Clinical pathology

临床病理学
  • 文章类型: Case Reports
    背景:母细胞性浆细胞样树突状细胞肿瘤(BPDCN)是一种罕见的临床侵袭性血液系统恶性肿瘤,起源于浆细胞样树突状细胞的前体。BPDCN经常累及皮肤,淋巴结,和骨髓,临床进展迅速,预后不良。BPDCN诊断主要基于免疫表型。
    方法:在本文中,我们回顾性分析了2例BPDCN。两名患者均为老年男性。病变表现为皮肤肿块。形态学表现包括真皮和皮下组织的弥漫性和致密性肿瘤细胞浸润。免疫组化染色显示分化簇CD4、CD56、CD43、CD123均为阳性。
    结论:在本文中,我们回顾性分析了2例BPDCN。两名患者均为老年男性。病变表现为皮肤肿块。形态学表现包括真皮和皮下组织的弥漫性和致密性肿瘤细胞浸润。免疫组化染色显示分化簇CD4、CD56、CD43、CD123均为阳性。
    BACKGROUND: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and clinically aggressive hematologic malignancy originating from the precursors of plasmacytoid dendritic cells. BPDCN often involves the skin, lymph nodes, and bone marrow, with rapid clinical progression and a poor prognosis. The BPDCN diagnosis is mainly based on the immunophenotype.
    METHODS: In this paper, we retrospectively analyzed 2 cases of BPDCN. Both patients were elderly males. The lesions manifested as skin masses. Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues. Immunohistochemistry staining showed that cluster of differentiation CD4, CD56, CD43, and CD123 were positive.
    CONCLUSIONS: In this paper, we retrospectively analyzed 2 cases of BPDCN. Both patients were elderly males. The lesions manifested as skin masses. Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues. Immunohistochemistry staining showed that cluster of differentiation CD4, CD56, CD43, and CD123 were positive.
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  • 文章类型: Review
    背景:本研究旨在探讨临床病理特征,诊断指标,和鉴别诊断玫瑰花结形成的胶质神经肿瘤(RGNT)的关键因素。
    方法:这项回顾性研究包括6例经手术治疗的RGNT病例。对其临床表现进行分析和总结,放射学特征,组织学形态学,免疫表型,和分子遗传变化,辅以文献综述。
    结果:患者包括4名男性和2名女性,平均年龄为35岁。肿瘤位于小脑(2例);第四脑室,四叉池,第三脑室(各1例);第四脑室和脑干(1例)。临床表现包括4例头痛,左眼睑下垂1例,只有在体检中发现一例无症状病例。微观上,肿瘤细胞大小均匀,在神经纤维和血管周围有玫瑰花状或假玫瑰花状结构。免疫组织化学显示了双相模式。神经纤维周围玫瑰花状结构的中央神经纤维成分和血管周围区域的假花结结构表达Syn,而玫瑰花环周围的细胞表达Olig2而不是GFAP。GFAP和S-100在神经胶质成分中表达,但在玫瑰花结或假玫瑰花结区域不表达。Ki-67增殖指数通常较低。分子遗传学分析显示,主要的分子变化涉及FGFR1突变,并伴有PIK3R1突变。所有患者术后均未接受放化疗。随访时间在4到23个月之间变化,没有记录到复发或转移。
    结论:RGNT是一种比较罕见的混合性神经胶质神经肿瘤,发生在中线结构中。其形态显示与其他低度神经上皮肿瘤有一定的重叠。识别神经纤维周围的玫瑰花对形态学诊断至关重要,FGFR1突变伴随PIK3R1突变的分子鉴定可以促进诊断。
    BACKGROUND: This study aimed to investigate the clinicopathological characteristics, diagnostic indicators, and critical factors for the differential diagnosis of rosette-forming glioneuronal tumor (RGNT).
    METHODS: This retrospective study included six surgically treated RGNT cases. We analyzed and summarized their clinical manifestations, radiological features, histological morphology, immunophenotype, and molecular genetic changes, supplemented with a literature review.
    RESULTS: The patients comprised four males and two females with a mean age of 35 years. The tumors were located in the cerebellum (two cases); the fourth ventricle, quadrigeminal cistern, and third ventricle (one case each); and the fourth ventricle and brainstem (one case). Clinical manifestations included headaches in four cases, left eyelid ptosis in one case, and one asymptomatic case only identified during physical examination. Microscopically, the tumor cells were uniform in size and were marked by rosette-like or pseudorosette-like structures around the neuropil and blood vessels. Immunohistochemistry revealed biphasic patterns. The central neuropil components of the rosette-like structures around the neuropil and the pseudorosette structures of the perivascular regions expressed Syn, while the cells surrounding the rosettes expressed Olig2 and not GFAP. GFAP and S-100 were expressed in the glial components but not in the rosette or pseudorosette regions. The Ki-67 proliferation index was typically low. Molecular genetic analysis showed that the main molecular changes involved FGFR1 mutation accompanied by PIK3R1 mutation. None of the patients received chemoradiotherapy postoperatively. Follow-up durations varied between 4 and 23 months with no recorded recurrence or metastasis.
    CONCLUSIONS: RGNT is a comparatively rare mixed glioneuronal tumor that occurs in the midline structures. Its morphology shows certain overlaps with other low-grade neuroepithelial tumors. Identifying the rosettes around the neuropil is critical for morphological diagnosis, and the molecular identification of FGFR1 mutations accompanied by PIK3R1 mutations can facilitate diagnosis.
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  • 文章类型: Journal Article
    背景:非侵入性血清标志物胃蛋白酶原I(PGI),胃蛋白酶原II(PGII),胃泌素-17(G17),和PGI:PGII比率(PGR)最近被提出作为预测各种胃病的新工具。
    方法:共83例经胃镜检查确诊的胃炎患者。78例同时进行结肠镜检查。对照组包括99名健康受试者。酶联免疫吸附试验用于检测PGI,PGII,G17和PGR。使用受试者工作特征(ROC)曲线评估血清学分析检测胃炎病理的性能。
    结果:G17和PGII水平显着增加(P<.001),而胃炎组PGR水平下降(P=.001)。ROC分析显示PGR的敏感性和特异性分别为70.83%和86.67%,分别,在预测幽门螺杆菌感染胃炎的敏感性和特异性分别为88%和65.52%,分别,预测活动性胃炎。同时进行结肠镜检查的胃炎患者G17水平显着升高(P<0.05)。
    结论:发现胃蛋白酶原I:胃蛋白酶原II的比率是活动性胃炎和幽门螺杆菌感染胃炎的有用预测因子。此外,发现G17与结肠镜检查发现的病理状况密切相关,可以为胃炎患者是否应同时进行结肠镜检查提供建议。
    BACKGROUND: The noninvasive serum markers pepsinogen I (PGI), pepsinogen II (PGII), gastrin-17 (G17), and PGI:PGII ratio (PGR) have recently been proposed as a new tool for predicting various gastric pathologies.
    METHODS: A total of 83 gastritis patients confirmed by gastroscopy were enrolled, with 78 undergoing concurrent colonoscopies. The control group included 99 healthy subjects. Enzyme-linked immunosorbent assay was used to detect PGI, PGII, G17, and PGR. The performance of serological analysis for detecting gastritis pathology was evaluated using receiver operating characteristic (ROC) curves.
    RESULTS: The G17 and PGII levels increased significantly (P < .001), whereas PGR levels decreased (P = .001) in the gastritis group. The ROC analysis revealed that PGR had a sensitivity and specificity of 70.83% and 86.67%, respectively, in predicting Helicobacter pylori-infected gastritis and a sensitivity and specificity of 88% and 65.52%, respectively, in predicting active gastritis. The G17 levels were significantly elevated in gastritis patients undergoing concurrent colonoscopies (P < .05).
    CONCLUSIONS: Pepsinogen I:pepsinogen II ratio was found to be a useful predictor of active gastritis and H pylori-infected gastritis. Furthermore, G17 was found to be closely related to pathological conditions found by colonoscopy and may provide recommendations for whether gastritis patients should undergo a concurrent colonoscopy.
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  • 文章类型: Case Reports
    异位脑组织很少见,尚未见报道。我们中心做了第一份报告。4岁零2个月大的女孩在右上腹痛2周后出现右肾上腺囊性肿块。手术成功了,经术后病理证实。手术后6个月,切口愈合良好,无复发。该病例报告有详细的诊治过程和满意的检查结果。为临床HBT的诊治提供参考,降低误诊误治风险。
    Heterotopic brain tissue is rare and has not been reported. Our center made the first report. 4 years and 2 months old Girl presented with a cystic mass in the right adrenal gland 2 weeks after right upper abdominal pain. The operation was successful, and the diagnosis was confirmed by postoperative pathology. 6 months after the procedure, the incision healed well without recurrence. This case report has a detailed diagnosis and treatment process and satisfactory examination results. It can provide a reference for diagnosing and treating clinical HBT and reduce the risk of misdiagnosis and mistreatment.
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  • 文章类型: Review
    背景:恶性间皮瘤(MM)是一种起源于胸膜的肿瘤,腹膜,或心包腔。它分为弥漫性和局限性恶性间皮瘤,弥漫性MM有四种亚型:上皮样,肉瘤样,去可塑性,和双相的,双相不太常见。这个肿瘤的发病是阴险的,在某些情况下预后极差,中位生存期为6-18个月,过去没有标准治疗方案。目的:我们报告了一例腹膜恶性间皮瘤,并通过转化疗法成功治疗。并对相关文献进行综述,以期为此类患者的治疗和病理诊断提供参考。方法:对腹膜恶性间皮瘤的病例进行处理,并对不同阶段的活检标本进行常规报道。结果与结论:我们报告一例起源于肝肾隐窝的恶性肿瘤,通过活检被诊断为双相恶性间皮瘤。免疫组织化学检测显示PD-L1表达。经过多学科的讨论,病人接受了转化性治疗,包括联合免疫疗法的试验。肿瘤明显缩小,患者获得了根治性手术切除的机会。显微镜检查显示病变区域有明显的胶原化,几乎没有残留肿瘤.经过19个月的综合治疗,患者在双肺胸膜下出现多个蓬松的混浊。CT引导下经胸芯针活检,病理显示机化性肺炎,根据既往治疗史,将其视为由免疫治疗引起的迟发性间质性肺炎。此例腹膜恶性间皮瘤成功综合治疗,病人已经活了33个月没有疾病的证据,长期随访。在这个过程中,病理学家有三次病理诊断的机会,这需要了解病人的病史,注意标本的临床目的,并对不同阶段的形态变化提供准确的反应,以及相应的描述和诊断,为临床治疗提供有效的信息。
    Background: Malignant mesothelioma (MM) is a tumor originating from the pleura, peritoneum, or pericardial cavity. It is divided into diffuse and localized malignant mesothelioma, with four subtypes in diffuse MM: epithelioid, sarcomatoid, desmoplastic, and biphasic, with biphasic being less common. The onset of this tumor is insidious, and the prognosis is extremely poor in some cases, with a median survival of 6-18 months and no standard treatment options in the past. Aims: We report a case of peritoneal malignant mesothelioma that was successfully treated with transformative therapy. We also review the literature in the hope of providing reference for the treatment and pathological diagnosis of such patients. Methods: The case of the peritoneal malignant mesothelioma was processed and reported in the routine manner for biopsy specimens at different stages. Results and conclusion: We report a case of a malignant tumor originating in the hepatorenal recess, which was diagnosed as biphasic malignant mesothelioma through a biopsy. Immunohistochemical testing showed PD-L1 expression. After multidisciplinary discussion, the patient received transformative treatment, including a trial of combined immunotherapy. The tumor significantly shrank, and the patient obtained a chance for curative surgical resection. Microscopic examination showed significant collagenization in the lesion area, with almost no residual tumor. After 19 months of comprehensive treatment, the patient developed multiple fluffy opacities under the pleura of both lungs. Transthoracic core needle biopsy under CT guidance, the pathology showed organizing pneumonia, considering it as delayed interstitial pneumonitis due to immunotherapy based on previous treatment history. Successful comprehensive treatment was achieved for this case of peritoneal malignant mesothelioma, and the patient has been alive without evidence of disease for 33 months, with long-term follow-up. In this process, the pathologist had three opportunities for pathological diagnosis, which required understanding the patient\'s medical history, being attentive to the clinical purpose of the specimen, and providing accurate responses to morphological changes at different stages, along with corresponding descriptions and diagnoses to provide effective information for clinical treatment.
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  • 文章类型: Review
    暂无摘要。
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  • 文章类型: Journal Article
    先前的证据表明,儿童晒伤可能是皮肤恶性黑色素瘤(MM)和非黑色素瘤皮肤癌(NMSC)的危险因素。然而,现有的观察性研究无法揭示遗传上的因果关系。这项研究旨在调查儿童晒伤与皮肤癌之间是否存在遗传因果关系。单变量孟德尔随机化(MR)和因果分析使用总结效应分析进行因果估计和评价水平多效性。多变量MR和中介效应分析用于检验因果关系是否由潜在的混杂因素介导。儿童晒伤与MM之间存在明显的因果关系(OR=4.74;95%CI:1.31-17.19;p=1.79E-02)。遗传预测的儿童晒伤与整体原位黑色素瘤(MIS)的风险增加显着相关(OR=4.02;95%CI:2.00-8.08;p=9.40E-05),面部MIS(OR=18.28;95%CI:5.28-63.35;p=4.59E-06),和树干MIS(OR=7.05;95%CI:2.06-24.13;p=1.88E-03)。儿童晒伤和NMSC也发现了类似的趋势(OR=8.16;95%CI:6.07-10.99;p=1.53E-20),包括基底细胞癌(BCC)(OR=3.76;95%CI:2.96-4.77;p=2.19E-08)和鳞状细胞癌(SCC)(OR=7.44;95%CI:5.09-10.87;p=2.19E-08)。调整头发和皮肤颜色后,面部老化,维生素D水平,身体质量指数,酒精消费,和吸烟状况,童年晒伤表现出与MIS的独立关联,MIS的脸,后备箱的MIS,以及NMSC,包括BCC和SCC。中介分析显示无明显的中介效应。这项研究表明,儿童晒伤与MM和NMSC的风险之间存在因果关系。这表明加强筛查和预防儿童晒伤可能有助于早期发现和降低MM和NMSC的风险。
    Previous evidence has suggested that childhood sunburn could be a risk factor for cutaneous malignant melanoma (MM) and non-melanoma skin cancer (NMSC). However, existing observational studies could not reveal the causal associations genetically. This study aimed to investigate whether there was a genetic causal relationship between childhood sunburn and skin cancers. Univariable Mendelian randomization (MR) and Causal Analysis Using Summary Effect analysis was carried out for causal estimates and evaluation for the horizontal pleiotropy. Multivariable MR and the mediation effects analysis were used to test whether the causal associations were mediated by potential confounders. A suggestively significant causal association between childhood sunburn and MM was indicated (OR = 4.74; 95% CI: 1.31-17.19; p = 1.79E-02). Genetically predicted childhood sunburn was significantly associated with increased risk of overall melanoma in situ (MIS) (OR = 4.02; 95% CI: 2.00-8.08; p = 9.40E-05), MIS of face (OR = 18.28; 95% CI: 5.28-63.35; p = 4.59E-06), and MIS of trunk (OR = 7.05; 95% CI: 2.06-24.13; p = 1.88E-03). Similar trends were found for childhood sunburn and NMSC (OR = 8.16; 95% CI: 6.07-10.99; p = 1.53E-20), including both basal cell carcinoma (BCC) (OR = 3.76; 95% CI:2.96-4.77; p = 2.19E-08) and squamous cell carcinoma (SCC) (OR = 7.44; 95% CI: 5.09-10.87; p = 2.19E-08). After adjustment for hair and skin color, facial ageing, vitamin D levels, body mass index, alcohol consumption, and smoking status, childhood sunburn showed an independent association with MIS, MIS of face, MIS of trunk, as well as NMSC, including both BCC and SCC. Mediation analysis showed no significant mediation effect. This study demonstrated a causal relationship between childhood sunburn and the risk of both MM and NMSC, which suggested that enhanced screening and prevention for childhood sunburn could contribute to the early detection and decreased risk of MM and NMSC.
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  • 文章类型: Case Reports
    转移性甲状腺癌是罕见的。这里,描述了转移到甲状腺的结肠癌患者的情况。患者于2017年8月接受直肠癌根治术,术后接受6周期奥沙利铂联合卡培他滨化疗。2018年8月4日,患者因超声发现甲状腺结节和癌胚抗原水平在正常范围内入院。细针穿刺活检提示恶性肿瘤。患者接受了甲状腺癌根治术。使用术中快速冷冻病理,诊断为髓样癌。采用术后常规病理结合免疫组化结果,诊断为结直肠腺癌的甲状腺转移。手术后,患者定期到门诊接受卡培他滨化疗。截至2023年5月,患者仍然活着,没有复发。
    Metastatic thyroid cancer is rare. Here, the case of a patient with colon cancer that metastasized to the thyroid is described. The patient underwent radical rectal cancer surgery in August 2017 and received six cycles of chemotherapy with oxaliplatin and capecitabine postoperatively. On August 4, 2018, the patient was admitted to the hospital due to the discovery of thyroid nodules on ultrasound and carcinoembryonic antigen levels within the normal range. The biopsy from the fine needle aspiration suggested a malignant tumor. The patient underwent radical thyroid cancer surgery. Using intraoperative rapid frozen pathology, medullary carcinoma was diagnosed. Using postoperative routine pathology combined with immunohistochemistry results, thyroid metastasis from colorectal adenocarcinoma was diagnosed. After surgery, the patient regularly visited the outpatient clinic for chemotherapy with capecitabine. As of May 2023, the patient is still alive with no recurrence.
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  • 文章类型: Journal Article
    分析中国T1型乳腺癌患者的临床病理危险因素和区域淋巴结转移(LNM)的规律,以及对总生存期(OS)和无病生存期(DFS)的影响。
    在1999年至2020年之间,符合单侧纳入标准的乳腺癌患者,没有远处转移部位,并对T1期浸润性导管癌进行回顾性分析。从病历中检索临床病理特征。使用Kaplan-Meier方法和校正的Cox比例风险模型进行生存分析。
    我们招募了11,407名符合条件的患者作为发现队列,以探索LNM的危险因素,并招募了3484名T1N0期患者作为生存分析队列,以确定这些危险因素对OS和DFS的影响。与N-状态患者相比,N+状态的患者年龄较小,肿瘤较大,更高的Ki67水平,更高等级,更高的HR+和HER2+百分比,和较高的管腔B和HER2阳性亚型百分比。Logistic回归分析显示,年龄是LNM的保护因素,肿瘤大小/高级别/HR+和HER2+危险因素。与有限的LNM(N1)患者相比,广泛的LNM(N2/3)患者有较大的肿瘤大小,更高的Ki67水平,更高等级,较高的HR-和HER2+百分比,和较低的腔A型亚型百分比。Logistic回归显示HR+是广泛LNM的保护因素和肿瘤大小/更高级别/HER2+危险因素。Kaplan-Meier分析表明,等级是OS和DFS的预测因子;HR是OS的预测因子,但不是DFS。使用Cox回归模型的多变量生存分析表明,年龄和Ki67水平是T1N0期患者DFS的OS和分级和HER2状态的预测因子。
    在T1乳腺癌患者中,N+和N+患者之间有一些差异,有限的LNM和广泛的LNM患者。此外,HR+在区域LNM中起着双重作用。在没有LNM的患者中,年龄和Ki67水平是OS的预测因素,分级和HER2是DFS的预测因子。
    UNASSIGNED: To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS).
    UNASSIGNED: Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model.
    UNASSIGNED: We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients.
    UNASSIGNED: In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.
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  • 文章类型: Journal Article
    目的:在本研究中,对于宽基无蒂声带息肉的不同临床和组织病理学特征,我们回顾性回顾并比较了办公室经鼻声带息肉切除术(TVFP)与显微手术(MLS)的治疗结果和并发症.
    方法:我们回顾性回顾了159例接受TVFP或MLS治疗的广基无蒂声带息肉患者的记录。根据声带息肉的不同类型,比较两种手术方法在疗效和并发症方面的差异。
    结果:据报道,在水肿患者中,TVFP和MLS治疗的结果令人满意,声带息肉的凝胶状和血管类型(p>.05)。纤维性息肉组TVFP的疗效略差于MLS(p<0.05)。TVFP治疗的患者没有出现明显的并发症,而几名接受MLS治疗的患者出现了不同的并发症.
    结论:TVFP和MLS治疗广基无蒂声带息肉的疗效与其临床特点和组织学类型有关。在水肿中取得了令人满意的结果,凝胶状,以及两种手术后息肉的血管类型。TVFP的手术并发症比MLS少,这可以是门诊治疗广基无蒂声带息肉的首选选择。对于不能耐受全身麻醉或喉部悬吊的患者,TVFP也可以是替代手术选择。相比之下,MLS已被证明对患有纤维型息肉的患者是特别有利的治疗方法。
    OBJECTIVE: In this study, we retrospectively reviewed and compared the treatment outcomes and complications of office transnasal vocal fold polypectomy (TVFP) with those of microplarygoscopic surgery (MLS) for different clinical and histopathological features of broad-based sessile vocal fold polyps.
    METHODS: We retrospectively reviewed the records of 159 consecutive patients with broad-based sessile vocal fold polyps treated by TVFP or MLS. The differences in efficacy and complication between these two surgical techniques were compared according to the different types of vocal fold polyps.
    RESULTS: Satisfactory outcomes of both TVFP and MLS treatments were reported in patients with oedematous, gelatinous and vascular types of vocal fold polyps (p > .05). The efficacy of TVFP was slightly worse than MLS in fibrous polyps group (p < .05). The TVFP-treated patients did not exhibit obvious complications, whereas several MLS-treated patients had suffered different complications.
    CONCLUSIONS: The therapeutic effects of both TVFP and MLS on the treatment of broad-based sessile vocal cord polyps are related to their clinical characteristics and histological types. Satisfactory outcomes are achieved in oedematous, gelatinous, and vascular types of polyps after either surgical procedure. TVFP has fewer surgical complications than MLS which can be a preferred option for the treatment of broad-based sessile vocal cord polyps at outpatient setting. TVFP also can be an alternative surgery option for patients who could not tolerate general anaesthesia or laryngeal suspension. In contrast, MLS has proven to be a particularly advantageous treatment in patients who have fibrous type of polyps.
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