Translator
Category Archives: Larynx
Laryngeal Cancer
Laryngeal Cancer
Classify according to location
1. Supraglottic
2. Glottic
3. Subglottic
4. Transglottic
Prognostic implication of this classification
1. Glottic tumours have better prognosis due to lack of lymphatics and surrounding cartilaginous wall (allows for localization of tumour and lack of lymph node involvement). Also present with hoarseness due to vocal cord involvement and come to clinical attention earlier.
2. Supraglottic and subglottic tumours present later since the tumour enlarges substantially before coming to clinical attention. Abundant lymphatics mean that these tumours often present with lymph node involvement. (Transglottic tumours have the highest lymphatic involvement).
Laryngectomy specimen pathology
1. Ink surgical resection margins
2. Describe appearance of tumour and location (eg. supra-, sub-, trans- or glottic tumour)
3. Measure tumour in three dimensions including maximal depth of invasion
4. Describe presence/absence of involvement of surrounding soft tissue
5. Assess presence/absence of involvement of anterior/posterior commissure and conus elasticus
6. Fix specimen at least 2-4 hours before sectioning
7. Open specimen from posterior aspect
8. Section tumour sequentially (2-3 mm slices) and submit sections demonstrating greatest depth of invasion
9. Recover and submit all lymph nodes from upper, middle and lower portions of specimen
10. Submit decalcified bone and cartilage if involved
Gross and surgical report important features
1. Patient identifiers and demographics
2. How specimen was received
3. Type of specimen and procedure performed
4. Orientation as outlined by surgeon
5. Overall dimensions
6. Tumour location and appearance
7. Tumour dimensions (all three dimensions and greatest depth of invasion)
8. Extension across midline
9. Extralaryngeal involvement
10. Lymph node dissection and involvement by metastasis
11. Histology of tumour
12. Grade
13. Surgical margin involvement
Posted in Larynx
Tagged laryngeal cancer, laryngeal carcinoma, Laryngectomy, larynx cancer
Comments Off
Larynx Papilloma
Larynx Papilloma
Etiology – HPV (types 6 and 11)
Transmission:
Perinatal vertical transmission in children
Mode of infection in adults unknown – query orogenital contact
Prognosis:
Juvenile – extensive growth, rapid recurrences
- Can spontaneously regress at puberty
Adult – less dramatic
Malignant transformation uncommon, usually in setting of predisposing factor (smoking, irradiation)
Posted in Larynx
Tagged , hpv, human papilloma virus, laryngeal, Larynx, Larynx papilloma, Papilloma
Comments Off
Larynx papilloma papillary carcinoma
Larynx papilloma vs papillary carcinoma
Papillary squamous cell carcinoma
- soft, friable, polypoid/papillary, arises from a thin stalk
Papilloma
- forms soft raspberry-like excrescences, rarely more than 1 cm
- pedunculated or sessile with finely lobulated surface
Posted in Larynx
Tagged , Larynx, larynx cancer, larynx papillary carcinoma, Larynx papilloma
Comments Off
Larynx Cancer
Larynx Cancer
Larynx Carcinoma
Glottis (arise from true vocal cords)
a. Remain localized for long periods because of surrounding cartilaginous wall and paucity of lymphatic vessels
Supraglottic (involve false cord, ventricle, epiglottis)
b. Tends to spread to pre-epiglottic space
c. Rarely invades into oropharynx due to hyoepiglottic ligament
d. Incidence of LN spread 40%
Transglottic (cancers that cross the laryngeal ventricle)
e. Highest incidence of LN involvement (52%) – lymph node dissection
Infraglottic (true cord with subglottic extension of more than 1 cm or tumours entirely confined to subglottic area)
f. Tends to spread laterally to cricoid cartilage, prelaryngeal wall and thyroid gland
g. Mets to cervical LN in 15-20%; paratracheal LN in 50% – lymph node dissection