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Reporting of carcinomas of the larynx and hypopharynx

dr. Nina Zidar

Institute of Pathology, Faculty of Medicine

University of Ljubljana

Slovenia

Guidelines by International Collaboration on Cancer reporting (ICCR)

http://www.iccr-cancer.org/datasets

Arch Pathol Lab Med 2019; 143: 432-8

Core (required) elements

• Operative procedure

• Specimen type and dimensions

• Tumour site

• Histologic tumour type and grade

• Tumour focality

• Tumour dimensions

• Extent of invasion

• Perineural invasion

• Lymphovascular invasion

• Margin status

• Pathologic staging (pTNM)

Operative procedure, type and dimensions of specimen

• Biopsy (incisional, excisional)

• Resection

• Other

• Dimensions of specimen

• Hypopharynx

• Larynx

- endolaryngeal excision

- transoral laser excision

- supraglottic laryngectomy

- supracricoid laryngectomy

- total laryngectomy

- vertical hemilaryngectomy

- partial laryngectomy

- other

Tumour site and subsite

• Site determines the use of staging (UICC, AJCC)

Tumour focality and dimensions

• Unifocal, multifocal

• Principal site of involvement should be recorded

• Maximal dimension (in mm)

• Key determinant for staging carcinoma of hypopharynx

• Not staging criteria for carcinoma of larynx

• 30% of tissue shrinkage after fixation

Histologic tumour type and grade

• SCC

• Neuroendocrine carcinoma

• Salivary carcinomas

• Grade 1, 2, 3

• Well, moderately and poorly differentiated

Squamous cell carcinoma

1. Conventional SCC

2. SCC subtypes

- Verrucous carcinoma

- Papillary SCC

- Spindle cell SCC

- Basaloid SCC

- Adenosquamous carcinoma

- Lymphoepithelial carcinoma

Verrucous carcinoma

• Well differentiated SCC with favourable prognosis

• Slow growth, destruction

• No metastatic potential

• High frequency of initialmisdiagnosis

• Etiology similar to conventionalSCC

• Not related to HPV infection

Verrucous carcinoma

Hybrid carcinoma

• Verrucous carcinoma withfoci of conventional SCC

• Metastatic potential

• Must be treated as conventional SCC

Spindle cell carcinoma

• Biphasic tumor: conventionalSCC and malignant spindlecells

• Sarcomatoid carcinoma, carcinosarcoma

• Neoplastic epitheloid cellschange to spindle cells

• Pathogenesis: epithelial-mesenchymal transition

• Etiology: radiation

Spindle cell carcinoma

cytokeratin

vimentin

• 341 patients with spindle cell carcinoma, compared to 67 882 conventional SCC: worse prognosis in spindlecell carcinoma

• favourable prognosis: polypoid tumors, no history ofirradiation

Papillary squamous cell carcinoma

• Exophytic, papillary growthpattern and good prognosis

• Larynx: HPV neg.

• Recurrences are frequent(38%)

• Friable and soft, may extendover a broad surface area

• Difficult to demonstratestromal invasion

Papillary squamous cell carcinoma

Papillary squamous cell carcinoma

Basaloid squamous cell carcinoma

• Biphasic tumor: basaloidcells and SCC

• Aggressive, high grade SCC variant

• No characteristic grossappearance

• DD: HPV pos. carcinoma, neuroendocrine ca

• p16, synaptophysin, chromogranin

Basaloid squamous cell carcinoma

• 145 patients with basaloid SCC and 20 866 patients withconventional SCC

• poorer disease-specific survival in basaloid SCC

Adenosquamous carcinoma

• Two components: SCC (in situ or invasive) and adenocarcinoma

• Both components separated

• Not intermingled as in muco-epidermoid ca

• Aggressive clinical courseand poor prognosis

Lymphoepithelial carcinoma

• Poorly differentiated ca withlymphoplasmacytic stromalinfiltration

• Synonym: undifferentiatedcarcinoma of the nasopharyngeal type

• Usually HPV- and EBV-

• Aggressive, with regionallymph node and distantmetastases

Extent of invasion

• Involves mucosa

• Involves paraglotticspace

• Involves pre-epiglotticspace

• Partial thicknessinvasion of cartilage

• Full thickness invasionof cartilage

Perineural invasion

• Tumour cells within any of the three layers of the nerve sheath

• At least 1/3 of circumference

• Enables spread beyond the extent of local invasion

• Locoregional recurrence, decreased survival

Lymphovascular invasion

• Presence of tumour cells within an endothelial-lined space

• Lymphatic vessels, capillaries, veins

• Not necessary

• Weak predictor of nodal and distal metastases

• Should not be considered synonymous with metastasis

• Tumour cells in the lymphatic system and circulation can be destroyed

podoplanin

Margin status

• Clear margins = no invasive or in situ carcinoma

• Adequate margins = how much healthy tissue around the tumour must be removed

• Between 3 and 5 mm

• In laser excision of glottic cancer, even 1 mm may be adequate

• Report the distance from invasive/in situ carcinoma to the closest margin

Pathologic staging (pTNM)

Pathologic staging (pTNM)

• T: extent of tumour and infiltration of surrounding structures and organs

• N: nodal status - number of metastatic nodes, their location and size, and presence of extranodalextension

• M: presence of distant metastases

• UICC, AJCC

• Clinical + pathologic information

Noncore (recommended) elements

• Neoadjuvant therapy

• Tumour thickness

• Pattern of invasive front

• Coexistent pathology

• Ancillary studies

Neoadjuvant therapy

• Essential for correct interpretation of pathologic findings

• Presence and extent of changes (% of the tumour volume) related to previous treatment (e.g., necrosis, fibrosis)

• ypTNM

Pattern of invasive front

Expansive (cohesive) Infiltrative (noncohesive)

Pattern of growth at invasive front is not core data as there is insufficient evidence of their prognostic value for carcinoma of the larynx and hypopharynx.

Ancillary studies Coexistent pathology

• Immunohistochemistry

• p16 or HPV test not obligatory

• Flow cytometry

• Molecular genetics

• Infection, necrotizing sialometaplasia, dysplasia

• Thyroid pathology, lymphoma

Coexistent pathology

Thyroid carcinoma Lymphoma

Conclusions

• Use ICCR guidelines and data sets.

• Larynx anatomy is complex.

• Clinical information is needed forstaging.

• Extranodal extension is included in the new pTNM.

• Molecular genetics, new histologicprognostic markers, targeted therapy ???

Thank you for your attention!

Svečinske gorice, Slovenija