Larynx Path 2002 01 Slidesxx

8/18/2019 Larynx Path 2002 01 Slidesxx

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athology of the

Larynx

1

Nikolay opnikolov M.D.,

h.D.

Fellow, UTMB Dept. of

athology January !!


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Nor"al #nato"y

an$

%i&tology

2


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Nor"al #nato"y an$

%i&tology

3


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Nor"al #nato"y an$

%i&tology

4


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Nor"al #nato"y

an$

%i&tology

5


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Nor"al #nato"y

an$

%i&tology

6


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Nor"al #nato"y an$

%i&tology

7


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Laryngeal 'pitheliu"

8


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-ua"ou& 'pitheliu"

10


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ero"u+inou& (lan$&

11


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Du+t fro" ero"u+inou&

(lan$&

12


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ero"u+inou& (lan$&

13


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n+o+yti+ Tran&for"ation of

ero"u+inou& 'pitheliu"

14


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/o+al ro+e&& of the

#rythenoi$

*artilage

15


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*hon$roi$ Metapla&ia

16


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Non0neopla&ti+

Le&ion& of the

Larynx

17


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Tu)er+ulo&i&

18


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(ranulo"atou

&

1nfla""ation

19


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Fungal 1nfe+tion&

20

3€Histolplasmo

sis

3€Coccidiomycosis

3€Cryptococcos

is

3€Blastomycosi

s


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ther

(ranulo"atou

& Di&ea&e&

21

3€Leprosy

3€Tertiary

Syphilis

3€Sarcoidosis

3€Crohn’sdisease

3€Wegener’s

granulomatosis


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#+ute 'piglottiti&

22

3€Haemophylus infuenzae type B

3€eddened! mar"edly

edematous supraglotticstructures

3€#dema $ith mar"ed in%ltrate o&

neutrophyls $ith or $ithoutmicroa'scess &ormation


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Diphtheria

23


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Diphtheri

a

24


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/o+al *or$ No$ule&

25

3€(sually 'ilateral

3€Anterior or middle third o& true )ocalcord

3€Any age group

3€elated to chronic )oice a'use3€Hoarseness or )oice changes


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/o+al *or$ olyp&

26

3€(sually single

3€*iddle third o& true )ocal cord! 'ut

may originate &rom the )entriculararea

3€Any age group

3€Sessile! rasp'erry+li"e!pedunculated

3€elated to chronic )oice a'use!

in&ection! #T,H! smo"ing!


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/o+al *or$ olyp

27


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'$e"atou&0Myxoi$ Type

3€ Su'mucosal

accumulation o&pale 'lue to pin"material admi-ed$ith sparsely

cellular and)aria'ly)ascularizedstroma

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/a&+ular0%yaline Type

3€ .ilatedsu'mucosal

)ascular spaces anddeposition o&dense

eosinophilic %'rin+li"e material

29


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/o+al *or$ olyp2 Fi)rou&

Type

3€ *oderatelycellular

su'mucosalproli&eration o&uni&orm o)al tospindle+shaped

cells $ith )aryingamount o&%'rous tissuedeposition

30


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Laryngo+ele

31

3€A'normal dilatation o& the saccule/appendi- o& the )entricle0 containing

air and maintaining an opencommunication $ith laryngeal lumen

3€*en 1$omen

3€Bilateral + 243€Hoarseness! lateral nec" mass!

dyspnea! dysphagia! laryngopyocele/pain0


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Laryngo+ele2 Type&

32

3€Internal:

laryngocele con%ned to the

intrinsic laryn-

3€External:

dilated sac pro5ects up$ard and

laterally3€Combined


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Laryngo+ele2 'tiology

33

3€Acquired:increased intralaryngeal

pressure /glass'lo$ers!musicians! $eight li&ters0

3€Congenital

3€SCC in 64 o& cases


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Laryngo+ele

3€Smooth +sur&aced! sac+li"e structureusually %lled34$ith


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Laryngo+ele

3€espiratoryepithelial+ lined/ciliated!columnar0 cyst$ith a %'rous $all

3€S7uamousmetaplasia

3€,ncocyticmetaplasia35


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Laryngo+ele2

Differential

Diagno&i&

36

3€Branchial cle&tcyst

3€,ncocyticpapillarycystadenoma

3€Laryngeal cysts


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*onta+t Ul+er& of the Larynx

3 yogeni+ (ranulo"a of the

Larynx4

37

3€Benign! tumor+li"e condition! occurringmost commonly along the posterioraspect o& one or 'oth )ocal cords

3€*en1Women! usually adults

3€Hoarseness! dysphagia! sore throat!dysphonia! di8culty 'reathing! cho"ing!

pain3€#tiology9 )ocal a'use! acid

regurgitation! postintu'ation trauma



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Larynx4

3€(lcerated!

polypoid! nodular!or &ungating mass$ith a 'ee&y red totan+$hite

appearance! up to3 cm in diameter

38


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3 yogeni+ (ranulo"a of the Larynx4

3€ (lcerated lesion $ith associated %'rinoidnecrosis!granulation tissue! acute and chronic

infammation39



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Larynx4

3€:iant cells! )ascularproli&eration! andspindle40


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*onta+t Ul+er& of the

Larynx2 Differential

Diagno&i&

41

3€;n&ectious diseases

3€SCC3€Spindle cell carcinoma

3€


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Laryngeal #"yloi$o&i&

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3€#-tracellular accumulation o&%'rillar proteins

3€Systemic or localized3€>rimary or secondary

3€*en 1 $omen! in the th and ?thdecades

3€>olypoid mass /glottis andsupraglottis0 or di@use mucosals$elling /su'glottis0

3€Hoarseness


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3€ #-tracellular!eosinophilic!amorphous material

deposited randomlythroughoutsu'mucosadepositions around or$ithin the $alls

3€ .isappearance o&the seromucousglands!

3€ *i-ed chronic

infammatory43


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3€Congo red9 apple+green 'ire&ringenceunderpolarized44


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u)glotti+ teno&i&

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3€Congenital or ac7uired

3€are ac7uired 1 congenital

3€>rogressi)e respiratory di8culty!stridor! dyspnea! air hunger!hoarseness! a'normal cry!

aphonia! dysphagia3€#tiology9 trauma! neoplasms!

in&ectious or autoimmune diseases!idiopathic


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u)glotti+ teno&i&

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3€arro$ing o& the endolaryngealdiameter $ith mucosal or su'mucosalmass or 'ulging

3€Histologic picture depends on the cause

3€;diopathic stenosis9 su'mucosal %'rousproli&eration $ith associated non+speci%c

chronic infammation3€.i@erential diagnosis9 in&ectious

diseases! Wegener’s granulomatosis!collagen )ascular diseases! neoplasms

1$iopathi+


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u)glotti+

teno&i&

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Ter"inology of 'pithelial


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*hange&

48malignan

3€Leukoplakia:$hite lesion on a mucosal mem'rane/clinical0

3€Erythroplakia:red lesion on a mucosal mem'rane /clinical0

3€Hyperplasia:

thic"ening o& epithelial sur&ace as a resulto& an a'solute increase in the num'er o&cells

3€Pseudoepitheliomatous hyperplasia:

e-u'erant reacti)e or reparati)e o)ergro$th

Ter"inology of 'pithelial


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*hange&

anoth

er49

3€eratosis:presence o& "eratin on an epithelialsur&ace

3€Parakeratosis:presence o& nuclei in the "eratin layer

3€!yskeratosis:a'normal "eratinization o& epithelial

cells3€"lceration:

erosion or loss o& sur&ace epithelium

3€#etaplasia:

Ter"inology of


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'pithelial

*hange&

50

)iral/H>


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'pithelial

*hange&

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3€eacti)e or reparati)e 'enign process!refecting the epithelial response to astimulus or an in5ury

3€*en 1 $omen

3€,ccurs any$here! 'ut mainly alongthe true )ocal cords

3€Hoarseness

3€#tiology9 smo"ing! #T,H! )oice a'use!

chronic infammation

%yperpla&ti+


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'pithelial

*hange&

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3€Dlat! papillary! or )errucoid lesion $ith a$hite /leu"opla"ic0 or red /erythropla"ic0

appearance3€Small or di@use

3€ Thic"ening o& epithelial sur&ace as a resulto& an a'solute increase in the num'er o&

cells

3€>resence o& super%cial "eratin layer/"eratosis0 or nuclei in the super%cial

"eratin layer /para"eratosis0

%yperpla&ti+


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'pithelial

*hange&

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3€>resence o& "eratohyaline granulesin the granulosa cell layer

3€>resence o& "oilocytosis3€>resence o& cytologic atypia

3€>resence o& dys"eratosis

3€.i@erential diagnosis9contact ulcer! )erruca )ulgaris!)errucous carcinoma! $ell+di@erentiated Econ)entionalE SCC

5erato&i& with


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'pithelial %yperpla&ia

w6o Dy&pla&ia

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Laryngeal Leukoplakia with a


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apillary or /erru+oi$

#ppearan+e

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Laryngeal Leukoplakia with a


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apillary or /erru+oi$

#ppearan+e

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Dy&pla&ti+


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'pithelial

*hange&

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3€*en 1 $omen

3€,ccurs any$here! 'ut mainly

along the anterior portion o& thetrue )ocal cords! 24 'ilateral

3€Hoarsen

ess

3€#tiology9smo"ing!

#T,H!chronic

Dy&pla&ti+


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'pithelial

*hange&

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3€Localized! circumscri'ed fat orpapillary area $ith $hite! red orgray appearance

3€Cytologic alterations9hyperchromasia! increase o&nuclearFcytoplasmic ratio!mitoses! cro$ding o& cells $ith

loss o& cellular polarity3€Begins in 'asal or para'asalareas

Dy&pla&ti+ 'pithelial


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*hange&2

(ra$ing

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3€#ild:lo$er 6F3 o& the thic"ness o&

epithelium3€#oderate:

lo$er 2F3 o& the thic"ness o&epithelium

3€Se'ere:&rom 2F3 to almost complete thic"ness

Dy&pla&ti+


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'pithelial

*hange&

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3€ormal maturation o& the super%ciallayers o& the epithelium

3€;ntact 'asement mem'rane

3€*ay 'e associated $ith "eratosis ordys"eratosis! or other hyperplasticchanges

3€Dull+thic"ness dysplasia /carcinoma insitu0 is not a prere7uisite prior to thede)elopment o& an in)asi)e CA

3€.i@erential diagnosis9 reacti)e

Flat 5erato&i& with


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'pithelial %yperpla&ia an$

Mil$ Dy&pla&ia

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5erato&i& with


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Mo$erate

Dy&pla&ia

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evere Dy&pla&ia without


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5erato&i&

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Benign Neopla&"& of

the Larynx

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Laryngeal apillo"a

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3€Benign! e-ophytic neoplastic gro$thcomposed o& 'ranching &ronds o&s7uamous epithelium $ith

%'ro)ascular cores3€The most common 'enign

laryngeal neoplasm

3€o se- predilection3€Changes in phonation! dyspnea!

cough! dysphagia! stridor

3€H>< types ? and 66


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Laryngeal apillo"a

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3€ (u'enile type:multiple lesions $ith e-tensi)egro$th and rapid recurrence! mayremit spontaneously or persist intoold age

3€Adult type:

more o&ten single! recurs lesso&ten! less li"ely to spread


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3€#-ophytic! $arty! &ria'le! tan+$hiteto red gro$ths

67


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3€ >apillary &ronds o& multilayered 'enigns7uamous epithelium containing%'ro)ascular cores

683€ Little or no "eratin


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Laryngeal apillo"a

3€A'sence o&stromalin)asion

3€Certaindegree o&

cellular atypia3€=oilocyticchanges69

Laryngeal (ranular


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*ell Tu"or

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3€*en 1 $omen

3€Hoarseness3€Along the posterior aspect o&

true )ocal cord / 'ut also in

supraglotic and in&ragloticareas0

(ranular *ell Tu"or


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3€Solitary!

polypoid!sessile!papillary! orcystic lesion!measuring upto

3G cm in71

(ranular *ell Tu"or


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3€ >oorlycircumscri'edsu'epithelial lesion$ith syncytial!tra'ecular! ornested gro$thpattern

3€ ound to polygonalcells $ith round to)esicular nuclei andcoarsely granularcytoplasm >oorlyde%ned cell 'orders

3€


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1""uno&tain

73

&eu$oepithelio"atou&

hyperpla&ia


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74

(ranular *ell Tu"or


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3€ Cytoplasmic granules:>ASFd ! Alcian 'lue pH 2 ! trichrome /red0

3€ Angulate bodies9

needle shaped! >AS 'odies in theinterstitial cells

3€ )umor cells:S+6GG! S#

3€ Interstitial cells *ith angulate bodies:S+6GG + and myelin protein

3€ E#:

mem'rane 'ound autophagic )acuoles

containin mitochondria # m elin

Malignant (ranular


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*ell Tu"or

)essel

s

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3€are / 64 o& all :CT0

3€.o not occur in

ne$'orns 3€Size 1 Icm

3€;ncreased cellularity!

pleomorphism! necrosis!prominent nucleoli! spindleshaped cells and 1 2 mitosesF6GH>D

*hor$o"a


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3€(ncommon

3€*ales 1

&emales

3€.yspnea!strydor! andhoarseness

3€*ay originates &rom epiglottis!cricoid! arytenoid! or thyroidcartilages

*hor$o"a


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3€Lo'ulated!normallyloo"ing

chondrocytes3€A'sence o&

pleomorphism! 'inucleatedchondrocytes!or mitoticacti)ity

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8ha)$o"yo"a


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3€Benign tumor o& striated muscle

3€Adult type9

3€less common3€*ales 1 &emales 1 IG yFo

3€Hoarseness! dyspnea

3€Well+de%ned! lo'ulated! red+'ro$nmass! up to cm in diameter

8ha)$o"yo"a2 #$ult


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Type

3€ Large polygonal toround cells $itha'undant deeplyeosinophylic cyroplasmand one or t$o

periphery placed)esicular nuclei

3€ ucleoli!cytoplasmic)acuolization

3€ Cross+striation

3€ A'sent mitoses

3€ A'undantcytoplasmicglycogen /diastase

80

8ha)$o"yo"a2 Fetal


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Type

81

3€osterior auricular su'cutaneoustissue 1 nasopharyn-! parotis! nec"

3€Solitary! $ell to moderately

circumscri'ed nodule! 6+K cm insize! gray to pin" mucoidappearance

8ha)$o"yo"a2 Fetal


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Type

3€ Spindle cells andimmature muscle%'ers $ith in amy-oid stroma

3€ Cross+striationrarely discerni'le*ature muscle%'ers can 'e

seen in theperiphery

3€ A'sence o& mitoses!necrosis! and

signi%cant

82


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Malignant

Laryngeal

Neopla&"&

83

1n itu -ua"ou&

*ell


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*ar+ino"a

84

3€ *ales 1 &emales

3€ ?th Mth decades

3€ *ost o&ten in)ol)es anterior portion

o& true )ocal cord

3€ Hoarseness

3€ *ay coe-ist $ith in)asi)e SCC

3€ *ay 'e isolated or multi&ocal

3€ Circumscri'ed or di@use lesion $ith a$hite! red! or gray color and smoothor granular appearance

1n itu -ua"ou&

*ell


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*ar+ino"a

3€ .ysplastic processin)ol)es the entirethic"ness o& theepithelium

3€ Loss o& cellularmaturation andpolarity

3€ ;ncrease o&

nuclearFcytoplaslicratio

3€ ormal anda'normal mitoses85

Mi+roinva&ive or uperfi+ially

1nva&ive -ua"ou& *ell


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*ar+ino"a

3€ ests o& malignantcells that ha)epenetrated the

'asement mem'raneand in)adedsuper%cially into thesu'mucosa

3€ Capa'le o&

metastasizing3€ .e)elopment &rom

carcinoma in situ or&rom epithelium $ithno e)idence o& C;S86

1nva&ive -ua"ou& *ell

*ar+ino"a


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87

3€24 o& all cancers in men

3€G4 o& all cancers in

$omen 3€N4 o& all

laryngeal carcinomas

3€#tiology9 #T,H /supraglottic0!to'acco /glottic0! as'estos! nic"el!

$ood! isopropyl alcohol! radiation

3€..9 reacti)e epithelialchanges!

1nva&ive -ua"ou&

*ell *ar+ino"a


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88

upraglotti+

-ua"ou& *ell


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*ar+ino"a

89

3€2IG4 o& laryngeal SCC

3€#piglottis /'ase0! &alse )ocal cords

3€Changes in the 7uality o& )oice!dysphagia! odonophagia! hoarseness!hemoptisis! dyspnea

3€*arginal carcinomas /suprahyoid

epiglottis! aryepiglottic &olds0 remain7uiescent &or longer period and present atmore ad)anced stage

upraglotti+

-ua"ou& *ell


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*ar+ino"a

90

3€(lcerated! fat!e-ophytic! or papillary

3€Tend to 'e

non"eratinizing 3€;n situ

component 3€*itoses

and necrosis

upraglotti+

-ua"ou& *ell


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*ar+ino"a

3€Large! tan+$hite

neoplasm inthe rightsupraglottis!

e-tendingup$ard to$ardepiglottis

91

upraglotti+

-ua"ou& *ell


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*ar+ino"a

92

(lotti+ **


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93

3€#arly9 irregular area o& mucosalthic"ening

3€Ad)anced9 e-ophytic!

&ungatic! endophytic!ulcerated mass

3€*ore commonly "eratinizing!

$ell to moderatelydi@erentiated

3€;n situ component

(lotti+ **


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(lotti+ **


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(lotti+ **


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96

u)glotti+ -ua"ou& *ell

*ar+ino"a


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97

3€ 4 o& all laryngeal tumors

3€ Tend to remain clinically 7uiescent! presenting$ith ad)anced stage

3€ Air$ay o'struction /dyspnea! stridor0 and )ocal

cord %-ation /)oice changes0

3€ Large e-ophytic! &ungating! ulcerating! orendophytic

3€ Tend to 'e "eratinizing moderately to

poorly di@erentiated

3€ ;n situ component is less common

3€ ;n)asi)e pattern is predominantlyin%ltrati)e

u)glotti+ **


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98

u)glotti+ -ua"ou& *ell

*ar+ino"a


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99

3€,)erall +year sur)i)al rate J IG4

3€Spread9

? ;nto thyroarytenoid muscle /)ocal cord

%-ation0? Anteriorly9 through cricothyroid mem'rane

into thyroid gland superiorly9 glottis andsupraglottis

? in&eriorly9 trachea posteriorly9 'elo$ thecricoid cartilage and into the esophagus

? Lymphatic drainage9 upper and lo$er

Tran&glotti+ **


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100

3€;n)ol)es 'oth glottic andsupraglottic structures

3€epresents ad)anced tumor

3€odal metastases and e-tranodalspread

3€,)erall +year sur)i)al rate JIG4

Tran&glotti+ **


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101

pin$le *ell 3-ua"ou&4

*ar+ino"a 3**4


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102

3€ Doci o& con)entional SCC associated $ithmalignant spindle cell stromal component

3€ Synonyms9 carcinosarcoma! pleomorphiccarcinoma! metaplastic carcinoma! collision

tumor! pseudosarcoma! Lane tumor3€ *en /K40! ?th Kth decades

3€ True )ocal cords 1 &alse )ocal cords andsupraglottis 1 oral ca)ity 1 s"in 1 tonsil and

pharyn-3€ Symptoms )ary according to site

3€ o speci%c etiology


*ar+ino"a 3**4


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*ar+ino"a 3**4


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3€Spindle cellcomponent$ith )aria'le

degree o&pleomorphism!mitoses

3€Dascicular!

stori&orm! orpalisadingpatterns may'e associated

i h

104


*ar+ino"a 3**4


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3€Spindle cells are cyto"eratin+positi)e! 'utnegati)ity does not e-clude the105

%eterologou& 'le"ent&


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106


*ar+ino"a 3**4


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107

3€.i@erential diagnosis9

3€eacti)e /%'ro'lastic0 proli&eration

3€*alignant %'rous histiocytoma

3€Di'rosarcoma

3€*alignant melanoma


*ar+ino"a 3**4


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3€Contro)ersial histogenesis #pithelialderi)ation is support 'y9

F Association $ith con)entional SCC

F ;CH9 cyto"eratin F Cartilage or 'one component ha)e not

'een reported in metastases

3€*etastases may include con)entionalorFand spindle cell component

3€>oor prognosis /metastases in lymphnodes and lungs0

/erru+ou& *ar+ino"a


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109

3€Highly di@erentiated )ariant o& SCC $ith&ocally destructi)e! 'ut not metastaticcapa'ilities

3€6+34 o& all laryngeal carcinomas3€*en 1 $omen! ?th

Mth decades3€,ral ca)ity 1 nasal &ossa 1 sinonasaltract! nasopharyn-

3€Laryn-9 hoarseness

3€;n the laryn- most common in theglottic area

3€>otential etiologic &actors9 to'acco!)iruses

/erru+ou& *ar+ino"a


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110

3€ Tan or $hite! $arty! &ungating! or e-ophytic!%rm to hard mass! attached 'y a 'road 'ase

3€ S7uamous cell proli&eration9

F uni&orm cells $ithout dysplastic &eatures and

mitosesF mar"ed sur&ace "eratinization

F 'road or 'ul'ous rete pegs $ith pushing!,T in%ltrati)e margin

F .ysplastic &eatures limited and con%ned to'asal sone

3€ *i-ed chronic immfammarory cellin%ltrate

/erru+ou& *ar+ino"a


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3€ Tan or $hite!$arty!

&ungating! ore-ophytic! %rmto hard mass!attached 'y a

'road 'ase

111

/erru+ou& *ar+ino"a


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112

/erru+ou& *ar+ino"a


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3€ S7uamous cellproli&eration9

F uni&orm cells $ithoutdysplastic &eatures and

mitoses

F mar"ed sur&ace"eratinization

F 'road or 'ul'ous rete pegs$ith pushing! ,Tin%ltrati)e margin

F .ysplastic &eatures limitedand con%ned to 'asalzone113

/erru+ou& *ar+ino"a


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114

3€.i@erential diagnosis9F =eratotic s7uamous papilloma

F eacti)e "eratosis and epithelial

hyperplasiaF >seudoepitheliomatous hyperplasia

F


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115

3€*etastasis in regional lymph nodesare rare! and distant metastases donot occur

3€#-cellent prognosis a&ter completesurgical remo)al

3€Anaplastic trans&ormation may result indistant metastases

3€Ade7uate 'iopsy material $ith a goodepithelial+ stromal inter&ace is critical &orthe interpretation

Ba&aloi$ -ua"ou& *ell

*ar+ino"a


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116

3€An in)asi)e neoplasm!composed o& 'asaloid cells

3€(ncommon

3€*en 1 $omen! ?th

Mth decades3€Hypopharyn- /pyri&orm sinus0!laryn- /supraglottis0! andtongue

3€Hoarseness! dysphagia! pain!nec" mass

3€#tiology9 #T,H! ta'acco


*ar+ino"a


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117

3€ Dirm to hard! tan+$hite mass! o&ten $ithassociated central necrosis

3€ >atterns9 solid! lo'ular! cell nests! cri'ri&orm!cords! tra'eculae! gland+li"e! or cystic

3€ Comedonecrosis3€ ;ntercellular deposition o& a hyaline or

mucohyalin material

3€ Docal s7uamous di@erentiation or association

$ith SCC! SCC;S! s7uamous dysplasia! or spindlecell component


*ar+ino"a


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3€ ;n%ltrating tumor originating &rom the sur&aceepithelium118$ith solid gro$th pattern and


*ar+ino"a


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3€ Small! closelyapposed cells$ith

hyperchromaticnuclei! scantycytoplasm!mar"ed mitoticacti)ity! largecells orpleomorphismcan 'e seen

119

Ba&aloi$ ** with

Fo+al

5eratini9ation


120/140

129


*ar+ino"a


121/140

lamina

121

3€ Histochemistry:

>AS and Alcian 'lue material in thecystic spaces

3€ IHC:

cyto"eratin /0! #*A /0! C#A /0!S+6GG /0

chromogranin /+0!synaptophysin /+0! muscle+

speci%c actin /+03€ E#:

'asaloid component9desmosomes! rare tono%laments


122/140


*ar+ino"a


123/140

123

3€*ulti&ocal! deeply in)asi)e!metastatic

3€*etastases9 lymph nodes! lung!'one! s"in! 'rain

3€*etastases include 'oth 'asaloid

and s7uamous components3€apidly &atal

#$eno&-ua"ou

&

*ar+ino"a

3€ * li hi h d i h li l l i h


124/140

124

3€ *alignant high grade epithelial neoplasm $ithhistologic &eatures o& adenocarcinoma and SCC

3€ (ncommon

3€ *en 1 $omen! ?th Mth decades

3€ Laryn-! hypopharyn-! oral ca)ity! sinonasalca)ity

3€ Hoarseness! dysphagia! pain! nec" mass!nasal o'struction

3€ #tiology9 not clear /#T,H! to'acco0

3€ Cell o& origin9 unclear possi'le a singletotipotential cell &rom sur&ace epithelium orseromucous glands

#$eno&-ua"ou

&

*ar+ino"a

3€ # h ti ' l & i 'l d t


125/140

in)asion

125

3€ #-ophytic or su'mucosal! &ria'le! edematousor granular mass $ith or $ithout sur&aceulcerations

3€ SCC component:

F Well to poorly di@erentiated! associated insitu carcinoma or in)asi)e SCC

F ;ndi)idual cell "eratinization! intercellular'ridges! "eratin pearl &ormation! dys"eratosis

3€ Adenocarcinoma component:F ;n the su'mucosa! glandular di@erentiation!

3€ Both components can 'e admi-ed

3€ Cellular pleomorphism! mitoses! necrosis!

#$eno&-ua"ou

&

*ar+ino"a


126/140

126

#$eno&-ua"ou

&

*ar+ino"a

3€Hi t h i t >ASFd /0 d


127/140

127

3€Histochemistry9 >ASFd /0 andmucicarnine /0 intraluminalmaterial

3€;HC9 cyto"eratin /03€Beha)es )ery aggressi)ely!

irrespecti)e o& the size o& neoplasm

3€#arly lymph node metastases! lung!li)er

3€>oor prognosis9 +year sur)i)al rate

Neuroen$o+rine

*ar+ino"a2

*la&&ifi+ation


128/140

128

3€Carcinoid/$ell di@erentiated0

3€Atypical carcinoid/moderately di@erentiated0

3€Small %+oat,& cellcarcinoma

/poorly di@erentiated0

Neuroen$o+rine *ar+ino"a


129/140

129

3€Su'mucosal nodular orpolypoid mass $ith tan+

$hite appearance and upto I cm in diameter

3€Sur&ace ulceration may

present in moderately or$ell+di@erentiatedneuroendocrine carcinoma

*ar+inoi$


130/140

3€ ,rganoid ortra'ecular gro$thpattern $ith

%'to)ascularstroma

3€ :lands ors7uamous

di@erentiation can'e seen

3€ A'sence o&sur&ace130

*ar+inoi$


131/140

3€ (ni&orm cells $ithcentrally locatedround nuclei!)esicular

chromatin! andeosinophiliccytoplasm

3€ A'sence o&

pleomorphism!mitoses!necroses

3€ Lo$131

*ar+inoi$

3€


132/140

3€Histochemistry: >ASFd mucin!

argyrophilia3€ IHC:

Cyto"eratin !Chromogranin ! S#

! synaptophysin 3€ E#:neurosecretory

granules! cellular132

#typi+al *ar+inoi$

3€ , id t ' l


133/140

3€ ,rganoid! tra'ecular!cri'ri&orm! or solidgo$th pattern

3€ *ild to mar"ed

cellularpleomorphism

3€ ucleoli may 'e

prominent 3€ *itoses and

&ocal necrosis 3€


134/140

3€ Solid nests!sheets! or ri''ons!$ith a'sence o&%'ro)ascular

stroma3€ Sur&ace ulceration

3€ Lympho)ascularand perineural

in)asion3€ :landular or

s7uamousdi@erentiation134rarely

"all *ell *ar+ino"a

3€ *ar"ed cellular


135/140

3€ *ar"ed cellularpleomorphism!Pcrush’ arti&acts!necrosis!hyperchromatic o)al

to spindle nuclei!a'undant mitoses

3€ Highnuclear9cytoplasmicratio

3€ IHC:cyto"eratin!chromogranin!synaptophysin!S# positi)e135

*hon$ro&ar+o"a

3€are


136/140

136

3€are

3€*ales 1Demales! Ith + Mthdecades

3€Cricoid 1 thyroid cartilage1 arytenoid

3€Smooth! lo'ulated! hard

su'mucosal mass larger than 2cm

*hon$ro&ar+o"

a 3high

gra$e4


137/140

3€ Lo'ulatedhypercellular tumor$ith

hyperchromatic!pleomorphic nucleiand prominentnucleoli

3€ Binucleate or

multinucleatedcells

3€ *itoses9 usually

uncommon137

ynovial ar+o"a


138/140

138

ynovial ar+o"a


139/140

139

ynovial ar+o"a


140/140

140

Documents

Larynx Path 2002 01 Slidesxx