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Carcinoma larynx

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Carcinoma larynx

  1. 1. ACADEMIC REVIEW Carcinoma of the larynx
  2. 2. Anatomy of larynx
  3. 3. Larynx
  4. 4. Larynx
  5. 5. Grossing of the larynx
  6. 6. PATIENT DETAILS Mr. Muthusamy 52 years / Male MR/17/067985 Biopsy No: 890/17 Date of report: 13.04.2017 Nature of specimen: Total laryngectomy
  7. 7. 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. CT findings: Irregular wall thickening with soft tissue density Supraglottis – 1.8cm Glottis and subglottis – 8mm involving preglottic and paraglottic space Clinical diagnosis: Ca glottis – stage III (T3N0Mx)
  8. 8. Gross examination
  9. 9. Scanner view
  10. 10. IMPRESSION • 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.
  11. 11. Carcinoma larynx • Squamous cell carcinoma is the most common malignancy in the larynx • 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 - functional compromise • 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
  12. 12. • 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
  13. 13. Variants of squamous cell carcinoma • Verrucous carcinoma • Spindle cell carcinoma • Basaloid squamous cell carcinoma • Papillary squamous cell carcinoma • Adenosquamous carcinoma
  14. 14. Verrucous carcinoma • Well-differentiated and nonmetastasizing variant • “Ackerman's tumor.” • Gross: Well-circumscribed, warty and exophytic, broad-based white or tan mass. • Microscopy: • Consists of very thick, club-shaped papillae with a broad pushing base • ”elephant's feet.” • Excellent prognosis
  15. 15. Verrucous carcinoma
  16. 16. 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. Microscopy: 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. Differential diagnosis • 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)
  17. 17. Spindle cell carcinoma
  18. 18. Basaloid squamous cell carcinoma • Aggressive variant of squamous carcinoma • composed almost entirely of basaloid cells giving “blue cell “appearance. • Gross: Centrally ulcerated mass with thickening at the edges and commonly with extensive submucosal induration and spread at the periphery. • Microscopy, • 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.
  19. 19. Basaloid squamous cell carcinoma
  20. 20. Papillary squamous cell carcinoma • Uncommon variant of squamous cell carcinoma • Gross: It is a soft, polypoid and friable tumor. • Microscopy • 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 Better prognosis
  21. 21. Adenosquamous carcinoma • Gross • It is not unique, is either exophytic or ulcerated with indurated edges. • Microscopy • It consists of both true adenocarcinoma and squamous carcinoma. • 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 the mass Differential diagnosis • Mucoepidermoid carcinoma
  22. 22. 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
  • abnormal premature keratin below stratum granulosum
  • Salivary gland, tumor giant cells, mitotic fig, epiglottis
  • CD10 expression supports hair follicle derivation
  • thick club shaped papillae with broad pushing base
  • Spindle cell carcinoma-malignant epithelial cells showing spindling/sarcomatoid appearance
  • Basaloid squamous cell carcinoma biphasic tumor showing basaloid malignant islands with peripheral palisading and comedonecrosis (arrow) (H&E stain, ×100). Inset depicts squamous differentiation with keratin pearl formation (arrowhead) (H&E stain, ×100)
  • Adenosquamous carcinoma-biphasic tumor showing true glandular differentiation (arrowhead) along with squamous differentiation (arrow) (H&E stain, ×100). Inset depicts alcian bluepositive mucin secretion (×400)

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