Moderately differentiated squamous cell carcinoma of larynx

1. ACADEMIC REVIEW
Carcinoma of the larynx

2. Anatomy of larynx

5. Larynx

6. Larynx

8. Grossing of the larynx

9. 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

10. 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)

11. Gross examination

13. Scanner view

22. 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.

23. 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

24. • 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

25. Variants of squamous cell carcinoma
• Verrucous carcinoma
• Spindle cell carcinoma
• Basaloid squamous cell carcinoma
• Papillary squamous cell carcinoma
• Adenosquamous carcinoma

26. 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

27. Verrucous carcinoma

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. Spindle cell carcinoma

30. 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.

31. Basaloid squamous cell carcinoma

32. 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

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 Joint Committee on Cancer
Staging Guidelines for Tumors of the Larynx