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a Verrucous carcinoma. Prominent surface keratinization, projection and invagination of well-differentiated squamous epithelium invading the stroma with pushing margins. b Spindle cell carcinoma of the larynx. Proliferation of malignant spindle cells with marked mitotic activity. bInset Positive immunohistochemical reaction for Snail in some tumor cells
Source publication
Chapter 3 “Tumours of the hypopharynx, larynx, trachea, and parapharyngeal space” of the World Health Organization (WHO) Blue Book 2017 “Classification of Head and Neck Tumours” shows a shortened list of entities, especially due to reducing the number of benign and malignant soft tissue tumours, malignant melanoma and some others, which are transfe...
Citations
... Based on the latest indication of WHO Classification of Head and Neck Tumors [10], the following findings were considered (i) histology of the tumor; (ii) grade of the tumor (low or high grade); (iii) postoperative resection margins (according to Hermanek and Wittekind) (R0, Rclose, R1, or R2) [11]; (iv) lymphovascular invasion (LVI) (absent, focal or <2 figures of LVI, diffuse or >2 figures of LVI); (v) perineural invasion (absent or present); (vi) extraglandular growth (absent or present). ...
Background: This study aims to retrospectively investigate the prognostic significance of the tumor microenvironment, with a focus on TILs (tumor-infiltrating lymphocytes), in relation to survival in a large cohort of patients with parotid gland cancer, and it uses the method proposed by the International TILs Working Group in breast cancer. Methods: We included a cohort of consecutive patients with biopsy-proven parotid cancer who underwent surgery between January 2010 and September 2023. A retrospective review of medical records, including surgical, pathological and follow-up reports, was performed. The density of TILs was determined according to the recommendations of the International TILs Working Group for breast cancer. Results: A weak negative correlation (p = 0.3) between TILs and time of survival and a weak positive correlation (p = 0.05) between TILs and months of survival (high TILs were correlated with longer survival in months) were identified. High TILs were weakly negatively, but not statistically significantly p (0.7), correlated with the grading of tumor; this means that high TILs were associated with low-grade tumors. Conclusions: Contrary to previous preliminary reports, this retrospective work found no statistically significant prognostic role of TILs in parotid gland malignancies. This case series represents the largest cohort ever reported in the literature and includes all malignant histological types. Future larger molecular studies may be useful in this regard.
... Seventy percent of the patients are already stage 4 at the time of diagnosis. Therefore, they have lost their chance of surgery [29,35,36]. In a meta-analysis by Strojan et al., large and small cell NECs seen in the larynx were evaluated in terms of treatment and survey, and they could not show any significant variable other than the stage and histologic type of the disease in a multivariate model [28]. ...
Purpose of Review
Although non-squamous tumors of the larynx are really rare, they may not always be viewed from the same perspective in the multidisciplinary treatment approach once the diagnosis is made. In this review, non-squamous tumors of the larynx and current approaches in treatment will be discussed.
Recent Findings
When the studies and meta-analyses presented in the last 5 years are evaluated, it is seen that these tumors usually show non-specific symptoms. Due to their submucosal location, the stage of the disease at the time of diagnosis is often advanced. In the literature, treatment may vary in these particular cases.
Summary
The majority of non-squamous tumors of the larynx includes minor salivary gland tumors, neuroendocrine carcinomas, sarcomas, cartilage tumors, and malignant melanomas. Once treating a patient with these diagnoses, it should be kept in mind that the histopathological subtype is almost as important as the stage of the tumor.
... Great effort has been devoted to identifying novel diagnostic or prognostic markers that reliably discriminate tumor behavior to improve patient stratification and prediction of outcome beyond the current clinical and histopathological criteria. In this regard, a new WHO classification has recently been established for laryngeal dysplasia into low-grade versus high-grade dysplasia, which attempts to overcome the limited predictability of previous three-tier grading as mild, moderate, and severe dysplasia [29,30]. Improving the laryngeal cancer diagnosis continues to be a priority research area aimed at detecting cancer at an earlier and more curable stage, which nowadays remains an unmet need. ...
... The presence of lesions with dysplastic features is related to a higher cancer risk; however, some cancers develop from lesions lacking dysplastic changes. A new WHO classification has recently been established for laryngeal dysplasia into low-grade versus high-grade dysplasia [29,30], which attempts to overcome the limited predictability of the previous 3-tier grading system. None of these classifications significantly predicted laryngeal cancer risk in our cohort, thus reflecting the still limited value of histologic grading in accurately predicting outcome. ...
... All patients were men, with a mean age of 65 years (ranging from 36 to 83 years). A total of 8 (13%) premalignant lesions were classified as low-grade dysplasia and 54 (87%) as high-grade dysplasia according to the WHO classification (4th Edition) [29,30]. ...
The PIK3CA and SOX2 genes map at 3q26, a chromosomal region frequently amplified in head and neck cancers, which is associated with poor prognosis. This study explores the clinical significance of PIK3CA and SOX2 gene amplification in early tumorigenesis. Gene copy number was analyzed by real-time PCR in 62 laryngeal precancerous lesions and correlated with histopathological grading and laryngeal cancer risk. Amplification of the SOX2 and PIK3CA genes was frequently detected in 19 (31%) and 32 (52%) laryngeal dysplasias, respectively, and co-amplification in 18 (29%) cases. The PIK3CA and SOX2 amplifications were predominant in high-grade dysplasias and significantly associated with laryngeal cancer risk beyond histological criteria. Multivariable Cox analysis further revealed PIK3CA gene amplification as an independent predictor of laryngeal cancer development. Interestingly, combined PIK3CA and SOX2 amplification allowed us to distinguish three cancer risk subgroups, and PIK3CA and SOX2 co-amplification was found the strongest predictor by ROC analysis. Our data demonstrate the clinical relevance of PIK3CA and SOX2 amplification in early laryngeal tumorigenesis. Remarkably, PIK3CA amplification was found to be an independent cancer predictor. Furthermore, combined PIK3CA and SOX2 amplification is emerging as a valuable and easy-to-implement tool for cancer risk assessment in patients with laryngeal precancerous lesions beyond current WHO histological grading.
... According to World Health Organization (WHO) 2017, NENs of head and neck are classified into three categories: well-differentiated tumor, or grade1 (G1, previously called "typical carcinoid"), accounting for approximately 5% of laryngeal NENs, which generally occur in the supraglottic region (4,5); moderately differentiated tumor, or G2 (formerly referred to as "atypical carcinoid"), the most frequent type, accounting for 54% of laryngeal NENs (5,6); poorly differentiated carcinoma, G3 neuroendocrine cancer (NEC), which is the second most common type of laryngeal NENs (48.6%), including two subtypes, small cells neuroendocrine cancer (SNEC) or small cell undifferentiated neuroendocrine carcinoma (SCUNC) (41.9%) and large cells neuroendocrine cancer (LCNEC) (6.7%) (5,7,8). ...
Background
Laryngeal neuroendocrine tumors (NETs) represent less than 1% of all malignancies originating from the larynx and available data are limited on case reports. Calcitonin secreting laryngeal NETs are extremely rare and serial dosing of calcitonin in these patients might reveal early relapse or persistence.
Case Description
We report the case of a 71-year-old woman with persistent pharyngodynia who underwent surgery for an initial diagnosis of small cell undifferentiated neuroendocrine carcinoma (SCUNC) of the larynx (on the epiglottis extended to the left glosso-epiglottic vallecula). The immunohistochemical profile showed the presence of synaptophysin, neuron-specific enolase (NSE), chromogranin A, pan-cytokeratin, including cytokeratin AE1-AE2, and focally calcitonin. The circulating NSE was 13.4 microg/L (normal level <12.5 microg/L) and the basal serum level of calcitonin was 237 pg/mL (normal level <11.5 pg/mL). The patient was started on first-line carboplatin-etoposide chemotherapy because of early relapse to an axillary lymph node. After 4 cycles of treatment, a radiological stability and metabolic response were demonstrated together with a drastic decrease of circulating serum level of calcitonin (from 237 to 57.9 pg/mL). During the follow up, locoregional relapse of disease occurred, associated with an increase of serum calcitonin (89.3 pg/mL). Disease further progressed on and rechallenge with platinum-etoposide chemotherapy was administered, during which clinical progression was confirmed. Due to the lack of response, a revision of the histology was performed and concluded for a definitive diagnosis of moderately differentiated G2 NET, with a Ki-67 index of 22.6%.
Conclusions
This is the eighth case report of laryngeal NET, highlighting the challenge in pathological differential diagnosis and therapeutic strategies. The association with elevated serum calcitonin and the trend of this parameter during clinical progression suggest a role of this marker in the diagnosis and early identification of recurrent laryngeal NETs.
... The 5-year survival rate represents only 15% of the total cases reported. (5) Large cell neuroendocrine carcinoma incidence was not yet properly explored due to its rareness and difficulty in establishing a histologic diagnosis and due to its recent reclassification as a new entity only in 2017 by the World Health Organization (WHO Classification of Head and Neck Tumor 2017). Yet, it comprises <10% of all laryngeal neoplasms, considering that SCC is the most common form of laryngeal cancer, and its incidence is estimated at 90%. (6) Thus, a tumor simultaneously containing these two histological compositions becomes an even rarer entity. ...
Laryngeal cancer ranks third among the most common head and neck neoplasms. The most common histological subtype is squamous cell carcinoma, and neuroendocrine tumors are rare. An even rarer entity is a composite tumor with both these histologies. This case reports a metastatic combined carcinoma of squamous cells and large neuroendocrine cells, presenting favorable response to treatment with a total laryngectomy followed by adjuvant therapy including chemo-, radio-, and immunotherapy.
Keywords:
Laryngeal neoplasms; Carcinoma, neuroendocrine; Carcinoma, squamous cell; Head and neck neoplasms; Carcinoma, large cell
... Принимая во внимание этиологические факторы, провоцирующие развитие хронических заболеваний гортани (ХЗГ), тенденции к снижению заболеваемости в настоящее время не наблюдается [2,3]. Среди опухолеподобных образований наиболее часто встречаются полипы (39-68%), отек Рейнке (5,5%), кисты (5%) и неспецифические гранулемы (3%) [4,5], а среди доброкачественных новообразований довольно распространены папилломы (20-45%) и гемангиомы (до 13-18%) [6][7][8][9]. ...
The topicality of the issue of treating chronic diseases of the larynx is beyond dispute. Given the increased load on the vocal apparatus, no downward trend in disease incidence is observed. The percentage of patient visits to an otorhinolaryngologist with complaints of prolonged changes in voice timbre, vocal fatigue, and difficulties with voice control is 7–12%. Chronic productive formations of the larynx account for up to 55–70% of pathologies in the proliferative upper respiratory disease pattern. If not treated promptly, chronic diseases of the larynx can significantly affect a person’s ability to speak, swallow and breathe normally. Today, various methods for surgical treatment of chronic diseases of the larynx are used: both classical cold instruments and high-energy laser systems. The history of laser medicine dates from the late 1960s and is associated with the introduction of a high-intensity device emitting a photon stream in the infrared range into medical practice. The first carbon dioxide lasers were difficult to use (they were large in size and had complex technical settings), but at the same time they showed high resection and coagulation qualities, and it earned them their popularity. Over 3 thousand new laser devices representing a practical interest for laryngeal surgery have appeared on the medical market for more than 60-year period. Despite the fact that fundamental research demonstrates the positive results of phonosurgery with high-power devices, many otolaryngologists continue be in awe of lasers. The article presents the results of the use of traditional devices in phonosurgery for chronic diseases of the larynx and draws conclusions about the effectiveness and safety of high-power devices.
... Spindle cell neoplasms can affect the soft tissue, bone, or any part of the human body and it is often very difficult for the pathologists to differentiate it from other similar microscopic simulates [5].Immunochemistry is presently the most important adjunct tool in the evaluation of spindle cell tumors because of its practicability and relatively low cost. Immunochemistry is helpful to exclude pertinent differential diagnosis and permit a reliable preoperative diagnosis of tumor in doubtful cases. ...
Spindle cells are of mesenchymal origin and constitute part of the body's connective tissue [1]. The spindle cells are fusiform in shape with cytoplasmic extensions away from the nucleus. They vary in size with moderate amount of blue cytoplasm. The nucleus of the cell is round to oval in shape and has a smooth to fine lacy chromatin pattern. The nucleoli usually are not visible in non-neoplastic spindle cell but when the spindle cells are malignant, their nucleoli become more prominent, coarse chromatin, basophilic cytoplasm with increase nuclear cytoplasmic ratio [2]. Some of the cells which exhibit spindle morphology are fibroblast, myofibroblast, smooth muscle cells, myoepithelial cells, perineural cells, pericytes, schwann cells and myoepithelial cells [3]
... According to the WHO, laryngeal neuroendocrine cancers (NEC) are classified into well-differentiated, moderate, and poorly differentiated cancers. The latter is further divided into small cell NEC and large cell NEC (7). Small cell cancers represent only 0.3% of all head and neck cancers (5). ...
Small cell cancer (SCC) is a neuroendocrine neoplasm, which is most frequently found in the lungs. Extrapulmonary location of SCC is rare and may involve 2.5-5% of SCCs. We present a case of a 31-year-old male patient with an extremely uncommon subglottic SCC. The patient was qualified for a radical sequential chemoradiotherapy. After treatment, patient’s condition suggested complete remission. Recurrence was detected one year later, and the disease rapidly progressed, despite a second line chemotherapy. The patient died 29 months after initial diagnosis. This case aims to raise awareness on the aggressive laryngeal SCC and its good response to first line chemotherapy composed of cisplatin and etoposide, followed by radiotherapy.
... Leukoplakia is a chameleon-like epithelial transformation that can range from benign thickening to malignant tumors. As a result, the name "leukoplakia" is insufficient to characterize the lesion's histological identity [15][16][17][18]. ...
... There are previous reports on a tissue-specific classification of vascular changes associated with laryngeal leukoplakia. According to former reports, age, non-homogenous lesion texture, and the existence of hyperemia are independent predictors of malignancy [18][19][20]. These reports support the findings of the present study to a certain extent because they also provide evidence that age and lesion texture may predict prognosis. ...
Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32–73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group—group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn’t significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.
... Notably, despite their condition, most patients had an ECOG performance status of 0, indicating that it did not significantly impact their daily activities [35]. Our study found that most patients had GIII-GIV tumors, which typically indicate a more aggressive disease and a poor prognosis [36]. Our research aligns with previous studies, indicating the necessity for further investigation into successful prevention and treatment methods. ...
Background and objective
Head and neck squamous cell carcinoma (HNSCC) is a prevalent cancer type that affects the mucosal lining of the upper aerodigestive tract. Soluble programmed death-ligand 1 (sPD-L1) is a significant factor in hindering T cells' function, which prevents cancer cells from being detected by the immune system. This means that sPD-L1 is an essential component in the immune evasion of cancer. This study aimed to explore the potential of sPD-L1 as a prognostic biomarker for patients with HNSCC undergoing concurrent chemotherapy and radiation therapy.
Methodology
The study included 106 patients with locally advanced HNSCC who received three courses of induction chemotherapy followed by concurrent chemoradiation and 60 healthy subjects as controls. sPD-L1 levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit, and the cutoff value was determined based on receiver operating characteristic (ROC) curve analysis.
Results
The results showed that sPD-L1 levels were significantly higher in HNSCC patients compared to healthy controls, with a cutoff value of 31.51 pg/mL. Higher sPD-L1 levels were associated with poorer overall survival rates.
Conclusions
These findings suggest that sPD-L1 may serve as a valuable prognostic biomarker for HNSCC patients undergoing concurrent chemotherapy and radiation therapy. The study highlights the importance of exploring new biomarkers and therapeutic strategies for HNSCC to improve patient outcomes and reduce morbidity and mortality rates associated with this disease.
