Amyloidosis of the larynx.Amyloidosis Amyloidosis Definition Amyloidosis is a progressive, incurable, metabolic disease characterized by abnormal deposits of protein in one or more organs or body systems. is characterized by the accumulation of insoluble fibrillar fi·bril·lar or fi·bril·lar·y adj. 1. Relating to a fibril. 2. Relating to the fine rapid contractions or twitchings of fibers or of small groups of fibers in skeletal or cardiac muscle. protein (amyloid) in tissues and organs throughout the body. Some deposition processes are local and some are systemic. Of the several types of amyloidosis, nodular amyloidosis is the type found most frequently in the larynx and nasopharynx, as well as in the trachea and lungs. A 48-year-old basketball coach presented with a 2.5-year history of progressive hoarseness, vocal fatigue, loss of high and low range, and pain when speaking. His problems had become severe enough to force him to retire from coaching. Prior to his visit, his otolaryngologist had diagnosed amyloidosis of the larynx. Histopathologic evaluation on H&E staining of a soft-tissue mass revealed normal surface squamous epithelium, chronic subepithelial inflammatory infiltrate, and diffuse eosinophilic eosinophilic /eo·sin·o·phil·ic/ (-fil´ik) 1. readily stainable with eosin. 2. pertaining to eosinophils. 3. pertaining to or characterized by eosinophilia. intercellular deposits (some of which caused pressure necrosis of the surrounding stoma stoma or stomate Any of the microscopic openings or pores in the epidermis of leaves and young stems. They are generally more numerous on the undersides of leaves. ) (figure 1). Sections stained with Congo red dye demonstrated the characteristic yellow and apple-green birefringence, and the lesion had the beta-pleated sheet structure and antiparallel antiparallel /an·ti·par·al·lel/ (-par´ah-lel) denoting molecules arranged side by side but in opposite directions. conformation by low-angle x-ray diffraction, typical of amyloidosis. (figure 2). The patient was referred to the senior author (R.T.S.) for further treatment. A thorough systemic workup revealed no evidence of amyloid outside the head and neck. Physical examination and videostroboscopy detected a large left supraglottic mass that obscured visualization of the anterior two-thirds of the left vocal fold (figure 3A). Endoscopy also revealed a partial supraglottic obstruction of the airway and a good subglottic airway, despite evidence of a tracheal mass (figure 3B). Videostroboscopy also detected both a pharyngeal (figure 3C) and a tongue base (figure 3D) mass. Surgical resection of the supraglottic mass resulted in an improved voice. From the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University It began as Jefferson Medical College in 1824. On July 1, 1969 the institution officially became Thomas Jefferson University. The university is made up of three colleges:
implacable detective with photographic memory. [Br. Lit.: The Ticket-of-Leave Man, Barnhart, 546] See : Sleuthing ). |
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