52 years / Male
Biopsy No: 890/17
Date of report: 13.04.2017
Nature of specimen: Total laryngectomy
Direct laryngoscopy findings:
Growth involving right cord, anterior and posterior commissure
and extending to supra and subglottic region
Right cord is fixed. Left has restricted mobility.
Irregular wall thickening with soft tissue density
Supraglottis – 1.8cm
Glottis and subglottis – 8mm involving preglottic and paraglottic
Clinical diagnosis: Ca glottis – stage III (T3N0Mx)
• Features consistent with Moderately differentiated
Squamous cell carcinoma involving supraglottis,
glottis, both vocal cords and subglottis, infiltrating
underlying outer cortex of thyroid cartilage and
adjacent minor salivary gland tissue (pT4a)
• Epiglottic shave, right and left aryepiglottic shave,
tracheal shave, hyoid magins, cricoid and arytenoid
cartilages, thyroid gland, strap muscles and
preepiglottic pad of fat were free of tumor.
• Squamous cell carcinoma is the most common malignancy in
• Age – 60s and 70s
• M:F – 5:1
• Tobacco use and alcohol
• Most commonly involved sites – glottis or supraglottic region
• Glottic tumors – present earliest and at the smallest size -
• Glottic region has a sparse lymphatic supply, and spread
beyond the larynx is uncommon.
• Supraglottic larynx is rich in lymphatic spaces – metastasis to
cervical lymph nodes
• Subglottic tumors - quiescent
• SCC of the larynx begin as in situ lesions - appear as
pearly gray, wrinkled plaques on the mucosal
surface, ultimately ulcerating and fungating.
• The glottic tumors are usually keratinizing, well- to
moderately differentiated squamous cell carcinomas
• Well-differentiated and nonmetastasizing variant
• “Ackerman's tumor.”
• Gross: Well-circumscribed, warty and exophytic, broad-based
white or tan mass.
• Consists of very thick, club-shaped papillae with a broad
• ”elephant's feet.”
• Excellent prognosis
Spindle cell carcinoma
• (SpCC) is poorly differentiated carcinoma that adopts a sarcomatoid, spindled, or
mesenchymal-appearing morphology but it is of epithelial origin.
• Biphasic with a spindled component and intermingled squamous cell carcinoma.
Gross: Polypoid with an ulcerated surface.
Typically consist of sheets of spindle cells mimicking a fibrosarcoma or malignant
fibrous histiocytoma .
Biphasic – showing component of squamous cell carcinoma
Foci of recognizable sarcomatous differentiation such as chondrosarcoma,
osteosarcoma, or rhabdomyosarcoma sometimes occur.
• granulation tissue polyp
• true sarcoma
• inflammatory myofibroblastic tumor.
Malignant spindle cell neoplasm in the larynx should be considered as SpCC until
proven otherwise ( as sarcomas are uncommon)
Basaloid squamous cell carcinoma
• Aggressive variant of squamous carcinoma
• composed almost entirely of basaloid cells giving “blue cell
• Gross: Centrally ulcerated mass with thickening at the edges
and commonly with extensive submucosal induration and
spread at the periphery.
• Two components. The first is basaloid cells with
hyperchromatic round nuclei, inconspicuous nucleoli, and
scant cytoplasm which grow in solid sheets or in rounded
nests often with comedo-type central necrosis.
• The second is typical keratinizing type squamous cell
carcinoma, either in situ or invasive which is always focal.
Papillary squamous cell carcinoma
• Uncommon variant of squamous cell carcinoma
• Gross: It is a soft, polypoid and friable tumor.
• Predominantly papillary growth pattern with fibrovascular
cores lined by full thickness markedly dysplastic squamous
cells, which are very immature and basaloid appearing.
The differential diagnosis
• Squamous papilloma,
• Verrucous carcinoma
• It is not unique, is either exophytic or ulcerated with
• It consists of both true adenocarcinoma and squamous
• The two components are usually close to each other but still
have a tendency to segregate. Squamous component
occupies the more superficial aspects, whereas the
adenocarcinoma component occupies the deeper aspects of
• Mucoepidermoid carcinoma
2010 American Joint Committee on Cancer
Staging Guidelines for Tumors of the Larynx
Hinweis der Redaktion
pyriform – space bet aryepiglottic fold and thyroid cartilage. Recurrent laryngeal nerve lies deep inside it
thyroid – 1.5x 1 Growth 4.8 x 1.5
arranged in nests and lobules with thin fibrous septa infiltrated by dense neutophils admixed with lymphoplasmacyrtic infiltrate