Cathepsin D in laryngeal carcinoma. preliminary report

The biological activity of tumor cells seems to be related to some peptides produced in the same neoplastic cytoplasms. Cathepsin D is considered one of these proteins, which is able to promote mitosis and tumor invasion. The effects of cathepsin D have been studied in tumors of the breast, ovary and endometrium, and in few cases of laryngeal cancer. Using an immunohistochemical method, we have attempted to evaluate cathepsin D expression in 17 cases of laryngeal squamous cell carcinoma in comparison with the presence of the same protein in the adjacent normal laryngeal mucosa and in inflammatory cells surrounding the tumor. In 11 cases, cathepsin D was present in more than 50% of neoplastic cells, in 4 cases positive cells were 30-50% of all neoplastic cells, in the last 2 cases less than 30% of neoplastic cells expressed the antigen. In normal respiratory epithelium the expression of cathepsin D was limited to the apex of cells. In flat metaplastic epithelium, we observed a positive reaction of basal and parabasal cells. Such positivity became diffuse to all cellular layers in dysplastic foci. A minimal positivity was also detected in salivary glands and ducts. A strong positivity was present in macrophages around and among tumor cells. Our findings suggest that cathepsin D plays a role in cancerogenesis and growth of laryngeal squamous cell carcinoma. The expression of cathepsin D also in normal and inflammatory cells may influence the quantitation of this antigen in studies in which cytosolic levels of cathepsin D are measured after protein extraction.

Cholesteatoma in children: histopathologic findings in middle ear ossicles

Middle ear ossicles removed during ear surgery in 40 patients were examined in order to compare the histopathologic changes in children with those observed in adults. Bone resorption, mainly localized at the level of the periosteum and haversian canals in adults, was much more extensive in children. Replacement of bone by fibrous granulation tissue was observed in 60% of children's ossicles and in 27% of those belonging to adults. In children, extensive active resorptive osteitis of the ossicles was frequently associated with intensive round cell infiltration, which seems to play an important role in bone absorption and in the aggressiveness of cholesteatoma.

[Invasion of cricoid cartilage by T2-T3 laryngeal cancer]

This paper reports a study of microscopic infiltration of the cartilage of the cricoid carried out in 335 patients with T2-T3 carcinomas of the larynx who had undergone total laryngectomy. The results of the investigation revealed microscopic infiltration of the cricoid cartilage in 12% (14/335) of the cases examined. The incidence, however, was much higher in those cases of extension to the hypoglottis (28% vs 5%, p < 0.0001) or in cases of an even greater extension of the tumor (13% vs 7%). In the 161 patients with neoplasias situated in the glottis, there was cricoid invasion in 30 cases regardless of the tumor class. However, with regard to cases with extension to the hypoglottis, a higher incidence of cricoid infiltration (20% vs 8%, p < 0.002) for all T classes was observed. As for as those cases with neoplasias in the supraglottis are concerned, there were no patients classified T2 (0/50) with cricoid infiltration against 8% in T3 subjects (10/124). In these subjects extension to the hypoglottis led to microscopic invasion of the cricoid cartilage in a greater number of patients (31% vs 3%, p < 0.0001). These observations confirm that microscopic infiltration of the cartilagenous skeleton of the larynx, especially of the cricoid, is relatively frequent. Factor of even higher risk are occurrence in the glottis and, in all the situations examined, extension to the hypoglottis. In addition, except in cases of vestibular T2, there is a 5 to 8% possibility of microscopic infiltration of cricoid cartilage even in the absence of clinical signs of hypoglottic invasion.(ABSTRACT TRUNCATED AT 250 WORDS)

[The status of receptors in laryngeal carcinoma: a study of receptors for estrogen, progesterone, androgens and glucocorticoids]

In order to verify the hypothesized hormone sensibility of the laryngeal carcinoma, we evaluated the level of steroid receptors in this type of neoplasm and correlated this datum with common pathological and clinical prognostic indices. Estrogen and progesterone receptors were evaluated in 105 patients with a squamous cell carcinoma and 2 patients with a mucoepidermoid laryngeal carcinoma. Receptors for androgens and glucocorticoids were evaluated in 35 patients (all with a squamous cell carcinoma). Dosage was performed on fresh neoplastic tissue using the DCC (Dextran Coated Charcoal) method. Estrogen receptors were present in 26 cases (24.3%); progesterone receptors were present in 18 cases (16.8%); both receptors were revealed in 8 patients (7.5%). Androgen receptors were evident in 4 patients (4/35, 11.4%); glucocorticoid receptors were evident in 7 patients (7/35, 20%); both receptors were revealed in 4 (11.4%) cases. No statistical difference with regard to grading, site and extension of the cancer, extralaryngeal tissue involvement or node metastasis was noted in the groups of patients with or without steroid receptors.

Lipomatous tumors of the uterus. Clinico-pathological features of 10 cases with immunocytochemical study of histogenesis

The clinico-pathological and immunocytochemical findings of 10 uterine fatty tumors (1 pure lipoma and 9 lipoleiomyomas) are referred. This kind of tumor is more frequent in older postmenopausal women, treated for a preoperative diagnosis of uterine leiomyoma. Macroscopically the tumor may show different consistence and colour as a consequence of the amount of lipomatous component. The microscopical detection of areas of perivascular immature mesenchymal cells with differentiation into adipocytes supports the hypothesis of "neometaplasia" of the lipomatous component derived from immature perivascular cells. On the contrary, the evidence of multivacuolation in smooth muscular cells and the presence of muscle markers in typical mature adipocytes in lipoleiomyomas, as revealed by immunocytochemistry, suggests the hypothesis of direct transformation of smooth muscle cells into adipocytes.

Immunohistochemical and immunoradiometric evaluations of total cathepsin D in human larynx

By using a commercially available immunoradiometric technique (Cath-D-IRMA, Cis BioInt.) the distribution of total cathepsin D (cath-D) in 30 malignant and in the corresponding histologically-proven non-malignant fragments obtained from lymph node negative patients suffering from larynx cancer was investigated. In both tissues the oestrogen and progesterone receptors were also assayed. In 17 out of the 30 samples, the cath-D was also assayed by immunohistochemistry using the M1G8, a mouse monoclonal antibody raised against cath-D (Cis BioInt.). Our data indicate that cath-D is present in prismatic cells of the normal laryngeal epithelium and in the cancerous cells. In cancerous larynx, the outer cell layer of large tumour nests showed the highest degree of immunoreactivity, while fibroblasts and inflammatory cells always showed a very faint staining. Cathepsin D levels were significantly higher (P < 0.0001) in the cancerous fragments (with a mean of 33 +/- 3.4 pmol/mg protein) than in the corresponding non-cancerous specimen (with a mean of 20.8 +/- 2 pmol/mg protein). A significant positive association (P < 0.001) between cath-D and progesterone receptor (PR) concentration values in the cancerous larynx was observed; accordingly, tumours expressing PR had significantly (P = 0.0005) higher cath-D levels than the tumours which did not contain the receptor. In contrast, such a relationship was absent in the non-malignant specimens. As regard the oestrogen receptor, no significant relationship between this and cath-D was observed. We conclude that cath-D measured by IRMA in tissue cytosols is mainly derived from cancerous cells, the contribution from fibroblasts and inflammatory cells being negligible. Cathepsin D overexpression and association with the PR in the malignant part of the larynx could indicate a possible role of the receptor in the biology of this disease.

Effects of progesterone administered by nasal spray on the human postmenopausal endometrium

The aim of the study was to assess the effectiveness of progesterone (P) administered by nasal spray (NS) in inducing secretory changes within estrogen and non-estrogen primed postmenopausal endometrium. Ten healthy post-menopausal women before vaginal hysterectomy for prolapse were randomly treated by either oral estrogens for 3-4 weeks combined for the last 5-7 days with nasally administered P at the daily dose of 34 mg, or by only P for 6 days. Endometrial samples were taken before P administration and 8 h after the last dose. In the group not treated with estrogens, P did not induce significant secretory changes in any case except one which showed a proliferative endometrial pattern at the first evaluation. In the group treated with estrogens, in all the cases after P administration clear secretory changes (abundant vacuoles, endoluminal secretion) occurred. It is possible to conclude that P administered by NS exerts an end-organ effect within the endometrium of postmenopausal women pretreated with estrogens.

Effects of the repetitive administration of progesterone by nasal spray in postmenopausal women

OBJECTIVE

To study the effects of 10 days of nasal spray P treatment on P serum levels and the endometrium.

DESIGN

Prospective.

SETTING

University Medical School.

PATIENTS

Eight postmenopausal women received oral conjugated estrogens at a daily dose of 0.625 mg for 4 weeks immediately before vaginal surgery for prolapse. For the first 9 of the last 10 days the patients also received a nasal spray dosage of 11.2 mg P three times a day; on the 10th day they received only one dose.

MAIN OUTCOME MEASURES

Blood samples were taken at 8:00 A.M. on treatment days 1, 3, 5, 7, 10, and 11 to follow P serum concentration levels. Endometrial samples for histologic examination were collected before P administration and immediately after surgery to evaluate the end-organ effect.

RESULTS

Mean P serum levels increased sixfold after 9 days of nasal spray P administration [from 0.612 +/- 0.280 ng/mL (1.958 +/- 0.896 nmol/L) to 3.925 +/- 1.553 ng/mL (12.560 +/- 4.970 nmol/L)] and declined thereafter, returning to the before treatment levels 24 hours after the last administration. In all subjects, the first histologic evaluation showed proliferative endometrium; the second showed clear secretive changes.

CONCLUSIONS

Repetitive nasal spray P administration for 10 days in postmenopausal women led to increasing P serum levels and, when the estrogen stimulation was adequate, to secretory changes in the endometrium (end-organ effect).

Morphologic precursors of ovarian epithelial tumors

OBJECTIVE

To correlate various types of hyperplastic lesions of the ovarian surface epithelium with primary disease of the female genital tract.

METHODS

Using whole-organ multiple sections of the ovary, we studied 200 hysterectomy and bilateral salpingo-oophorectomy specimens distributed into four groups: cases without hyperplastic or neoplastic disease in the tube, uterus, or vagina; those with contralateral epithelial ovarian tumors; those with endometrial adenocarcinomas; and those with polycystic ovary disease.

RESULTS

We found a high frequency of hyperplastic and metaplastic changes in the surface epithelium or in the inclusion cysts in ovaries with contralateral epithelial ovarian tumors (92%), endometrial adenocarcinomas (76%), and polycystic ovary disease (68%) compared to ovaries without hyperplastic or neoplastic disease (22%). These changes were frequently associated with intracystic papillae and psammoma bodies similar to those observed in epithelial tumors. The inclusion cysts were unrelated morphologically to signs of preceding ovulation, but were related to deep crypts of the ovarian epithelium and to stromal hyperplasia.

CONCLUSIONS

The hyperplastic and metaplastic changes of the surface epithelium and related inclusion cysts can be considered morphologic precursors of common epithelial tumors. Similar changes are found as a response to a hormonal ovarian or extraovarian stimulus, which may play an important role in ovarian carcinogenesis.

[What is the prognostic significance of histomorphology in small cell lung carcinoma?]

What is the prognostic significant of the histomorphology in the small cell carcinomas of the lung? After the WHO classification of the lung cancer (1981), several studies criticized the subdivision of the small cell carcinoma in three sub-types (oat-cell, intermediate cell and combined types). The role of histology in the prognostic predition has been devaluated. In order to verify the prognostic value of the morphology of the small cell types of lung cancer, we performed a multivariate analysis in 62 patients. The survival rate was analytically compared with the following parameters: nuclear maximum diameter, nuclear form, nuclear chromatism, chromatine distribution, presence of nucleolus, evidence of cytoplasm. The results showed that none of these parameters are able to express a prognostic value. According to the recent studies, we think that the small cell carcinoma of the lung is a neoplasia with a multiform histologic pattern. Differences observed in clinical management are not correlate with the morphology, but with other biological parameters still unknown.

[The prognostic significance of the extralaryngeal microscopic extension of a T3 glottic carcinoma]

Incidence of microscopic infiltration of the laryngeal framework, with or without extra-laryngeal extension, was studied retrospectively in a series of 63 patients treated surgically for glottic T3 carcinomas in order to establish prognostic values. The results of histopathological examination revealed neoplastic invasion of the fibro-cartilaginous skeleton in 46 of the patients examined and in half of these microscopic diffusion in peri-laryngeal tissue. As far as prognosis is concerned, there was a clear-cut correlation between a decrease in survival rates and a contemporaneous increase in the real extension of the neoplasia, even if microscopic. In fact the NED survival rate of confirmed T3 patients was 85% while in cases reclassified as pT4, it was 64% and 47% on the basis on the absence or presence of extra-laryngeal extension. With these observations it is possible to affirm that the major staging is also attributable to cases with initial infiltration of the "laryngeal framework" without an extensive extension toward peri-laryngeal tissue. As far as T recurrences are concerned, a high incidence of relapse of the neoplasia was observed principally in the cases with extra-cartilaginous diffusion. This observation may have a predictive role and therefore direct post-surgery follow-up as well as eventual complementary treatment.

Expression of cathepsin D in malignant and in the corresponding non-malignant node-negative laryngeal samples: correlation with receptors for androgen, glucocorticoid, oestrogen and progesterone

A standard immunoradiometric technique was used to investigate the distribution of the intracellular aspartic proteinase cathepsin D in 33 malignant and in the corresponding histologically-proven non-malignant fragments obtained from lymph node negative patients suffering from larynx cancer. In both tissues the androgen, glucocorticoid, oestrogen and progesterone receptors were also assayed. Our data indicate that cathepsin D was present in both tissues, with level significantly higher (P < 0.0001) in the cancerous fragments (with a mean of 33 +/- 3.4 pmol/mg protein) than in the corresponding non-cancerous specimen (with a mean of 20.8 +/- 2 pmol/mg protein). A significant positive association (P < 0.001) between cathepsin D and PR concentration values in the cancerous larynx was observed; accordingly, tumours expressing PR had significantly (P = 0.0005) higher cathepsin D levels than the tumours which did not contain the receptor. In contrast, such a relationship was absent in the non-malignant specimens. As regards the other steroid receptors, no significant relationship between them and cathepsin D was observed. We conclude that cathepsin D may have a role also in laryngeal carcinoma and that its association with the PR could indicate a possible role of the receptor in the biology of this disease.

A new approach to the histologic study of ovarian tumors by analytical morphometry

In recent years, borderline epithelial tumors of the ovary have been investigated by morphometric techniques to allow for a differential diagnosis from benign and malignant neoplasms. In order to enhance this discriminant power, we have applied a new analytical procedure to the evaluation of the nuclear shape in epithelial ovarian tumors. Sixty nuclei of benign ovarian serous neoplasms, 60 nuclei of serous borderline tumors and 60 nuclei of serous carcinomas (18 cases in all) were examined using the software system SAM (Shape Analytical Morphometry). The morphometric procedure consisted of three different phases: (i) extraction of nuclear fundamental curve: this is a function curve giving the smoothing of the original contour by two parametric equations (separately for x and y values as dependent variables); (ii) evaluation of nuclear contour irregularities by Fourier analysis; (iii) evaluation of nuclear shape asymmetry by SAE (Shape Asymmetry Evaluator): this is the ratio between the length of a segment of a parabola interpolating the original curve points and a straight line joining its extremities for a 180 degrees barycentric rotation according 10 degrees steps. All the obtained independent parameters were submitted to statistical analysis. Nuclei of borderline tumors showed dimensional parameters which were intermediate between those of benign and malignant tumors. Both the asymmetry and the irregularities of nuclear contour were greatest in carcinomas.

Laryngeal intraepithelial neoplasia (LIN). An analytical morphometric approach

Laryngeal Intraepithelial Neoplasia (LIN) is graded in 3 levels (LIN Grade I-II-III), corresponding to the classic aspects of mild, moderate and severe dysplasia-in situ carcinoma, on the basis of the number and position of mitoses and of the undifferentiated or atypical cells limited to the basal or extended to the intermediate or the superficial layers of epithelium. In order to reduce the subjective imprecision of these parameters we have applied not only traditional dimensional evaluators but also procedures of analytical morphometry to the nuclear shape. By using the software system S.A.M. (Shape Analytical Morphometry) we have examined fifty nuclei of the basal layer in LIN grade I, II and III, fifty nuclei in normal laryngeal mucosa and fifty nuclei in invasive carcinoma of the larynx (twenty-five cases in all). Normal and dysplastic nuclei did not show any dimensional differences, while the carcinomatous nuclei were significantly larger. An asymmetric distortion of the nuclear contour was noted in the moderate and severe dysplasia, but not in carcinomatous cells. Also the Fourier parameters, increased in severe dysplasia, decreased dramatically in carcinomatous cells which showed nuclei with minor contour irregularities than the normal cells. These findings outline the discriminative power of the analytical morphometry and suggest a possible correlation between nuclear shape and cell biology.

Steroid receptor status in malignant and non-malignant larynx

We investigated for the first time the relationships among all the different steroid receptor classes and between steroid receptor status and lymph node involvement in laryngeal carcinoma. Androgen (AR), oestrogen (ER), progesterone (PR) and glucocorticoid (GR) receptors were assayed in the high-speed soluble fraction and in the nuclear extract from 73 carcinomas of the larynx. Forty-one, 26, 15, and 13 tumours expressed cytosolic GR, ER, AR, and PR, respectively, while 33, 26, 13 and 13 biopsies were nuclear-positive for GR, ER, AR, and PR, respectively. Data obtained in histologically-proven non-cancerous larynx (N = 20) compared to those obtained in the malignant specimens showed a significant loss of ER and PR in cancerous larynx over that in the non-cancerous tissue. Lymph node metastases were evaluated in only 53 of the 73 patients and they were noted in 22 cases (41.5%). No significant relationships were found either among the different classes of steroid receptors or between steroid receptors and lymph node involvement. Despite the apparent absence of any interrelationships among the different receptors or tendency towards metastasis, the presence of steroid receptors would justify the use of hormonal manipulations which could be effective in the management of this disease.

[The reliability of biopsy-determined grading in laryngeal squamous cell carcinoma]

Grading evaluation is becoming increasingly more important in establishing a valid prognosis and in the choice of therapeutical strategies in dealing with squamous laryngeal cancer. It follows, therefore, that grading of bioptic tissue, made before therapy planning, must offer reliable data and correspond to data gathered through grading of the entire neoplasm. Thus the aim of our study carried out on 267 cases was to verify if grading of bioptic tissue corresponds to that of the operatory specimen. In 7% of the cases (19 in 267) bioptic grading overestimated the neoplasm in that post-operatory grading revealed a less differentiated form. On the contrary, in 16% of the cases (43 in 267) bioptic grading underestimated the form since as post-operatory grading showed a more highly differentiated form. It appears clear that these values depend on the clinical extension of the neoplasm in that the difference was inferior in the case of limited neoplasms and greater in that more largely extended ones. Generally speaking then, the less extended the neoplasm (the most frequently observed clinical form), the more coinciding the bioptic evaluation indicating good differentiation with the post-operatory evaluation. On the other hand, bioptic evaluation indicating moderate or poor differentiation is less reliable since it does not coincide with findings in approximately 16% of the neoplasms, above all those most limited (12%). This means that any reductive adoption of therapy planning made on the basis of the degree of differentiation revealed upon bioptic examination is possible only in the case of those forms more advanced with regard to extension.(ABSTRACT TRUNCATED AT 250 WORDS)

Candida and stapedial otosclerosis: histopathological findings

The stapes of 6 patients with stapedial otosclerosis was found to contain fungus hyphae (Candida) in the sectioned specimens. The footplate of all cases and the head of the stapes in 2 of the cases revealed single or multiple erosion cavities containing numerous thin branching PAS-positive fungus hyphae with swollen terminal endings and scanty blastospores. Osteoclasts were not observed; occasional osteoblasts, blue mantles and otosclerotic foci were seen. Four patients had been treated for several years with antibiotics and corticosteroids for recurrent serous otitis media and 1 patient had had frequent catheterization of the eustachian tube. It may be suggested that the Candida infection was a secondary event induced by a general and/or local immunodepressed condition.

Multivariate analysis of metastasis risk in laryngeal carcinoma. II. Immune response

The presence of inflammatory reaction, plasma cells, and eosinophils in peritumoral connective tissue and in neoplastic stroma was evaluated with morphometrical method in 181 patients affected by laryngeal carcinoma. A logistic multiple regression model was applied making it with the use of an independent variable represented by the "infiltrating" or "expansive" types of tumor growth, in order to evaluate the probability of nodal metastatsis of each parameter. The results suggest an inverse correlationship between plasma cells and inflammatory infiltration and incidence of nodal metastatsis only in the comparison of the extreme conditions: those with scarce infiltration versus the ones with large infiltration. Inflammatory or plasmacellular infiltration may represent both a defense mechanism against cancer and an aspecific or allergic reaction. The eosinophilic infiltration shows no value in the prevention of nodal involvement.

Multivariate analysis of metastasis risk in laryngeal carcinoma. I. Tumor factors

A multivariate analysis with a logistic regression model was performed in 181 cases of patients affected by laryngeal cancer, in order to evaluate the histologic tumor factors in predicting metastatic risk. The patterns used were: grading, localization, extension to the extralaryngeal structures, mode of growth. Nodal metastases are less influenced by the localization and the differentiation grade of the tumor. Cancer extended to the extralaryngeal tissues and with "infiltrating" type of growth are significantly correlated with nodal involvement. Multivariate analysis seems to be the best method to identify the exact value of each histological parameter used in prognosis of laryngeal carcinoma.

[Stapedo-ovalar ankylosis: histomorphologic patterns]

This study reports the results of the histo-pathological investigation on the stapes (fragments or complets) of 46 patients (34 females and 12 males) with clinical diagnosis of stapedial otosclerosis and submitted to stapedectomy. Otospongiotic and otosclerotic areas have been found only in some cases; more frequently, erosion cavities filled with fibrous tissue and round-cells infiltration with lymphocytes and/or macrophages have been seen. Osteoclasts were observed only in few cases. Blue mantles have been observed in about half of the cases. Our findings show that non specific chronic inflammation should be more frequent than otospongiosis or otosclerotic foci, and indicate that a phlogosis could be the pathogenetic agent of this disease. This conclusion is in agreement with our previous research, and has been recently confirmed by the observations in stapes of otosclerotic patients of viral antigens and antibodies.

Bacteriological and histological study of 40 loose cemented hip prostheses

The causes of the loosening of a hip prosthesis may be inflammatory, mechanical, immunitary or due to detritus. A bacteriological and histological study, in cases where further surgery was needed, may clearly contribute to the aetiopathogenesis of failure. Loose hip prostheses removed at operation were studied from a bacteriological and, in particular, histological point of view. There results were then correlated to clinical, radiographic and laboratory data obtained during follow-up. Inflammation proved to be a constant histological finding. The hyalinosis observed in 22 cases revealed significant analogies with histological pictures of silicotic granuloma, for which an immunitary pathogenesis is the current hypothesis. Thus, it is our belief that this correlation is suggestive of an immunitary based approach in cases where hip prostheses fail due to loosening.

Otomastoid cholesteatoma in children: histopathological findings

Clinical experience has shown that the otomastoid cholesteatoma is more aggressive and has a less favourable prognosis in the child than in the adult. In an attempt to verify whether, in children, the clinical behaviour of the cholesteatoma depends on the histomorphological characteristics of the perimatrix, we carried out a study of samples taken from 30 subjects under 16 years of age and from 30 adults (control group) during surgery for otomastoid cholesteatoma. The study took into account the number of plasmacytes, lymphocytes, macrophages, granulocytes and giant cells per high potency field (X 630). The results showed that in young subjects the perimatrix of the cholesteatoma is richer in mononuclear inflammatory elements with evidence of enzyme-collagenase activity. On the basis of this behaviour the authors conclude that the histomorphological characteristics of the surrounding matrix can play an important role in the pathogenesis of cholesteatoma and may explain the clinical differences that can be seen between cholesteatoma in children and in adults.

Morphometric analytical evaluators of lymphoid populations in nonneoplastic lymph nodes

A morphometric analysis using an Apple II microcomputer and shape analytical morphometry (SAM) software was performed of the nuclear shape in the lymphoid population of normal (nonneoplastic) lymph nodes to provide baseline parameters useful for distinguishing between different subtypes of lymphomas. Fourier harmonic analysis and two indices, a contour asymmetric evaluator (CAE) and a shape asymmetric evaluator (SAE), are proposed as non-dimensional shape parameters. Results obtained with the CAE and SAE indices indicate that they represent sensitive shape descriptors able to reveal even subtle irregularities of nuclear outline. With these parameters, centrocyte nuclei were easily differentiated from those of all other lymphoid cells while an interesting close relationship was found between lymphocytes and centroblasts. Lymphocyte nuclear shape was shown to be less regular than generally reported, suggesting the existence of subtle differences between stimulated and unstimulated nuclei. Immunoblast nuclei were shown to have the most regular shapes.

Local Morphologic Changes Related to Laryngeal Carcinoma

In a series of 178 patients who underwent partial or total laryngectomy for laryngeal carcinoma, the morphologic changes at a distance from the neoplasm were investigated with whole organ serial sections. We found 60 cases with extensive squamous metaplasia of the epithelium outside of the vocal cords, 24 case with hyperplastic epithelium of the vocal cords, 29 cases with mild or moderate dysplasia, 5 cases with foci of in situ carcinoma, 3 cases with a second carcinoma with minimal stromal invasion, and 4 cases with a double synchronous primary carcinoma. In 55 cases we observed the contemporary presence of a carcinoma and a mono-or bilateral laryngocele. In the excretory ducts of the salivary glands present in the laryngeal mucosa we found a reserve cell hyperplasia in 100 % of the cases, a mature squamous metaplasia in 25%, and an oncocytic metaplasia in 14 %. These observations led us to consider the laryngeal cancer as an organ disease, in which the oncogenic stimulus operates on all the laryngeal structures and determines lesions of different severity up to neoplasm.