A clinical case of a rare malignant tumor of the larynx, carcinosarcoma, is described. The features of the clinical picture, diagnostic methods: instrumental and morphological are presented.

This paper presents a unique clinical observation of 16 years of use without replacement of a domestic voice prosthesis in a patient after laryngectomy. Long-term recurrence-free survival was achieved as a result of treatment of laryngeal leiomyosarcoma.

The literature review presents historical and modern aspects of the rehabilitation of vocal function after laryngectomy, in particular, external devices, tracheopharyngeal bypass surgery, esophageal speech, tracheoesophageal bypass surgery without the use of a prosthetic device, voice prostheses are described. The advantages and disadvantages of each voice restoration technique, functional results, complications, prosthesis designs, their service life, bypass techniques, methods of prevention and treatment of damage to the valve apparatus of the prosthesis by colonies of microorganisms, fungal flora are analyzed.

A rare clinical observation of advanced myeloid sarcoma developed through blast transformation of post-polycythemia vera myelofibrosis as extramedullary manifestation of acute myeloid leukemia affecting larynx, laryngopharynx, trachea, soft tissues of the neck, pleura, and skeletal bones is presented.

This review discusses current aspects of the diagnosis and treatment of adenoid cystic carcinoma of the trachea and larynx. It describes different variants of surgical treatment, radiotherapy, combination therapy, endotracheal interventions using endoscopic techniques and physical methods, grafting, tracheal transplantation, complications, and oncological and functional treatment outcomes. We also analyze clinical aspects of adenoid cystic carcinoma of the larynx, most common tumor location, difficulties associated with morphological verification, and controversial issues related to surgery volume, considering that this disease is rare and clinical experience is often insufficient.

A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.

Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.

Adenocystic carcinoma accounts for 3-5% of all malignant neoplasms of the head and neck organs. Due to the rarity of detecting this cancer in the larynx, treatment options are still controversial: surgery with postoperative radiation therapy or surgery alone. Patient A., 64 years old, turned to the City Clinical Oncological Hospital No. 1 in October 2019 with complaints of moderate pain when swallowing, sensation of a foreign body. Fibrolaryngoscopy revealed an exophytic form of growth bright red color formation with a small tuberous surface up to 12 mm in size in the area of the free left edge of the epiglottis. There was a thickening of the pharyngeal-epiglottis fold. Histological examination revealed adenocystic cancer. Diagnosed with Laryngeal cancer with cT1N0M0. On December 23, 2019, endolaryngeal resection of the larynx was performed using an operating microscope in the volume R0. This observation is of interest both in morphological terms (extremely rarely detected cancer of the larynx) and in terms of treatment (an organ-preserving operation was performed - endolaryngeal resection of the larynx).

The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.

Transplantation of human internal organs is accompanied by the risk of the subsequent occurrence of a malignant neoplasm. The increased incidence of malignant neoplasms is due to immunosuppressive therapy, which leads to impaired immune surveillance for malignant neoplasms, as well as increased susceptibility to oncogenic viruses. We have not found a description of the laryngeal cancer development after heart transplantation in the available literature. Here is our observation. Patient P., 66 years old, was admitted to the department of head and neck tumors of the State Clinical Hospital No. 1 on 05/27/19 with complaints of hoarseness. Based on the examination, the diagnosis of laryngeal cancer cT3N0M0M was established. Anamnesis revealed that due to ischemic cardiomyopathy, post-infarction mitral insufficiency, balloon angioplasty and stenting of the right coronary artery on 17.08.11 and 06.11.13, orthotonic heart transplantation was performed. The clinical situation was discussed with mutual participation of oncologists, radiologists, chemotherapists - a combined treatment plan was developed with preoperative radiation therapy of total focal dose (TFD) 44Gy at the first stage, which was carried out with slight positive dynamics, followed by laryngectomy. The uniqueness of this observation lies in the fact that a patient 6 years after heart transplantation was diagnosed with laryngeal cancer, he underwent combined treatment with neoadjuvant radiation therapy, TFD 44 Gy and an operation in the volume of laryngectomy without complications.

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

The study objectiveis to perform the acoustic analysis of voice in patients after open diagonal resection of the larynx.Materials and methods. A total of 112 patients underwent diagonal resection of the larynx; of them 73 hadfrontolateral resection and 39 had expanded frontolateral resection. Primary laryngeal cancer was diagnosed in 107 patients; five patients had relapses after radiation therapy. Fifty-six participants underwent acoustic analysis of voice before surgery, 52 participants underwent it 1 month postoperatively, and 112 participants had it after completing their rehabilitation (6 months to 10 years postoperatively). To determine normal acoustic characteristics of voice, we examined 80 men with normal voice. We measured voice fundamental frequency (FF), maximum and minimum FF, FF variability, jitter, shimmer, voice intensity, amplitude of fundamental tone’s harmonics and their difference. Speech rehabilitation included breathing exercises according to E. Ya. Zolotareva and speech training according to S.L. Taptapova.Results.Patients with laryngeal cancer demonstrated significant changes in the acoustic characteristics of their voice (p <0.05) compared to healthy individuals, including increased mean FF (f0) (up to 143 ± 45 Hz vs 118 ± 18 Hz in controls), decreased voice intensity (from 60 ± 8 to 43 ± 8dB), and almost 2-fold decrease in the amplitude of fundamental tone’s harmonics (ω0, 2 ω0, 3 ω0). We also found an increased dispersion and variability of acoustic characteristics assessed compared to healthy individuals. The analysis of long-term treatment outcomes demonstrated more significant improvement of voice acoustic characteristics in patients who underwent speech rehabilitation compared to those who had no rehabilitation.Conclusion.Open resection of the larynx with endoscopic removal of granulations and ligatures and laser restoration of the laryngeal lumen by dissecting the scars complemented by speech rehabilitation allow restoring respiratory function in 91.1 % of patients and restoring voice in 91.8 % of patients (to achieve acoustic characteristics close to normal).

Introduction. The problem of treatment and rehabilitation of patients with laryngeal cancer has been a complicated and controversial one.Important conditions for selection of the type and scale of functionally sparing surgical intervention are accurate preoperative diagnosis of advancement of the tumor and oncological appropriateness of the intervention. Currently, the problem of single-step reconstruction of lost laryngeal functions after organ-preserving surgeries remains open. For this purpose, researchers use both auto-/homografts and endoprosthetics made of various materials. In some cases, endoprosthetics in lyrengectomy didn’t allow to restore laryngeal lumen due to granulation tissue, cicatricial stenosis, laryngotracheomalacia.The study objective is to increase treatment and rehabilitation effectiveness in patients with laryngeal cancer after open laryngectomy.Materials and methods. Our experience is based on open laryngectomies in 86 patients performed at the Clinical Oncology Dispensary No. 1 of the Moscow Healthcare Department in the period from 2011 to 2014. Primary laryngeal cancer was diagnosed in 84 (97.7 %) patients, recurrent laryngeal cancer after a full course of radiation therapy – in 2 (2.3 %) patients. Vertical laryngectomy was performed in 74 patients, horizontal – in 12 patients.Vertical laryngectomies were performed for tumors located near the vocal and vestibular flaps, anterior commissure, subglottis, laryngeal sinus;horizontal for tumors located near the epiglottis, vestibular flaps, vallecula, root of the tongue if arytenoids were intact and vocal cords were mobile. In the postoperative period, an important factor was restoration of the organ’s function through early rehabilitation of respiratory, vocal, and protective functions. Evaluation of the laryngeal lumen was performed using endoscopic examination. Any diagnosed ligatures, granulation tissue, scars were resected. Prior to decannulation, ultrasound examination of the larynx was performed. Effectiveness of vocal function restoration was evaluated using computer acoustic analysis of the voice.Results. Restoration of the lost laryngeal functions after organ-preserving open laryngectomies in patients with laryngeal cancer is achieved through reconstruction of the remaining parts of the organ, formation of an adequate lumen for breathing through postoperative endoscopic correction, and early rehabilitation of respiratory, vocal, and protective function.Conclusion. Open laryngectomies with restoration of the remaining parts and single-step reconstruction of the lumen with an endoprosthesis, as well as subsequent combined treatment, allowed to restore respiratory function in 93.1 % patients, vocal function – in 91.9 % patients.

Adenoid cystic carcinoma is one of the rare pathological conditions affecting the larynx. It is known to develop from the glandula elements present in this organ. The authors report a clinical observation of adenoid cystic carcinoma in the form of an exophytic tumour of the pale pink colour having a smooth surface and the well-pronounced vascular patterns at the base. The neoplasm is localized in the arytenoid and retroarytenoid cartilage regions. Being of 3.5-4 cm in size, the tumour causes the narrowing of the larynx in its posterior portions and restricts its mobility. Bearing in mind the considerable extension of the neoplastic process, we undertook laryngectomy including the resection of the orolaryngopharynx and the cervical portion of the oesophagus, the subtotal resection of the thyroid gland and the simultaneous reconstruction of the orolaryngopharynx.

In the structure of oncological morbidity of the upper respiratory tract, malignant tumors of the larynx, including tumors of mesenchymal origin, are the most common. From 1959 to 2013, 55 cases of laryngeal leiomyosarcoma were described in scientific literature. Rarity of this localization of the tumor was the reason for publication of a clinical observation of a patient with endophytic tumor of the right vocal fold.Differential diagnosis for myofibro-, fibro-, and leiomyosarcoma was conducted. Based on immunohistological examination, well-differentiated laryngeal leiomyosarcoma was diagnosed.

The objective of the present study was to enhance the effectiveness of rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngotomy with tracheoesophageal by-pass and endoprosthetics. Our experience in this field is based on the treatment of 102 patients. They were distributed by the nosological forms as follows: primary laryngeal cancer in 97 patients including T1NoMo - 8 (8.2%), T2NoMo - 63 (65%), T3NoMo - 18 (17.6%), T2N1Mo - 1 (0.9%), T4NoMo - 3 (2.9%), and T4N1M0 - 4 (3.9%), root of the tongue cancer spreading over the vestibular part of the larynx in one patient, laryngeal sarcoma in one patient, relapse of cancer following the full-dose radiotherapy and organ-sparing surgery in 3 patients. Laryngeal resection was performed in 83 patients; 19 patients underwent laryngectomy with tracheoesophageal by-pass and endoprosthetics using a domestically manufactured voice prosthesis. The systemic approach to the rehabilitation of the patients and the use of the proposed treatment algorithm made it possible to restore the function of the larynx by means of organ-sparing surgery in 79 (95.1%) of the 83 patients. The vocal function in the patients following laryngectomy with tracheoesophageal by-pass and endoprosthetics was restored in 18 (94.7%) of the 19 patients.

The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).

Despite broad current diagnostic capabilities, most (60–70 %) patients with larynx cancer seek medical advice only when they have stages III and IV. Until the present time, laryngectomy has remained the most common treatment option for cancer of the larynx and laryngopharynx. Tracheoesophageal shunting with endoprosthesis replacement is one of the most important surgical vocal rehabilitation techniques after laryngectomy. According to different authors» data, the mean lifetime of voice prostheses is 6–12 months. The long-term use of voice prostheses in patients after laryngectomy with tracheoesophageal shunting with endoprosthesis replacement was the object of our investigation.Patient G., aged 34 years was admitted to the Department of Head and Neck Tumors, Oncology Clinical Dispensary (OCD) One, Moscow Healthcare Department, with a diagnosis of larynx cancer spreading to lymph nodes (LN) (T3N1M0) in the left neck on September 16, 2010. Surgery involving laryngectomy with tracheoesophageal shunting and implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the left side were performed on September 21, 2010. During the 4-year use of the voice prosthesis, his voice was sonorous and good. The voice prosthesis was removed in November 2014. Antifungal therapy was used; a new voice prosthesis was implanted. His speech was fluent and his voice was sonorous and good.Patient M., aged 54 years was admitted to the Department of Head and Neck Tumors, OCD One, Moscow Healthcare Department, with a clinical diagnosis of laryngopharynx cancer (T4N1M0) and an aftereffect of gamma-therapy with a summary focal dose of 42 Gy on November 18, 2003. Surgery involving laryngectomy with laryngopharyngeal resection, tracheoesophageal shunting, and endoprosthesis replacement with implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the right side were performed on November 25, 2003. The voce prosthesis was removed in December 2014. Antifungal therapy was performed. A new Russian prosthesis was implanted in the tracheoesophageal shunt. His voice was sonorous and good.

Despite broad current diagnostic capabilities, most (60–70 %) patients with larynx cancer seek medical advice only when they have stages III and IV. Until the present time, laryngectomy has remained the most common treatment option for cancer of the larynx and laryngopharynx. Tracheoesophageal shunting with endoprosthesis replacement is one of the most important surgical vocal rehabilitation techniques after laryngectomy. According to different authors» data, the mean lifetime of voice prostheses is 6–12 months. The long-term use of voice prostheses in patients after laryngectomy with tracheoesophageal shunting with endoprosthesis replacement was the object of our investigation. Patient G., aged 34 years was admitted to the Department of Head and Neck Tumors, Oncology Clinical Dispensary (OCD) One, Moscow Healthcare Department, with a diagnosis of larynx cancer spreading to lymph nodes (LN) (T3N1M0) in the left neck on September 16, 2010. Surgery involving laryngectomy with tracheoesophageal shunting and implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the left side were performed on September 21, 2010. During the 4-year use of the voice prosthesis, his voice was sonorous and good. The voice prosthesis was removed in November 2014. Antifungal therapy was used; a new voice prosthesis was implanted. His speech was fluent and his voice was sonorous and good. Patient M., aged 54 years was admitted to the Department of Head and Neck Tumors, OCD One, Moscow Healthcare Department, with a clinical diagnosis of laryngopharynx cancer (T4N1M0) and an aftereffect of gamma-therapy with a summary focal dose of 42 Gy on November 18, 2003. Surgery involving laryngectomy with laryngopharyngeal resection, tracheoesophageal shunting, and endoprosthesis replacement with implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the right side were performed on November 25, 2003. The voce prosthesis was removed in December 2014. Antifungal therapy was performed. A new Russian prosthesis was implanted in the tracheoesophageal shunt. His voice was sonorous and good.

Cancers remain a priority for modern society. According to the WHO estimates, global cancer morbidity and mortality rates will triple in the period 1999 to 2030: from 10 to 30 million new cases and from 6 to 17 million deaths recorded every year, which will exceed deaths from cardiovascular diseases and injuries. The efficiency of treatment in cancer patients and their prediction are determined by timely disease diagnosis, tumor extent estimation, and adequate therapeutic measures. So search for ways to cardinally improve the early recognition of cancer is one of the major tasks in the study of the problems of cancer patients, those with throat cancer in particular.