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Laryngeal leukoplakia progression to invasive squamous cell carcinoma 2009 to 2013 with supracricoid laryngectomy

last modified on: Fri, 01/04/2019 - 17:40

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return to: Laryngeal leukoplakia white plaques on vocal cords

History: 67 yo referred to UIHC Nov 2010. Former 1 pack per day cigarette user with laryngo-pharyngeal reflux developed dysphonia in 2007 leading to treatment elsewhere in 2009 with microdirect laryngoscopy for "two areas of thickening with leukoplakia" on right and left vocal cords with a followup procedure for 'laser fulguration".

Initial presentation to our clinic following biopsy elsewhere 2010 November; treated with irradiation completed elsewhere 2011 Feb

Video of followup (2019) 5 1/2 yrs after extended supracricoid laryngectomy to include partial left arytenoidectomy:

Nov 2010 first visit after biopsy done elsewhere: "likely carcinoma in situ, severe dysplasia affecting both vocal cords"

Radiation completed elsewhere 12-2010 completed 02-2011

Followup March 2011

Followup April 2011

Followup July 2011

Followup August 2011

Followup Sept 2011 Microdirect laryngoscopy with biopsies

Biopsy from anterodorsal portion of the right vocal cord showing cytologic atypia

extending into the middle third of the mucosa with increased and mid-level mitoses, sufficient for a diagnosis of moderate squamous dysplasia.

While this biopsy from the posterior portion of the left vocal cord is superficial, it shows disordered architecture and

mild cytologic atypia confined to the lower third of the mucosa, warranting a diagnosis of mild squamous dysplasia.

Followup December 2011

Followup March 2012

Followup May 2012

Followup April 2012

Followup Jan 2013

Followup Feb 2013

2013 April:  Microdirect laryngoscopy with more extensive resection:

pathology = squamous cell carcinoma in situ (cis) right anterior, mid and posterior vocal cord;

invasive to 0.1 cm (1mm) squamous cell carcinoma arising in a background of cis along the left vocal cord;

false vocal cord (left) and base of epiglottis = inflamation, no dysplasia

May 2013 supracricoid laryngectomy with partial right arytenoid resection

  Low magnification of supracricoid laryngectomy show thyroid cartilage (left), ventricle (V), and

extensive squamous cell carcinoma in situ with focal invasion (black box) magnified on next photomicrograph 

Intermediate magnification of designated area showing an irregular, invasive nest (black arrows)

in the superficial submucosa and a deep keratin pearl (white arrow).

Low magnification of another area of the supracricoid laryngectomy with thyroid cartilage (right),

ventricle (V), and a focus of invasive carcinoma arising in obviously atypical mucosa (black box)

which is magnified in the next photomicrograph.

Intermediate magnification of boxed area showing infiltrating, irregular nests (black arrows)

extending into the superficial submucosa (<0.1 cm depth of invasion).


 
2013 March:  Microdirect laryngoscopy with aggressive resection: pathology = at least cis right anterior dorsal vocal cord (cannot exclude invasion); left posterior vocal cord with 0.1 cm invasion (1 mm); pseudoepitheliomatous hyperplasia left vocal cord; moderate dysplasia right vocal cord