagus

BACKGROUND Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper esophagus and hypopharynx. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpretedMaterials and methods: The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removalResults: After one-year of follow-up, the patient is going well, without recurrence of his polypConclusion: Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation.

Pharyngeal and hypopharyngeal reconstruction after mutilating surgery for malignant hypopharyngeal cancers

Abstract The authors summarise their reconstructive surgical experience after the radical excision of hypopharyngeal tumours. In selective cases the preservation of the larynx is a reliable surgical option and supraglottic surgery is sufficient to remove the tumour. Myocutaneous paddle flaps were used in every case after the surgical resection for the reconstruction of the pharyngo-oesophageal entrance. After total circular pharyngo-laryngectomy, the continuity of the upper digestive tract was reconstructed by tubed myocutanous flaps.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report

BackgroundThe surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome.Case presentationIn this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence.ConclusionsIt is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.