Pathology of the Larynx

January 2002

1
Normal Anatomy and
Histology

2
Normal Anatomy and Histology

3
Normal Anatomy and Histology

4
 Normal Anatomy and
Histology

5
 Normal Anatomy and
Histology

6
 Normal Anatomy and
Histology

7
 Laryngeal Epithelium

8
 Goblet Cells and Columnar
Mucinous Cells

9
 Squamous Epithelium

10
 Seromucinous Glands

11
Duct from Seromucinous Glands

12
 Seromucinous Glands

13
 Oncocytic Transformation of
Seromucinous Epithelium

14
Vocal Process of the Arythenoid
Cartilage

15
 Chondroid Metaplasia

16
 Non-neoplastic Lesions
of the Larynx

17
 Tuberculosis

18
 Granulomatous
Inflammation

19
 Fungal Infections

Histolplasmosis
Coccidiomycosis
Cryptococcosis
Blastomycosis
Aspergilosis
Candidiasis

20
 Other Granulomatous
Diseases

Leprosy
Tertiary Syphilis
Sarcoidosis
Crohn’s disease
Wegener’s granulomatosis

21
 Acute Epiglottitis

Haemophylus influenzae type B

Reddened, markedly edematous
supraglottic structures
Edema with marked infiltrate of
neutrophyls with or without microabscess
formation

22
 Diphtheria

23
 Diphtheria

24
 Vocal Cord Nodules

Usually bilateral
Anterior or middle third of true vocal cord
Any age group
Related to chronic voice abuse
Hoarseness or voice changes

25
 Vocal Cord Polyps

Usually single
Middle third of true vocal cord, but may
originate from the ventricular area
Any age group
Sessile, raspberry-like, pedunculated
Related to chronic voice abuse, infection,
ETOH, smoking, hypothyroidism
Hoarseness or voice changes
26
 Vocal Cord Polyp

27
 Edematous-Myxoid Type

 Submucosal
accumulation of pale
blue to pink material
admixed with
sparsely cellular and
variably vascularized
stroma

28
 Vascular-Hyaline Type

 Dilated submucosal
vascular spaces and
deposition of dense
eosinophilic fibrin-like
material

29
 Vocal Cord Polyp: Fibrous
Type

 Moderately cellular
submucosal
proliferation of
uniform oval to
spindle-shaped cells
with varying amount
of fibrous tissue
deposition

30
 Laryngocele

Abnormal dilatation of the saccule

(appendix of the ventricle) containing air
and maintaining an open communication
with laryngeal lumen
Men >women
Bilateral - 25%
Hoarseness, lateral neck mass, dyspnea,
dysphagia, laryngopyocele (pain)
31
 Laryngocele: Types

Internal:
laryngocele confined to the
intrinsic larynx
External:
dilated sac projects upward and
laterally
Combined

32
 Laryngocele: Etiology

Acquired:
increased intralaryngeal pressure
(glassblowers, musicians, weight
lifters)
Congenital
SCC in 15% of cases

33
 Laryngocele

Smooth -surfaced, sac-like structure usually filled

34with air
 Laryngocele

Respiratory epithelial-
lined (ciliated,
columnar) cyst with a
fibrous wall
Squamous metaplasia
Oncocytic metaplasia

35
 Laryngocele: Differential
Diagnosis

Branchial cleft cyst

Oncocytic papillary
cystadenoma
Laryngeal cysts

36
 Contact Ulcers of the Larynx
(Pyogenic Granuloma of the Larynx)

Benign, tumor-like condition, occurring most

commonly along the posterior aspect of one or
both vocal cords
Men>Women, usually adults
Hoarseness, dysphagia, sore throat, dysphonia,
difficulty breathing, choking, pain
Etiology: vocal abuse, acid regurgitation,
postintubation trauma

37
 Contact Ulcers of the Larynx
(Pyogenic Granuloma of the Larynx)

Ulcerated, polypoid,
nodular, or fungating
mass with a beefy red
to tan-white
appearance, up to 3
cm in diameter

38
 Contact Ulcers of the Larynx
(Pyogenic Granuloma of the Larynx)

 Ulcerated lesion with associated fibrinoid necrosis,

granulation tissue, acute and chronic inflammation
39
 Contact Ulcers of the Larynx
(Pyogenic Granuloma of the Larynx)

Giant cells, vascular proliferation, and

40 spindle cells
 Contact Ulcers of the Larynx:
Differential Diagnosis

Infectious diseases
SCC
Spindle cell carcinoma
Vascular neoplasms: lobular capillary
hemangioma, angiosarcoma, Kaposi’s
sarcoma
41
 Laryngeal Amyloidosis

Extracellular accumulation of fibrillar

proteins
Systemic or localized
Primary or secondary
Men > women, in the 5th and 6th decades
Polypoid mass (glottis and supraglottis) or
diffuse mucosal swelling (subglottis)
Hoarseness
42
 Laryngeal Amyloidosis

 Extracellular, eosinophilic,
amorphous material
deposited randomly
throughout submucosa;
depositions around or
within the walls
 Disappearance of the
seromucous glands,
 Mixed chronic
inflammatory infiltrate

43
 Laryngeal Amyloidosis

Congo red: apple-green birefringence under

44 polarized light
 Subglottic Stenosis

Congenital or acquired
Rare; acquired > congenital
Progressive respiratory difficulty, stridor,
dyspnea, air hunger, hoarseness,
abnormal cry, aphonia, dysphagia
Etiology: trauma, neoplasms, infectious or
autoimmune diseases, idiopathic

45
 Subglottic Stenosis

Narrowing of the endolaryngeal diameter with

mucosal or submucosal mass or bulging
Histologic picture depends on the cause
Idiopathic stenosis: submucosal fibrous
proliferation with associated non-specific chronic
inflammation
Differential diagnosis: infectious diseases,
Wegener’s granulomatosis, collagen vascular
diseases, neoplasms
46
 Idiopathic Subglottic
Stenosis

47
 Terminology of Epithelial
Changes

Leukoplakia:
white lesion on a mucosal membrane (clinical)
Erythroplakia:
red lesion on a mucosal membrane (clinical)
Hyperplasia:
thickening of epithelial surface as a result of an
absolute increase in the number of cells.
Pseudoepitheliomatous hyperplasia:
exuberant reactive or reparative overgrowth of
squamous epithelium with no cytologic evidence of
48malignancy.
 Terminology of Epithelial
Changes
Keratosis:
presence of keratin on an epithelial surface
Parakeratosis:
presence of nuclei in the keratin layer
Dyskeratosis:
abnormal keratinization of epithelial cells
Ulceration:
erosion or loss of surface epithelium
Metaplasia:
change from one histologic tissue type to
49 another
 Terminology of Epithelial
Changes

 Koilocytosis:
cytoplasmic vacuolization suggestive of viral (HPV)
effect
 Dysplasia or atypia:
abnormal maturation and cellular aberrations
 Carcinoma in situ:
full thickness epithelial dysplastic change with an
intact basement membrane.
 Superficially (microscopically) invasive SCC:
SCC in which there is violation of the basement
membrane with invasion into the underlying stroma.
50
 Hyperplastic Epithelial
Changes

Reactive or reparative benign process, reflecting

the epithelial response to a stimulus or an injury
Men > women
Occurs anywhere, but mainly along the true
vocal cords
Hoarseness
Etiology: smoking, ETOH, voice abuse, chronic
inflammation
51
 Hyperplastic Epithelial
Changes

Flat, papillary, or verrucoid lesion with a white

(leukoplakic) or red (erythroplakic) appearance
Small or diffuse
Thickening of epithelial surface as a result of an
absolute increase in the number of cells
Presence of superficial keratin layer (keratosis)
or nuclei in the superficial keratin layer
(parakeratosis)
52
 Hyperplastic Epithelial
Changes

Presence of keratohyaline granules in the

granulosa cell layer
Presence of koilocytosis
Presence of cytologic atypia
Presence of dyskeratosis
Differential diagnosis:
contact ulcer, verruca vulgaris, verrucous
carcinoma, well-differentiated
”conventional” SCC
53
 Keratosis with Epithelial
Hyperplasia w/o Dysplasia

54
 Laryngeal Leukoplakia with a Papillary
or Verrucoid Appearance

55
 Laryngeal Leukoplakia with a
Papillary or Verrucoid Appearance

56
 Dysplastic Epithelial
Changes

Men > women

Occurs anywhere, but mainly along the
anterior portion of the true vocal cords,
25% bilateral
Hoarseness
Etiology:
smoking, ETOH, chronic inflammation,
voice abuse, Vit A deficiency,
environmental exposure
57
 Dysplastic Epithelial
Changes

Localized, circumscribed flat or papillary

area with white, red or gray appearance
Cytologic alterations:
hyperchromasia, increase of
nuclear/cytoplasmic ratio, mitoses,
crowding of cells with loss of cellular
polarity
Begins in basal or parabasal areas

58
 Dysplastic Epithelial Changes:
Grading

Mild:
lower 1/3 of the thickness of epithelium
Moderate:
lower 2/3 of the thickness of epithelium
Severe:
from 2/3 to almost complete thickness

59
 Dysplastic Epithelial
Changes
Normal maturation of the superficial layers of
the epithelium
Intact basement membrane
May be associated with keratosis or
dyskeratosis, or other hyperplastic changes
Full-thickness dysplasia (carcinoma in situ) is
not a prerequisite prior to the development of
an invasive CA
Differential diagnosis: reactive epithelial
changes, infectious disease, SCC
60
 Flat Keratosis with Epithelial
Hyperplasia and Mild Dysplasia

61
 Keratosis with Moderate
Dysplasia

62
 Severe Dysplasia without
Keratosis

63
 Benign Neoplasms of the
Larynx

64
 Laryngeal Papilloma

Benign, exophytic neoplastic growth

composed of branching fronds of squamous
epithelium with fibrovascular cores
The most common benign laryngeal
neoplasm
No sex predilection
Changes in phonation, dyspnea, cough,
dysphagia, stridor
HPV types 6 and 11
65
 Laryngeal Papilloma

Juvenile type:
multiple lesions with extensive growth and
rapid recurrence, may remit
spontaneously or persist into old age
Adult type:
more often single, recurs less often, less
likely to spread

66
 Exophytic, warty, friable, tan-white to red
growths
67
  Papillary fronds of multilayered benign squamous
epithelium containing fibrovascular cores
68 Little or no keratin production
 Laryngeal Papilloma

Absence of
stromal invasion
Certain degree of
cellular atypia
Koilocytic changes

69
 Laryngeal Granular Cell
Tumor

Men > women

Hoarseness
Along the posterior aspect of true
vocal cord ( but also in supraglotic
and infraglotic areas)

70
 Granular Cell Tumor

Solitary, polypoid,
sessile, papillary,
or cystic lesion,
measuring up to
3.0 cm in
diameter

71
 Granular Cell Tumor

 Poorly circumscribed
subepithelial lesion with
syncytial, trabecular, or
nested growth pattern
 Round to polygonal cells
with round to vesicular
nuclei and coarsely
granular cytoplasm. Poorly
defined cell borders.
 Variable degree of cellular
pleomorphism
 Absence of mitoses or
necroses
72
 S-100 Protein Immunostain

73
 Pseudoepitheliomatous
hyperplasia

74
 Granular Cell Tumor

 Cytoplasmic granules:
PAS/d +, Alcian blue pH 2.5 +, trichrome + (red)
 Angulate bodies:
needle shaped, PAS + bodies in the interstitial cells
 Tumor cells:
S-100+, NSE +
 Interstitial cells with angulate bodies:
S-100 - and myelin protein +
 EM:
membrane bound autophagic vacuoles containing
mitochondria, RER, myelin, axon-like structures
75
 Malignant Granular Cell
Tumor

Rare ( 1% of all GCT)

Do not occur in newborns
Size > 4 cm
Increased cellularity, pleomorphism,
necrosis, prominent nucleoli, spindle
shaped cells and > 2 mitoses/10 HPF
Metastasize via lymphatics and blood
vessels
76
 Chordoma

Uncommon
Males > females
Dyspnea, strydor, and hoarseness
May originates from epiglottis, cricoid,
arytenoid, or thyroid cartilages
May arise in Reinke’s space
Lobulated, firm to hard, blue-gray,
submucosal mass, usually < 1 cm
77
 Chordoma

Lobulated,
normally looking
chondrocytes
Absence of
pleomorphism,
binucleated
chondrocytes, or
mitotic activity

78
 Rhabdomyoma

Benign tumor of striated muscle

Adult type:
less common
Males > females; > 40 y/o
Hoarseness, dyspnea
Well-defined, lobulated, red-brown mass,
up to 5 cm in diameter

79
 Rhabdomyoma: Adult Type

 Large polygonal to round

cells with abundant deeply
eosinophylic cyroplasm
and one or two periphery
placed vesicular nuclei
 Nucleoli, cytoplasmic
vacuolization
 Cross-striation
 Absent mitoses
 Abundant cytoplasmic
glycogen (diastase
sensitive PAS positive)
 Desmin +, Myoglobin +
80
 Rhabdomyoma: Fetal Type

Very rare
Male children < 3 y/o
Posterior auricular subcutaneous tissue >
nasopharynx, parotis, neck
Solitary, well to moderately circumscribed
nodule, 1-8 cm in size, gray to pink
mucoid appearance
81
 Rhabdomyoma: Fetal Type

 Spindle cells and

immature muscle fibers
with in a myxoid stroma
 Cross-striation rarely
discernible. Mature
muscle fibers can be
seen in the periphery
 Absence of mitoses,
necrosis, and significant
pleomorphism

82
 Malignant Laryngeal
Neoplasms

83
 In Situ Squamous Cell
Carcinoma

 Males > females

 6th – 7th decades
 Most often involves anterior portion of true
vocal cord
 Hoarseness
 May coexist with invasive SCC
 May be isolated or multifocal
 Circumscribed or diffuse lesion with a white,
red, or gray color and smooth or granular
appearance
84
 In Situ Squamous Cell
Carcinoma
 Dysplastic process involves
the entire thickness of the
epithelium
 Loss of cellular maturation
and polarity
 Increase of
nuclear/cytoplaslic ratio
 Normal and abnormal
mitoses
 Keratosis and dyskeratosis
 Extension into adjacent
seromucinous glands
85
 Microinvasive or Superficially Invasive
Squamous Cell Carcinoma

 Nests of malignant cells

that have penetrated the
basement membrane
and invaded superficially
into the submucosa
 Capable of metastasizing
 Development from
carcinoma in situ or from
epithelium with no
evidence of CIS

86
 Invasive Squamous Cell
Carcinoma

2.5% of all cancers in men

0.5% of all cancers in women
95% of all laryngeal carcinomas
Etiology: ETOH (supraglottic), tobacco
(glottic), asbestos, nickel, wood, isopropyl
alcohol, radiation
DD: reactive epithelial changes,
pseudoepitheliomatous hyperplasia
87
 Invasive Squamous Cell
Carcinoma

88
 Supraglottic Squamous
Cell Carcinoma

25–40% of laryngeal SCC

Epiglottis (base), false vocal cords
Changes in the quality of voice, dysphagia,
odonophagia, hoarseness, hemoptisis, dyspnea
Marginal carcinomas (suprahyoid epiglottis,
aryepiglottic folds); remain quiescent for longer
period and present at more advanced stage

89
 Supraglottic Squamous
Cell Carcinoma

Ulcerated, flat, exophytic, or

papillary
Tend to be nonkeratinizing
In situ component
Mitoses and necrosis

90
 Supraglottic Squamous
Cell Carcinoma

Large, tan-white
neoplasm in the
right supraglottis,
extending upward
toward epiglottis

91
 Supraglottic Squamous
Cell Carcinoma

92
 Glottic SCC

Early: irregular area of mucosal thickening

Advanced: exophytic, fungatic,
endophytic, ulcerated mass
More commonly keratinizing, well to
moderately differentiated
In situ component
Invasive component predominantly
infiltrative
93
 Glottic SCC

94
 Glottic SCC

95
 Glottic SCC

96
 Subglottic Squamous Cell
Carcinoma

 5% of all laryngeal tumors

 Tend to remain clinically quiescent, presenting with
advanced stage
 Airway obstruction (dyspnea, stridor) and vocal cord
fixation (voice changes)
 Large exophytic, fungating, ulcerating, or endophytic
 Tend to be keratinizing moderately to poorly
differentiated
 In situ component is less common
 Invasive pattern is predominantly infiltrative
97
 Subglottic SCC

98
 Subglottic Squamous Cell
Carcinoma

Overall 5-year survival rate < 40%

Spread:
 Into thyroarytenoid muscle (vocal cord fixation)
 Anteriorly: through cricothyroid membrane into
thyroid gland superiorly: glottis and supraglottis
 inferiorly: trachea posteriorly: below the cricoid
cartilage and into the esophagus
 Lymphatic drainage: upper and lower jugular
chains, perlaryngeal and paratracheal nodes
 Stomal recurrent tumor
99
 Transglottic SCC

Involves both glottic and supraglottic

structures
Represents advanced tumor
Nodal metastases and extranodal spread
Overall 5-year survival rate < 40%

100
 Transglottic SCC

101
 Spindle Cell (Squamous)
Carcinoma (SCSC)

 Foci of conventional SCC associated with malignant

spindle cell stromal component
 Synonyms: carcinosarcoma, pleomorphic carcinoma,
metaplastic carcinoma, collision tumor, pseudosarcoma,
Lane tumor
 Men (85%), 6th –8th decades
 True vocal cords > false vocal cords and supraglottis >
oral cavity > skin > tonsil and pharynx
 Symptoms vary according to site
 No specific etiology
102
 Spindle Cell (Squamous)
Carcinoma (SCSC)

103
 Spindle Cell (Squamous)
Carcinoma (SCSC)

Spindle cell
component with
variable degree of
pleomorphism,
mitoses
Fascicular,
storiform, or
palisading patterns;
may be associated
with myxomatous
stroma
104
 Spindle Cell (Squamous)
Carcinoma (SCSC)

Spindle cells are cytokeratin-positive, but

105 negativity does not exclude the diagnosis
 Heterologous Elements

106
 Spindle Cell (Squamous)
Carcinoma (SCSC)

Differential diagnosis:
Reactive (fibroblastic) proliferation
Malignant fibrous histiocytoma
Fibrosarcoma
Malignant melanoma

107
 Spindle Cell (Squamous)
Carcinoma (SCSC)

Controversial histogenesis. Epithelial derivation

is support by:
 Association with conventional SCC
 ICH: cytokeratin +
 Cartilage or bone component have not been
reported in metastases
Metastases may include conventional or/and
spindle cell component
Poor prognosis (metastases in lymph nodes and
lungs)
108
 Verrucous Carcinoma

Highly differentiated variant of SCC with focally

destructive, but not metastatic capabilities
1-3% of all laryngeal carcinomas
Men > women, 6th – 7th decades
Oral cavity > nasal fossa > sinonasal tract,
nasopharynx
Larynx: hoarseness
In the larynx most common in the glottic area
Potential etiologic factors: tobacco, viruses
109
 Verrucous Carcinoma

 Tan or white, warty, fungating, or exophytic, firm to

hard mass, attached by a broad base
 Squamous cell proliferation:
 uniform cells without dysplastic features and mitoses
 marked surface keratinization
 broad or bulbous rete pegs with pushing, NOT
infiltrative margin
 Dysplastic features limited and confined to basal sone
 Mixed chronic immflammarory cell infiltrate

110
 Verrucous Carcinoma

 Tan or white,
warty, fungating,
or exophytic, firm
to hard mass,
attached by a
broad base

111
 Verrucous Carcinoma

112
 Verrucous Carcinoma

 Squamous cell proliferation:

 uniform cells without dysplastic
features and mitoses
 marked surface keratinization
 broad or bulbous rete pegs with
pushing, NOT infiltrative margin
 Dysplastic features limited and
confined to basal zone
 Mixed chronic inflammatory cell
infiltrate

113
 Verrucous Carcinoma

Differential diagnosis:
 Keratotic squamous papilloma
 Reactive keratosis and epithelial hyperplasia
 Pseudoepitheliomatous hyperplasia
 Verruca vulgaris
 Keratoacantoma
 “Conventional” SCC

114
 Verrucous Carcinoma

Metastasis in regional lymph nodes are rare,

and distant metastases do not occur
Excellent prognosis after complete surgical
removal
Anaplastic transformation may result in distant
metastases
Adequate biopsy material with a good epithelial-
stromal interface is critical for the interpretation
Cervical adenopathy- reactive changes

115
 Basaloid Squamous Cell
Carcinoma

An invasive neoplasm, composed of

basaloid cells
Uncommon
Men > women, 6th – 7th decades
Hypopharynx (pyriform sinus), larynx
(supraglottis), and tongue
Hoarseness, dysphagia, pain, neck mass
Etiology: ETOH, tabacco
Cell of origin: unclear
116
Basaloid Squamous Cell
Carcinoma
 Firm to hard, tan-white mass, often with associated
central necrosis
 Patterns: solid, lobular, cell nests, cribriform, cords,
trabeculae, gland-like, or cystic
 Comedonecrosis
 Intercellular deposition of a hyaline or mucohyalin
material
 Focal squamous differentiation or association with SCC,
SCCIS, squamous dysplasia, or spindle cell component

117
 Basaloid Squamous Cell
Carcinoma

 Infiltrating tumor originating from the surface epithelium

118with solid growth pattern and comedonecrosis
 Basaloid Squamous Cell
Carcinoma

 Small, closely
apposed cells with
hyperchromatic
nuclei, scanty
cytoplasm, marked
mitotic activity,
large cells or
pleomorphism can
be seen

119
 Basaloid SCC with Focal
Keratinization

120
 Basaloid Squamous Cell
Carcinoma

 Histochemistry:
PAS+ and Alcian blue + material in the cystic
spaces
 IHC:
cytokeratin (+), EMA (+), CEA (+), S-100 (+);
chromogranin (-), synaptophysin (-),
muscle-specific actin (-)
 EM:
basaloid component: desmosomes, rare
tonofilaments
cystic spaces: stellate granules or replicated basal
lamina
121
 Basaloid SCC:
Differential Diagnosis

Adenoid cystic carcinoma

Neuroendocrine carcinoma
Adenosquamous carcinoma
Spindle cell carcinoma

122
 Basaloid Squamous Cell
Carcinoma

Multifocal, deeply invasive, metastatic

Metastases: lymph nodes, lung, bone,
skin, brain
Metastases include both basaloid and
squamous components
Rapidly fatal

123
 Adenosquamous
Carcinoma

 Malignant high grade epithelial neoplasm with histologic

features of adenocarcinoma and SCC
 Uncommon
 Men > women, 6th – 7th decades
 Larynx, hypopharynx, oral cavity, sinonasal cavity
 Hoarseness, dysphagia, pain, neck mass, nasal
obstruction
 Etiology: not clear (ETOH, tobacco)
 Cell of origin: unclear; possible a single totipotential cell
from surface epithelium or seromucous glands
124
 Adenosquamous
Carcinoma
 Exophytic or submucosal, friable, edematous or
granular mass with or without surface ulcerations
 SCC component:
 Well to poorly differentiated, associated in situ
carcinoma or invasive SCC
 Individual cell keratinization, intercellular bridges,
keratin pearl formation, dyskeratosis
 Adenocarcinoma component:
 In the submucosa, glandular differentiation,
 Both components can be admixed
 Cellular pleomorphism, mitoses, necrosis, perineural
125 invasion
 Adenosquamous
Carcinoma

126
 Adenosquamous
Carcinoma

Histochemistry: PAS/d (+) and

mucicarnine (+) intraluminal material
IHC: cytokeratin (+)
Behaves very aggressively, irrespective of
the size of neoplasm
Early lymph node metastases, lung, liver
Poor prognosis: 5-year survival rate of
127
Neuroendocrine Carcinoma:
Classification

Carcinoid
(well differentiated)
Atypical carcinoid
(moderately differentiated)
Small (“oat”) cell carcinoma
(poorly differentiated)

128
Neuroendocrine Carcinoma

Submucosal nodular or polypoid

mass with tan-white appearance
and up to 4 cm in diameter
Surface ulceration may present in
moderately or well-differentiated
neuroendocrine carcinoma

129
 Carcinoid

 Organoid or trabecular
growth pattern with
fibtovascular stroma
 Glands or squamous
differentiation can be
seen
 Absence of surface
ulceration

130
 Carcinoid

 Uniform cells with

centrally located round
nuclei, vesicular
chromatin, and
eosinophilic cytoplasm
 Absence of
pleomorphism,
mitoses, necroses
 Low
nuclear:cytoplasmic
131ratio
 Carcinoid

 Histochemistry:
PAS/d + mucin,
argyrophilia
 IHC:
Cytokeratin +,
Chromogranin +, NSE +,
synaptophysin +
 EM:
neurosecretory granules,
cellular junctional
complexes
132
 Atypical Carcinoid

 Organoid, trabecular,
cribriform, or solid gowth
pattern
 Mild to marked cellular
pleomorphism
 Nucleoli may be prominent
 Mitoses and focal necrosis
 Variable nuclear:cytoplasmic
ratio
 Surface ulceration and
lymphovascular and
perineural invasion
133
 Small Cell Carcinoma

 Solid nests, sheets, or

ribbons, with absence
of fibrovascular
stroma
 Surface ulceration
 Lymphovascular and
perineural invasion
 Glandular or
squamous
differentiation is
rarely seen
134
 Small Cell Carcinoma

 Marked cellular
pleomorphism, ‘crush’
artifacts, necrosis,
hyperchromatic oval to
spindle nuclei, abundant
mitoses
 High nuclear:cytoplasmic
ratio
 IHC: cytokeratin,
chromogranin,
synaptophysin, NSE
positive
 EM: rare neurosecretory
135granules
 Chondrosarcoma

Rare
Males >Females, 4th - 7th decades
Cricoid > thyroid cartilage >
arytenoid
Smooth, lobulated, hard submucosal
mass larger than 2 cm

136
 Chondrosarcoma
(high grade)

 Lobulated hypercellular
tumor with
hyperchromatic,
pleomorphic nuclei and
prominent nucleoli
 Binucleate or
multinucleated cells
 Mitoses: usually
uncommon

137
Synovial Sarcoma

138
Synovial Sarcoma

139
Synovial Sarcoma

140