Laryngeale Epitheldysplasie vs. laryngeale intraepitheliale Neoplasie

Abstract

Laryngeal cancer is the most frequent malignancy of the upper respiratory tract. Only the very early treatment of tumors or even of their precursor lesions will be both curative and organ preserving. Microsurgical techniques facilitate early detection and complete removal of limited lesions can be achieved quite frequently, but follow-up data for such lesions are difficult to obtain. The resulting lack of endpoint observations (i.e., malignant transformation, spontaneous involution) hampers the development, testing, and application of grading systems focusing on epithelial alterations, especially changes with only mild nuclear atypia and minimal structural alteration. Such lesions may be entirely benign or may indicate premalignant stages of well-differentiated carcinoma. For diagnosis we recommend a modified Kleinsasser's system to classify premalignant epithelial changes. Only the complete removal of suspicious lesions as far as possible or regular clinical follow-up in cases where complete removal cannot be achieved can prevent the development of advanced stage cancer.

Current review on squamous intraepithelial lesions of the larynx

“…As early as 1963, Kleinsasser suggested one of the first laryngeal classification systems with three subgroups: grade I (simple squamous epithelial hyperplasia) is characterized by thickening of the epithelium with normal maturation; grade II (epithelial hyperplasia with occasional atypia) represents slight localized cellular atypias and disturbance of differentiation only to a certain degree, so that the lesions cannot be classified as premalignant; grade III (CIS, precancerous epithelium) includes high‐grade dysplasia and CIS 109 . This classification has recently been modified using different terminology, such as three grades of intraepithelial neoplasia 117 . In 1971, the Ljubljana classification was devised by Kambič and Lenart 118 .…”

Larynxkarzinom durch intensive und mehrjährige Exposition gegenüber schwefelsäurehaltigen Aerosolen (BK 1319)

“…Als Plattenepithelkarzinom macht es 1-3 % aller malignen Tumoren und etwa 20 % aller Tumoren des oberen Atemtraktes aus [7,8]. Hauptrisikofaktoren sind dabei Tabakrauch und alkoholische Getränke.…”

“…Hauptrisikofaktoren sind dabei Tabakrauch und alkoholische Getränke. Nach validen Schätzungen sind ätiologisch etwa 75 % dieser Tumoren auf diese beiden Risikofaktoren zurückzufüh-ren [8,9].…”

“…Deshalb wird zunehmende Heiserkeit als eines der frühen und wichtigen klinischen Symptome beschrieben, welches auf die Entwicklung eines Karzinoms hindeuten kann. Die Prognose wird entscheidend durch Lokalisation, Ausdehnung und Differenzierung des Karzinoms bestimmt [7,8].…”