Quantitative pathology of the intraepithelial laryngeal neoplasia

Phonosurgical resection using submucosal infusion technique for precancerous laryngeal leukoplakia

OBJECTIVES/HYPOTHESIS

This study was designed to assess the feasibility of the submucosal infusion technique combined with microflap dissection as a radical therapeutic and diagnostic option for precancerous laryngeal leukoplakia.

STUDY DESIGN

Retrospective study.

METHODS

Severe dysplasia or carcinoma in situ was diagnosed after phonomicrosurgical dissections in 25 patients with unilateral laryngeal leukoplakia. Of these, 15 patients preferred no additional surgery (observation group), whereas 10 patients underwent further laser subligamental cordectomy (additional surgery group). The relationship between the initial surgical margin and histopathological characteristics of additionally excised tissues was assessed to evaluate diagnostic reliability. Disease control was assessed to determine the oncologic efficacy of the therapeutic procedure. Comparative multidimensional vocal assessments were performed in both groups to evaluate functional advantages of one-stage excision.

RESULTS

After the initial phonomicrosurgical resection, three patients had residual dysplastic lesions near the vocal process and anterior commissure, whereas three other patients had lesions suspicious for recurrence. No postoperative malignant transformation was observed in any patient. Although well-preserved vocal function was observed in the observation group, vocal quality deteriorated shortly after laser surgery in the additional surgery group. Regarding acoustics, aerodynamics, and quality-of-life evaluations, statistically equivalent scores were observed between the observation and control groups, whereas scores were inferior in the additional surgery group than in the control group.

CONCLUSIONS

Phonomicrosurgical resection may be a therapeutic option with oncologic efficacy against precancerous laryngeal leukoplakia. This radical management might achieve more satisfactory postoperative vocal function.

LEVEL OF EVIDENCE

NA Laryngoscope, 127:153-158, 2017.

MicroRNA-10a-5p and microRNA-34c-5p in laryngeal epithelial premalignant lesions: differential expression and clinicopathological correlation

This study was to analyze the dys-regulation of microRNA-10a-5p and microRNA-34c-5p and their correlations with clinicopathological characteristics of laryngeal epithelial premalignant lesions (LEPL). Quantitative real-time polymerase chain reaction was performed to detect the expression of microRNA-10a-5p and microRNA-34c-5p in 94 cases of LEPL and 47 controls. Retrospective follow-up data of all patients were collected and the correlation between the dys-regulation of microRNA-10a-5p/microRNA-34c-5p and clinicopathological characteristics was examined by linear regression analysis. Expression of microRNA-10a-5p was down-regulated in LEPL, showing statistical difference between low-risk lesion group and high-risk lesion group, while microRNA-34c-5p expression was up-regulated gradually in LEPL groups and dropped suddenly in squamous cell carcinoma group. In addition, the differential expression of microRNA-10a-5p is profiled with either LEPL grade or gender, showing a linear correlation; and microRNA-34c-5p expression is correlated with alcohol consumption in LEPL patients (P < 0.05). The dys-regulation of microRNA-10a-5p and microRNA-34c-5p in LEPL and their correlations with clinicopathological characteristics might provide important theoretical and experimental basis for LEPL classification and the two microRNAs can serve as more valuable markers in diagnosis and clinical management of LEPL.

Diagnostic Variability of Laryngeal Premalignant Lesions

Objective

This study was to analyze the interobserver histopathological variability and carcinoma transformation of laryngeal premalignant lesions.

Study Design

A historical cohort study.

Setting

Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

Subjects and Methods

κ-statistics analysis was performed to estimate interobserver histopathological variability among pathologists by reassessment of 237 cases with laryngeal premalignant lesion according to 2005 WHO classification system. A retrospective follow-up of 237 patients over 8-year duration was carried out, and the carcinoma transformation of laryngeal premalignant lesions was analyzed using Kaplan-Meier survival curve estimation.

Results

κ-values of 0.5989 concerning interobserver variability indicated a moderate agreement among 3 pathologists. Major source of intergrade diagnostic disagreement between the original and the consensus diagnoses involved 2 grade pairs, namely, mild and moderate dysplasia, severe dysplasia, and carcinoma in situ. In addition, follow-up study showed that 20 of 237 (8.44%) laryngeal premalignant lesion cases developed into invasive carcinoma. Carcinoma transformation in severe dysplasia group exhibited a similar risk compared to that in carcinoma in situ group ( P = .232).

Conclusion

Severe dysplasia shows the same carcinoma transformation potential as the carcinoma in situ does. Clinically, more attention to severe dysplasia is needed in comparison with mild and moderate dysplasia.

The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis

BACKGROUND

Laryngeal dysplasia is a pre-malignant condition with wide variability in rates of malignant transformation reported in the literature. The management and follow-up strategies of these lesions vary widely.

OBJECTIVES

To assess the risk of and interval to malignant transformation in patients with laryngeal dysplasia, the effect of different treatment modalities on malignant transformation and the effects that risk factors such as smoking, excessive alcohol intake and histological grade may have on this.

TYPE OF REVIEW

Systematic of observational studies with attempted meta-analysis.

SEARCH STRATEGY

A structured search of Medline (1966 to January 2010), EMBASE (1980 to January 2010), CINAHL (1981 to January 2010) and Cochrane databases (CENTRAL, Cochrane Library, 1995 to January 2010).

RESULTS

Nine hundred and forty cases from nine studies were included in the analysis. Overall malignant transformation rate was 14% (confidence interval 8, 22) and mean time to malignant transformation was 5.8 years. The malignant transformation rate is higher with increased severity of dysplasia grade - severe/CIS 30.4%versus mild/moderate 10.6% (P < 0.0002). Treatment modality did not show significant effects.

CONCLUSIONS

Laryngeal dysplasia carries a significant risk of malignant transformation. This risk triples with increasing severity of dysplasia. Transformation often occurs late and is not related to the grade of dysplasia. There is little evidence, therefore, to support the early discharge of patients with mild/moderate dysplasia, which is practised by some clinicians.

Epidemiological and clinical relief on hyperplastic lesions of the larynx

Chronic hyperplastic laryngopathies are considered precancerous lesions because of their possible transformation in time into malignant epithelial neoplasia. We studied 130 patients affected by "hyperplastic laryngeal lesions" according to their semeiological characteristics. The lesions affected the vocal cords in 127 cases and in only 3 cases the ventricular bands. All patients underwent microlaryngoscopy while under general anesthesia and were treated by limited excision (37%) or total stripping (63%). The histomorphological classification by Kleinsasser (7) was used. The following clinical checks showed that 30 out of 48 patients (62.5%) treated by partial stripping recovered; in 11 the lesion relapsed (23%) and in 7 cases (14.5%) a carcinoma appeared. Of those cases treated by total stripping 65 patients (79%) recovered, 12 (15%) relapsed and 5 (6%) showed carcinoma. In conclusion we noticed the appearance of a malignant lesion after surgery in 12 out of 130 cases (9.2%). The cancerization was about 3 times more frequent in patients with histological results of degree II than in those with degree I (17% vs. 6%). Our study confirms that the laryngeal hyperplastic lesion represents a possible passage to cancer in a limited number of cases (< 10%), but with a triple probability for degree II dysplasia in respect to degree I. The patients affected by dyskeratosis, regardless of type of lesion, need a regular follow-up and immediate radical surgery because of the frequent incidence of relapse.

Quantitative pathology of laryngeal epithelial hyperplastic lesions

We studied 40 laryngeal biopsies samples in order to ascertain the reliability of light microscopical criteria for subdividing laryngeal epithelial hyperplastic lesions (EHL) and carcinoma in situ as well as to determine the relationship between proliferative activity of their epithelial cells and the histological grade. The biopsies were divided into four groups in accordance with the Kambic-Lenart classification: simple, abnormal and atypical hyperplasia and carcinoma in situ. 10 cases in each group were included. The morphometrical analysis was carried out by a semiautomatic image analysis system. The proliferative activity was determined by the high percentage of cell nuclear antigen (PCNA) and Ki-67 positive epithelial cells and with counting nucleolar organizer regions (Ag-NORs) per nucleus. Our results suggest that measuring the nuclear area of the basal cells. augmented with basaloid cells and carcinomatous cells, is the most useful morphometrical method of differentiating three types of laryngeal EHL and carcinoma in situ, while the proliferative activity progressively increased with the degree of epithelial hyperplasia. Morphometrical methods and proliferative activity should be regarded as useful in conjunction with the traditional histopathological methods allowing more of objective grading of EHL.