Squamous cell carcinoma of the larynx in HIV-positive patients: difficulties in diagnosis and management.
ABSTRACT Patients who are infected with human immunodeficiency virus (HIV) are at increased risk of developing laryngeal squamous cell carcinoma. This malignancy on average appears in a younger age group at a more advanced stage and has a more aggressive course in HIV patients. These patients have difficult management challenges, diagnostically, in staging, and particularly in determining the optimal treatment for each individual patient because their underlying HIV infection can markedly increase morbidity associated with active treatments. They frequently have problems associated with swallowing both before and after treatment. We present two cases that highlight difficulties in the diagnosis and management of these patients as well as post-treatment complications, with particular emphasis on swallowing problems.
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ABSTRACT: Laryngeal cancers are not uncommon with several factors affecting its management in our environment compared to the developed countries. Such factors include the time of presentation and diagnosis, co-morbid disease, finance, consent, treatment options, surgical expertise and the problems of follow up. Thus this results to a lot management challenges to both the patients and the care givers. The aim of this paper is to highlight the challenges encountered in the management of laryngeal cancers at the Jos University Teaching Hospital, Nigeria. it is a retrospective study. The study was carried out at the ENT department of the Jos University Teaching Hospital and Bingham (ECWA Evangel) Hospital Jos Nigeria. This was a 48-month (October 2005 - September 2009) review of laryngeal cancers seen and treated in these hospitals. Data extracted included age, gender, histologic diagnosis and treatment modality. Data was analyzed using simple descriptive method and the result presented in tabular forms. A total of twenty one (21) cases consisting of 20 males and a female were seen during the period. The age range was 30 years to 70 years. The average age was 56.14 years. The time of presentation ranged from 3 months (earliest) to 2years. Twenty cases (95.24%) were advanced diseases with only one early disease. The histological types were 6 each for well and moderately differentiated squamus cell carcinoma respectively, 2 each for poorly differentiated and squamus cell carcinoma (uncharacterized) and 1 carcinoma insitu. Two patients (a male and female) were seropositive for HIV type I. Twenty (95.24%) of the patients had tracheostomy at presentation with two having peristomal spread in the course of the disease. Eight (38.10%) patients had total laryngectomy out of which one was a salvage laryngectomy with subsequent right pectoralis major myocutaneous flap; 6 had concomitant chemoradiotherapy with one discontinuing after the first course and while the sixth total laryngectomee had no chemoradiotherapy. Three (14.29%) had primary radiotherapy; 2 of the cases were advanced diseases and one early disease. Eight (38.10%) had no treatment. Of the 6 laryngectomees, three had tracheo-oesophageal fistula post-operatively while one had disease recurrence and died. The first laryngectomy case is still on follow-up, disease free four years now while the rest have been lost to follow up. Education and provision of standard oncologic treatment centres with trained personnel will help in alleviating theses challenges by providing treatment, data for assessment and improving the standard of our treatment.
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ABSTRACT: Neoplasms associated with human papillomavirus (HPV) infection occur at increased frequency in patients with HIV infection/AIDS. Although laryngeal squamous cell carcinomas (LSCCs) in HIV-positive patients are uncommon, a higher incidence of this malignancy in HIV-positive patients than in the general population has been reported. As a proportion of LSCCs are associated with HPV in the general population, the clinicopathological features of a series of LSCCs developing in HIV-positive patients were evaluated to investigate the possible relationship with HPV infection, and infection with other oncogenic viruses. All HIV-positive patients with LSCC diagnosed at a single institution from 1998 to 2007 were retrospectively evaluated. The clinicopathological features were analysed and tissues were tested by polymerase chain reaction (PCR), using the short PCR fragment 10 (SPF10) primer, a highly sensitive method for HPV DNA detection. Immunohistochemical studies for HIV p24, p16(INK4a) and p53 were performed. Epstein-Barr virus (EBV) and human herpes virus 8 (HHV-8) were also investigated. Six out of 4987 HIV-infected patients seen in this period in the Infectious Diseases Department developed LSCC (median age 41.5 years; male to female ratio 1:1). All patients were heavy smokers and the tumours presented at an advanced clinical stage. HPV was not detected in any tumour, not even in two patients with coexisting HPV-associated gynaecological neoplasm. Staining for HIV p24 and p16(INK4a) was negative, whereas p53 was positive in half the cases. EBV and HHV-8 were also negative. LSCC developing in HIV-positive patients is an infrequent neoplasm, not usually associated with HPV infection. It develops in young, heavy smokers and presents at an advanced clinical stage.HIV Medicine 08/2009; 10(10):634-9. DOI:10.1111/j.1468-1293.2009.00737.x · 3.45 Impact Factor