More Related Content
Similar to Carcinoma larynx
Carcinoma larynx
- 1. ACADEMIC REVIEW Carcinoma ofthe larynx
- 2.
- 5.
- 6.
- 8. Grossing of thelarynx
- 9. PATIENT DETAILS Mr. Muthusamy 52years / Male MR/17/067985 Biopsy No: 890/17 Date of report: 13.04.2017 Nature of specimen: Total laryngectomy
- 10. Direct laryngoscopy findings: Growthinvolving 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)
- 11.
- 13.
- 22. IMPRESSION • Features consistentwith 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.
- 23. Carcinoma larynx • Squamouscell 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
- 24. • SCC ofthe 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
- 25. Variants of squamouscell carcinoma • Verrucous carcinoma • Spindle cell carcinoma • Basaloid squamous cell carcinoma • Papillary squamous cell carcinoma • Adenosquamous carcinoma
- 26. Verrucous carcinoma • Well-differentiatedand 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
- 27.
- 28. 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)
- 29.
- 30. Basaloid squamous cellcarcinoma • 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.
- 31. Basaloid squamous cellcarcinoma
- 32. Papillary squamous cellcarcinoma • 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
- 34. 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
- 36. 2010 American JointCommittee on Cancer Staging Guidelines for Tumors of the Larynx
Editor's Notes
- #6 pyriform – space bet aryepiglottic fold and thyroid cartilage. Recurrent laryngeal nerve lies deep inside it
- #13 thyroid – 1.5x 1 Growth 4.8 x 1.5
- #14 arranged in nests and lobules with thin fibrous septa infiltrated by dense neutophils admixed with lymphoplasmacyrtic infiltrate
- #22 abnormal premature keratin below stratum granulosum
- #23 Salivary gland, tumor giant cells, mitotic fig, epiglottis
- #26 CD10 expression supports hair follicle derivation
- #28 thick club shaped papillae with broad pushing base
- #30 Spindle cell carcinoma-malignant epithelial cells showing spindling/sarcomatoid appearance
- #32 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)
- #36 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)