Basaloid squamous cell carcinoma of the larynx

Basaloid squamous cell carcinoma (BSCC) is a rare tumor with distinct morphological and biological features that differentiate it from the common form of squamous cell carcinoma (SCC) in the head and neck region. It is mostly seen in the supraglottic larynx, hypopharynx and a base of the tongue. We present two cases of BSCC of the larynx; both being transglottic tumors. Both of the patients underwent primary surgery including bilateral neck dissections. None of the patients had cervical metastases at histopathological examination. Both patients received radiotherapy after surgery. They were alive and free of disease at 24 and 27 months, respectively.     

Papillary squamous cell carcinoma of the larynx

A case of papillary squamous cell carcinoma of the larynx in a 50-year-old man is reported. The lesion was located in the supraglottic region and grossly presented a characteristic finger-like pattern of growth. The tumour pursued an indolent clinical course, and the patient is well and free of disease after 47 months of follow-up. The present paper recapitulates the macro- and microscopic features of this rare neoplasm and stresses its differential diagnosis with other exophytic squamous cell carcinomas of the region.     

Papillary squamous cell carcinoma of the larynx

Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma of the aerodigestive tract that has been correlated with a more favorable prognosis than conventional squamous cell carcinoma of the head and neck. In this report, the authors present a case of papillary squamous cell carcinoma and a review of the literature on this topic.     

Basaloid squamous cell carcinoma of the larynx

Most of the malignancies arising from the upper respiratory system are squamous cell carcinomas (SCC). Basaloid squamous cell carcinoma (BSCC) is a rarely seen high grade variant of SCC that carries a poor prognosis. In this article, we present a case of BSCC of the larynx. In addition, we provide a review of the relevant literature along with a discussion of the differential diagnosis.     

Basaloid squamous cell carcinoma of the larynx

Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma that was first described in 1986. In the English-language literature, only 26 cases of this infrequent histopathological entity have been reported in the larynx. Tumors have an aggressive biological behavior, justifying combined surgical treatment with radiotherapy. Two new cases are presented and the literature reviewed.     

Basaloid squamous cell carcinoma - larynx

Basaloid squamous cell carcinoma is a rare variant of squamous cell carcinoma, Larynx has been an uncommon site of this tumour which is said to have aggressive biological behaviour with high incidence of cervical and distant metastasis along with second primary. Two cases of laryngeal basaloid squamous cell carcinoma are reported with relevant review of literature. The submucosal spread of tumour is highlighted alongwith role of preoperative radio therapy.     

Laryngocele and squamous cell carcinoma of the larynx

We present a case report of a lady with a laryngocele and a squamous cell carcinoma of the larynx. The pathogenesis of the relationship between these two entities is discussed and the literature reviewed. This association means a carcinoma must be outruled if a laryngocele is detected clinically or radiologically.     

Basaloid squamous cell carcinoma of the supraglottic larynx

Basaloid squamous cell carcinoma (BSC) is regarded as a variant of squamous cell carcinoma, but displays distinct morphological and biological features as well as a different clinical course. The tumor is frequently seen in the head and neck and is preferentially located in the larynx, especially in supraglottic sites. Ten patients with BSC of the supraglottic larynx were treated from 1991 to 1995 at the Medical Faculty of the University of Istanbul. Results of treatment were compared retrospectively with a control group consisting of 44 patients with well-differentiated squamous cell carcinomas. Ages, ¶localizations, stages and treatment procedures were similar. In both groups mean survival, nodal involvement and distant metastases were comparable although the local ¶(laryngeal) recurrence rate in patients with early supraglottic (T2) disease in the BSC group after conservative partial surgery was distinct compared to the control group (P < 0.05). These results indicate that conservative surgery should be assessed with caution in patients with BSC, and postoperative irradiation be taken into consideration.     

Primary squamous cell carcinoma of the larynx.

While many clinicians would intuitively believe that surgical treatment of laryngeal carcinoma is superior to irradiation, we have found that in many instances this is not the case. When the results of initial radiation therapy combined with the surgical salvage rates for irradiation failures are analyzed and compared with the results of initial surgery and subsequent salvage of surgical failures, the overall cure rates are quite comparable. This point has not been sufficiently emphasized in the treatment of laryngeal cancer. Its importance lies in the ability to offer a significant percentage of patients a form of treatment which carries with it much less functional morbidity without asking the patient to assume a greater risk with regard to the overall cure rate. This non-randomized retrospective study will analyze our experience in the treatment of laryngeal cancer with specific emphasis on the overall cure rate when megavoltage teletherapy is combined with surgical salvage of radiation failures.     

Hemilaryngectomy for squamous cell carcinoma of the larynx with fixed cord

This retrospective clinicopathologic study is to determine whether true vocal cord fixation produced by epidermoid carcinoma of larynx is an absolute contraindication of treatment by hemilaryngectomy. Serial sections of 19 hemilaryngectomy specimens were re-examined and clinical records of each patient reviewed. The microscopic view revealed that true vocal cord fixation was caused by the vocalis muscle invasion in 16 of the 19 patients. "Positive margins" concerned with recurrences were present in 4 cases. There were 3 local recurrences. The five-year survival rate in the series demonstrates a 68 percent (13/19) determinant survival rate and a 76 percent (13/17) actual survival rate. The results suggest that careful attention to the exact anatomical extent of the tumor should determine its surgical resectability. True vocal cord fixation itself should not exclude the possibility for total laryngectomy.     

Prognostic factors in squamous cell carcinoma of the larynx

Sixty-three patients with squamous cell carcinoma of the larynx were included in a retrospective study examining the influence of the following prognostic indicators: localization, size of primary tumor, presence or absence of neck metastases, disease stage and histologic grade of differentiation. Flow cytometric analysis of the cell cycle, DNA ploidy and proliferative activity as direct prognostic indicators of tumor aggression was performed on paraffin-embedded blocks of specimens taken from 36 patients. Supraglottic tumor localization (p = 0.008), greater tumor size (p = 0.0064), local neck metastases (p = 0.00009), higher clinical disease stage (p = 0.0030), DNA aneuploidy (p = 0.0091), higher overall activity (p = 0.0001), and higher overall proliferative activity of diploid tumors (p = 0.0017) were found to be significant single unfavorable prognostic indicators of overall survival, whereas the histological grade of differentiation was not found to be a reliable prognostic indicator (p = 0.988). Only a higher overall proliferative activity of tumor cells was confirmed by the multivariate analysis as a reliable unfavorable prognostic indicator (p = 0.013). Cellular DNA content (ploidy, overall proliferative activity and overall proliferative activity of diploid tumors) correlated significantly with primary localization and size of the tumor, the presence of local metastases in the neck and the disease stage.     

Simultaneous squamous cell carcinoma with leiomyosarcoma of the larynx

Objective

To present the first reported case of a simultaneous squamous cell carcinoma with a leiomyosarcoma of the larynx, our treatment of the patient, and the 9-month follow-up results.

Study design

Case study.

Methods

Review of diagnostic studies, the operative technique, and the patient's chart for the 9-month period after treatment.

Results

A case with double laryngeal tumors with simultaneous evolution but different histological patterns is described. The squamous cell carcinoma and leiomyosarcoma involved both the vocal cords and the anterior commissure. A partial laryngectomy was performed, and the patient has been free of disease for 9 months.

Conclusions

Multiple laryngeal tumors are exceedingly rare. To our knowledge, no previous reports of a simultaneous squamous cell carcinoma and a leiomyosarcoma of the larynx have been reported. Both tumors were not invasive in this case, so conservation surgery was feasible.     

Basaloid squamous cell carcinoma of the larynx: report of a case

Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma. This malignancy has a predilection for the upper aerodigestive tract, although it has been found in multiple other sites. The tumor is highly aggressive biologically, and the overall prognosis is poor despite intensive treatment. We describe a case of basaloid squamous cell carcinoma of the larynx that metastasized to the spine.     

The basaloid variant of squamous cell carcinoma of the larynx

IntroductionBasaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known.ObjectiveIn this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. Study design: retrospective cohort study. Evidence level: Level 2b.Material and methodsRecords of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed.ResultsAmong 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively.ConclusionBSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant.     

Snail as a novel marker for regional metastasis in head and neck squamous cell carcinoma

Objective

Previous studies have shown Snail expression integral to the epithelial-mesenchymal transition during tumor progression. However, its behavior in clinical head and neck squamous cell carcinomas (HNSCCs) is yet undefined. We therefore sought to (1) investigate clinical and histopathologic characteristics of Snail-positive HNSCC and (2) understand the link between Snail and other commonly used HNSCC tumor markers.

Study Design

A retrospective case-control study was conducted.

Setting

This study was conducted in a large-scale academic center.

Study Subjects

Of 51 consecutive HNSCC, 42 surgical resections were included.

Methods

Two separate pathologists performed standard histopathologic reviews along with immunohistochemistries (Snail, E-cadherin, p16, epidermal growth factor receptor [EGFR]) and in situ hybridization (human papilloma virus [HPV]). Medical review for all cases was performed.

Results

Twenty-two (52%) of 42 cases stained 4+ Snail (>75% staining). The remaining 20 cases were considered negative. Snail was strongly inversely related to E-cadherin expression (ρ = −0.69, P < .001), but statistically independent from HPV, p16, or EGFR expression. Snail(+) tumors were equally represented from each anatomic subsite. Snail(+) tumors were strongly associated with poor differentiation (P < .001) and basaloid classification (P = .004). Snail(+) tumors were also strongly associated with lymphovascular invasion (P = .02), but not perineural invasion. Ultimately, 11 (50%) of 22 of Snail(+) tumors demonstrated positive nodal metastasis and 11 (79%) of 14 node-positive cases were Snail(+) (P = .02).

Conclusion

This pilot study provides promising evidence of Snail' role as a molecular prognostic marker for HNSCC. Snail positivity is significantly predictive of poorly differentiated, lymphovascular invasive, as well as regionally metastatic tumors. Because Snail positivity appears independent of HPV, p16, and EGFR expression, Snail may prove to improve upon these markers' predictive limitations.     

Reasons for irradiation failure in squamous cell carcinoma of the larynx.

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be: 1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals. 2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure. 3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions. 4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent. 5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice. 6. New cancer. Probably 25 percent of the so-called recurrences on the vocal cords are actually new primary lesions. The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy. In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re-irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.     

Malignant fibrous histiocytoma of the larynx after radiotherapy for squamous cell carcinoma

A few cases of malignant fibrous histiocytoma (MFH) of the larynx have been reported to date. All ages may be affected, but the tumor is more prevalent in the sixth and seventh decade of life. We describe a case of MFH in a 71-year-old Italian man who 8 years before underwent a right cordectomy and radiotherapy for squamous cell carcinoma. Recurrent tumor was found to be MFH. The clinico-pathological features of this tumor are presented and the possible relationship between radiotherapy and MFH discussed. The neoplasm was characterized by spindle-shaped atypical cells arranged in a diffuse storiform pattern. Mitoses were prominent, numerous, and often atypical. Immunohistochemically, neoplastic cells were strongly positive for vimentin and α₁-antichymotrypsin but were negative for cytokeratins and S-100 protein. These findings confirmed the diagnosis and excluded possible sarcomatoid carcinoma, inflammatory pseudotumor, and a new carcinosarcoma. The risk of sarcoma after radiotherapy for squamous cell carcinoma in the larynx is very low when considering the frequent use of radiotherapy, but long follow-ups are required. Received: 8 December 1998 / Accepted: 12 April 1999