E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 11 (5)
Volume: 11  Issue: 5 - 2003
ORIGINAL ARTICLE
1.The management of glottic and supraglottic cancers of the larynx in relation to neck metastasis
Ali Vefa Yücetürk, Onur Çelik, Görkem Eskiizmir
Pages 129 - 133
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Objectives: We evaluated the management of glottic and
supraglottic laryngeal cancers in relation to neck metastasis.
Patients and Methods: Fifty-two patients (51 males, 1
female; mean age 59.2 years; range 27 to 82 years) underwent
surgery for primary laryngeal cancers. Preoperative
and postoperative TNM classification and staging were
made according to the AJCC 1997 criteria. The mean followup
period was 39.4 months (range 6 to 74 months).
Results: The tumors were glottic in 31 patients and supraglottic
in 21 patients. Laryngectomies were partial in 34
patients and total in 18 patients. All the patients with supraglottic
tumors and those with glottic T2- 4 tumors underwent
neck dissection, as well. Radiotherapy was administered to 22
patients with established N2 or N3 tumors. Clinical assessment
was in agreement with the pathological result in 63.5%;
13.5% and 23.1% of cases were underdiagnosed and overdiagnosed,
respectively. The rates of neck metastasis were
0% in T1, 25% in T2, 75% in T3, and 66.7% in T4 supraglottic
tumors. The corresponding rates for glottic cancers were 0%,
16.7%, 28.6%, and 60%, respectively. The overall rate of N+
tumors was 28.9%. Four patients (7.7%) developed local, two
patients (3.9%) developed regional recurrences. Mortality
occurred in eight patients (15.4%) due to following causes:
laryngeal recurrence (T4N2, T4N2, T3N1), regional recurrence
( T4N2), a second primary malignancy in one patient, and other
causes in three patients. Five- and two-year disease-specific
survival rates (Kaplan-Meier analysis) were 90.7%, and overall
survival rates were 73.7% and 87.3%, respectively.
Conclusion: Neck metastasis and advanced stage of the
tumor were the most effective prognostic factors.

2.Detection of Epstein-Barr virus DNA by polymerase chain reaction in surgical specimens of patients with squamous cell carcinoma of the larynx and vocal cord nodules
Üzeyir Gök, Aykut Özdarendeli, Erol Keleş, Yasemin Bulut, Bengü Çobanoğlu
Pages 134 - 138
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Objectives: We investigated the incidence of Epstein-
Barr virus (EBV) infection in surgical specimens of squamous
cell carcinoma of the larynx and vocal cord nodules.
Patients and Methods: Formalin-fixed, paraffin- embedded
tissue samples randomly selected from 22 patients with squamous
cell carcinoma of the larynx (20 males, 2 females; mean
age 52 years) and from 17 patients with vocal cord nodules
(14 males, 3 females; mean age 38 years) were examined by
the polymerase chain reaction. The patients were assessed in
terms of localization of the disease, smoking habits, duration
of smoking, and the presence or absence of EBV DNA.
Results: Twenty-one patients with laryngeal carcinoma and
nine patients with vocal cord nodules were smokers.
Polymerase chain reaction showed EBV DNA in 11 patients
(50%) with laryngeal carcinoma and in seven patients
(41.2%) with vocal cord nodules. No significant differences
were found with respect to EBV DNA positivity, smoking
habits, smoking period, the number of cigarettes consumed
daily, localization of disease, and tumor stage (p>0.05).
Conclusion: Epstein-Barr virus does not seem to be
directly associated with the pathogenesis of laryngeal
squamous cell carcinoma, but its role in the etiology of
laryngeal proliferative diseases needs more elucidation.

3.Causes of dysphonia in patients above 60 years of age
Tolga Kandoğan, Levent Olgun, Gürol Gültekin
Pages 139 - 143
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Objectives: We evaluated the causes of hoarseness
in patients above 60 years of age.
Patients and Methods: The study included 98
patients (40 females, 58 males; mean age 64 years;
range 60 to 77 years) who presented with hoarseness.
All the patients were examined by videolaryngoscopy.
Temporary hoarseness secondary to respiratory
tract infections was excluded.
Results: The most common cause of hoarseness
was benign vocal fold lesions (28.6%) followed by
malignant lesions (27.6%), vocal fold paralysis
(25.5%), functional dysphonia (10.2%), and presbyphonia
(8.2%). Laryngopharyngeal reflux was found
in 13 patients (13.3%). Fourteen male and 11 female
patients had paralysis of the recurrent laryngeal
nerve. Malignancies that caused hoarseness without
paralyzing the vocal folds were larynx carcinoma
(n=18), hypopharynx carcinoma (n=8), and multiple
malignancy (n=1).
Conclusion: Our data show that dysphonia develops
due to disease processes associated with aging
rather than to physiologic aging alone. Considering
adverse influences of dysphonia on the quality of life
of elderly population, efforts should be directed to
elucidation of the cause and to performing appropriate
treatment.

CASE REPORTS
4.A case of Ewing’s sarcoma in the mandible and the skull base
M. Tayyar Kalcıoğlu, Semih Öncel, Murat Cem Miman, Tamer Erdem, Bülent Mızrak
Pages 144 - 147
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A thirteen-year-old boy with Ewing’s sarcoma was presented.
The treatment was considerably delayed because of the initial
diagnostic difficulties due to its insidious presentation and
the unwillingness of the child’s parents to further investigations
and treatment. During a three-year delay, the tumor
turned out to be a gross painful mass from a painless lesion.
Cranial computed tomography and magnetic resonance
imaging with contrast showed a destructive lesion extensively
involving the right mandible and the skull base, with invasion
to the intracranial space. Facial and intratemporal portions
of the mass were removed totally, but the intracranial
extension could not be totally excised because of cavernous
sinus involvement. Histologic and immunohistochemical findings
were consistent with the diagnosis of Ewing’s sarcoma.
The patient received systemic chemotherapy and radiotherapy
following surgery. A month after radiation therapy, radiologic
investigations showed a lung mass suggestive of metastasis.
He died two days after hospitalization, from an intracranial
hemorrhage associated with the intracranial mass.

5.A case of carotid body tumor
Arif Şanlı, Mehmet Eken, Sedat Aydın, Mustafa Paksoy, Mehmet Yıldırım
Pages 148 - 151
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A thirty-five-year-old woman had an asymptomatic,
slow growing mass that pushed the right tonsilla palatina
and was pulsatile in the oropharyngeal region.
Magnetic resonance imaging showed a vascular mass
at the carotid bifurcation, causing displacement of the
external and internal carotid arteries. The diagnosis of
a carotid body tumor was confirmed by magnetic resonance
angiography. Surgery included a subadventitial
dissection at the carotid bifurcation, preserving the
hypoglossal and vagal nerves. The patient developed
loss of function of the tenth cranial nerve postoperatively.
After a year follow-up period there was no
change in the function of the tenth cranial nerve.

6.Thyroid metastasis from renal cell carcinoma eight years after radical nephrectomy: a case report
Canan Uzel, Halil Coşkun, Tarık Terzioğlu, Necdet Aras
Pages 152 - 156
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A forty-five-year-old female patient presented with
thyroid nodules eight years after radical nephrectomy
for renal cell carcinoma (T2N0M0, grade 2, clear cell
subtype) in the right kidney. Ultrasonography of the
neck showed multiple hypoechoic macronodules.
There was no lymphadenomegaly. During total thyroidectomy
following an initial diagnosis of multinodular
goiter, frozen section analysis was made, which
showed metastasis from renal cell carcinoma.
Immunohistochemical studies demonstrated that the
tumor cells were negative for thyroglobulin staining.
No recurrences or other metastatic disease were seen
during a follow-up period of 12 months. Although clinically
the thyroid gland is a rare site for tumor metastasis,
this possibility should be kept in mind in patients
with a previous history of renal cell carcinoma.

7.Kimura’s disease in the parotid and submandibular regions: two case reports
Selma Kurukahvecioğlu, Sumru Yardımcı, Osman Kurukahvecioğlu, Erdal Yılmaz
Pages 157 - 160
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Two male patients (aged 13 and 50 years) who presented
with a complaint of painless mass in the parotid
and submandibular regions, respectively, were found
to have eosinophilia and increased blood
immunoglobulin E (IgE) levels. Following ultrasonographic
examination of the masses, surgical excision
was performed. Histopathologic evaluation revealed
massive lymphocytic and eosinophilic infiltration.
Histopathologic findings and the presence of peripheral
eosinophilia and high IgE levels led to a diagnosis of
Kimura’s disease. Postoperatively, no recurrences
were detected within a year follow-up.

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