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Peripheral nerve sheath tumors encompass a spectrum of well-defined clinicopathologic entities, ranging from benign tumors, such as neurofibromas, to high grade malignant neoplasms termed malignant peripheral nerve sheath tumors. Morphologic variability of these tumors is wide, and they engender some of the most controversial, difficult differential diagnoses. Localized neurofibromas often involve a major nerve and result typically in fusiform expansion of the nerve trunk (intraneural subtype). We report a case of circumscribed solitary neurofibromas in a 14-year-old boy with NF1 who presented to our department with a left neck swelling. The neurofibromas lesion involved the anterior branch of the great auricular nerve. The sensory symptoms initially reported by the patient (paresthesia and hyperesthesia) in the lower preauricular region. Surgical treatment represents the therapeutic method of choice in the approach to neurofibromas, considering functional disorders and possible aesthetic deformities. The case described presented difficulties in surgical excision, based on risk of functional and aesthetic results.

Relapsing polychondritis (RP) is a rare systemic disease that is characterized by recurrent episodic inflammation of the cartilaginous structures of the body, resulting in their progressive destruction and subsequent replacement with fibrotic scar. We present a case of RP that initially manifested with subglottic involvement and we propose an innovative strategy for the treatment for laryngeal RP in phase of active inflammation. A multidisciplinary approach (rheumatologist, otolaryngologist, immunologist, internist, cardiologist, etc) and adequate follow-up are essential. The timeliness of the diagnosis is fundamental to contain the destructive effects on the cartilages involved.

Neuroendocrine tumors are a spectrum of rare and highly heterogeneous neoplasms with distinct functional and biological behavior in relation to location, tumor size, and histological differentiation. Neuroendocrine tumors arise from the neuroendocrine cells of the diffuse neuroendocrine system located in almost every organ. Neuroendocrine tumors in the head and neck district are usually reported in sinonasal cavities and larynx. We present the case of a nasopharyngeal small-cell neuroendocrine carcinoma, which, as far as we know, is the 16th case reported in literature.

Introduction: The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness.Cases: In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO2) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement.Discussion: Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO2microlaryngoscopic techniques gives satisfactory results.

Candidiasis is a rare entity reported as an isolated and primary laryngeal disease. In this condition, inhaled steroids were the single most common predisposing factor. Also mycotic infections of larynx are frequently seen in patients with immune insufficiency, although they have also been reported in individual with normal immune status. We report a case of isolated laryngeal Candidiasis in an immunocompetent individual, with an unusual presentation with exophytic lesion, edema, ulceration, white plaque, and pseudomembranous formation mimicking supraglottic carcinoma, to highlight the clinical of this condition and provide a review of the literature.

Lymph node tuberculosis (TB) represents the most common form of extrapulmonary TB that affects most often laterocervical lymph nodes. The disease, favored by states of immunosuppression, manifests itself by usually unilateral swelling, which may be associated with skin changes (hyperaemia, infiltration or fistula) and poor systemic symptoms. Our study included 75 patients arrived at the hospital “V. Monaldi” of Naples from 2008 to 2012, in order to evaluate some aspects of clinical, diagnostic and therapeutic characteristics of tuberculous lymphadenopathy. All patients were subjected to clinical, microbiological and radiological findings, surgical biopsy (alternatively, fine needle aspiration cytology, FNAC) of lymph nodes affected by pathology, antituberculosis chemotherapy for six months and subsequent followup. 49% patients were female and 51% male (mean age 44.5 years). 50.7% of patients were immunocompromised (6.7% of HIV-positive cases, 4% with type II diabetes mellitus, 16% of drug users, 6.7% treated with immunosuppressive drugs, 4% affected by malnutrition, 12% homeless). The laterocervical lymphadenopathy was unilateral in 70.7% of cases, smaller than 2 cm in 66.7%, single in 62.7%, with normal overlying skin in 72%. 9.3% of cases showed pulmonary involvement. 68% of cases excisional biopsy was performed for microbiological and histopathological examination and in 32% patients FNAC (integrated with excisional biopsy in more than half of the cases). Lymph node tuberculosis is still a problem of high clinical significance. Diagnosis requires excisional biopsy for differential diagnosis from other forms of adenopathy; treatment utilises a multi-agent chemotherapy scheme that allows a good cure rate, with few side effects.

The timing of tracheotomy is a complex decision that requires understanding of the relative risks and benefits as compared with prolonging intubation. The role of tracheotomy during the COVID-19 pandemic remains to be determined. There is no evidence that early tracheostomy improves patient’s clinical course and it is not impact on the natural history of these patients. In our opinion, the tracheotomy should be proposed in stable COVID-19 patients after 18th days after orotracheal intubation when the viral load is finished. Only in the case of patients with difficult of intubation do we perform earlier tracheotomies.

BackgroundThe inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense.

Objectives/HypothesisMarkedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon‐γ (IFN‐γ) and interleukin‐4 (IL‐4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T‐cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL‐4 in T‐cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNγ and IL‐4 that occurs in vivo in anti‐H2–treated patients with allergic rhinitis (AR).

• During a double-blind clinical trial of a histamine (H2) antagonist (ranitidine) in monitoring allergic rhinitis, the clinical response, total serum IgE levels, and Parietaria IgE antibody levels were measured. Ranitidine induces an improvement in scores of subjective and objective symptoms, a decrease in total serum IgE levels, and no significant variations in Parietaria IgE antibody levels. Since H2 antagonists seem to induce these improvements by acting on suppressor T cells bearing H2 receptor, as shown in our previous studies, it is hypothesized that the lymphocytic subset that regulates the total IgE synthesis is not the same as that governing specific IgE synthesis.(Arch Otolaryngol Head Neck Surg. 1989;115:950-953)

Testa B, Mesolella C, Testa D, Mesolella M, Testa F, D'Alessio O.Suppressor T cell subsets in allergic rhinitis patients.Lymphocyte T cell subsets, total and Parietaria IgE levels were studied in 68 allergic rhinitis patients. in treated patients we observed an increase in the lymphocyte T cell subsets, which express a suppressor function, defined by several monoclonal antibodies, i.e., CD8, CD8 CD1 lb-, CD4 CD62L , CD4 CD45RO. This increase was significant for T suppressor cells, CD8 CDllb- (p < 0.046) and T memory cells, CD4 CD45RO (p < 0.013), whereas a slight decrease was observed in the control group. A decrease in total serum IgE levels was observed in anti-H2 treated patients; only a slight increase was noted in placebo groups; and no variations were found in Parietaria levels in either group. in vitro culture of T lymphocyte clones, T memory cells, from atopic subjects produces IL-4, which induces an increase in IgE synthesis An increase in T memory cells, observed in the treated group, should have accompanied an increase and not a decrease in total serum IgE levels, if the in vivo data correlated with those in vitro. Consequently, the behaviour of lymphocytes in vivo is not homologous to in vitro data.

This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated ‘morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation’ (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient’s medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin–etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended.

Glutathione (GSH), a major extracellular antioxidant, has been found in high concentrations in the epithelial lining fluid of the lower respiratory tract The GSH concentrations in nasal fluid, in normal and pathologic conditions, were investigated and found to be very low. A GSH aerosol (600 mg daily for 10 days) increased GSH levels in the nasal mucosa and induced a statistically significant improvement in nasal obstruction, rhinorrhea, and ear fullness. Thus, GSH administered by aerosol could be a means of defending the epithelial respiratory cells against a toxic oxidant.