Adverse histopathological findings in glottic cancer with anterior commissure involvement

Abstract

Open partial horizontal laryngectomy (OPHL) specimens include cartilage and lymph nodes. Pathological adverse findings (PAF): perichondrium, cartilage, perineural invasion, microvessel spread and prelaryngeal metastases can be detected histologically. We aimed at examining PAF in OPHL specimens and examining the interdependence with oncological outcomes. Prospective analysis of 254 glottis cancers: 87-T2a, 77-T2b and 90-T3 with anterior commissure (AC) involvement treated by OPHL at tertiary referral centre between 2001 and 2008. In 38/254 patients (15 %) PAF were found (16 prelaryngeal metastases, 22 other); more often in stage T2b/T3 versus T2a (p = 0.008). PAF other than prelaryngeal metastases were found more often in T2b than T2a tumours (p = 0.005). Outcomes revealed that out of 36 patients with local recurrence, 19 had PAF. Comparison of 216 patients with no PAF and 16 patients with prelaryngeal metastases revealed, respectively: 7.9 versus 81.3 % local recurrences (p = 0.034), 3.2 versus 68.8 % nodal recurrences (p = 0.011), 90.7 versus 43.8 % of 5-year organ preservation (p = 0.021) and 92.6 versus 75 % 5-year overall survival (p = 0.022). Out of 10 patients with close margins, 1 developed the local recurrence; impact for organ preservation and overall survival was not significant. In 22/254 cases including the cartilage into the operating specimen were therapeutically meaningful; in 16/254 with prelaryngeal metastases, the impact for larynx preservation and overall survival was significant. T2b patients had higher probability of PAF than T2a. PAF significantly influenced higher local recurrence rate. This finding ensures the authors, that OPHL type II is not the "overtreatment" compared to the TLM.

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

“…Apart the technical difficulties, the biological behavior of such a lesion becomes definitely unpredictable and not manageable with this approach because the medullary spread of the tumor within the thyroid cartilage is not amenable to intraoperative visual or histopathological confirmation. [20][21][22] The same holds true for the pathway of diffusion into the posterior paraglottic space, where the tumor reaches the cricoarytenoid joint and adjacent muscles, recurrent nerve and branches of the inferior laryngeal artery, and piriform sinus. Even at this level, removal of the arytenoid cartilage and part of the cricoid plate can be theoretically made through the laryngoscope even if the perivascular, perineural, and lymphatic progression of disease cannot be safely dominated.…”

“…In fact, the anterior encroachment of the thyroid cartilage or thyrohyoid membrane makes the tumor at risk of persistence after TLM even when part of the thyroid cartilage or prelaryngeal muscles are removed from the inside. Apart the technical difficulties, the biological behavior of such a lesion becomes definitely unpredictable and not manageable with this approach because the medullary spread of the tumor within the thyroid cartilage is not amenable to intraoperative visual or histopathological confirmation . The same holds true for the pathway of diffusion into the posterior paraglottic space, where the tumor reaches the cricoarytenoid joint and adjacent muscles, recurrent nerve and branches of the inferior laryngeal artery, and piriform sinus.…”

Morphological Evaluation of Thyroid Cartilage Invasion in Early Glottic Tumors Involving the Anterior Commissure

“…The level of histological differentiation, mitotic index, nuclear irregularity, and presence of nucleolus and tumor necrosis were not determining factors. A similar analysis was carried out by Leszczyńska et al [34] in 2015. The authors performed a histopathological analysis of 254 patients, finding 16 cases of prelaryngeal metastasis, perichondrial infiltration in 11 patients, 8 cases of invasion of the cartilaginous tissue, 2 patients with invasion of the microvessels, and 1 patient with perineural infiltration.…”