Pathology of the

Larynx

Nikolay Popnikolov M.D.,

Ph.D.
Fellow, UTMB Dept. of
Pathology January 2002
1

Normal Anatomy
and
Histology

Normal Anatomy and

Histology

Normal Anatomy and

Histology

Normal Anatomy
and
Histology

Normal Anatomy
and
Histology

Normal Anatomy and

Histology

Laryngeal Epithelium

Goblet Cells and

Columnar
Mucinous Cells

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

Granulomatou
s
Inflammation

19

Fungal Infections
3Histolplasmo
sis
3Coccidiomyc
osis
3Cryptococcos
is
3Blastomycosi
s
20

Other

Granulomatou
s Diseases

3Leprosy
3Tertiary
Syphilis
3Sarcoidosis
3Crohns
disease
3Wegeners
21
granulomatosis

Acute Epiglottitis
3Haemophylus influenzae type B
3Reddened, markedly
edematous supraglottic
structures
3Edema with marked infiltrate of
neutrophyls with or without
microabscess formation
22

Diphtheria

23

Diphtheri
a

24

Vocal Cord Nodules

3Usually bilateral
3Anterior or middle third of true vocal
cord
3Any age group
3Related to chronic voice abuse
3Hoarseness or voice changes
25

Vocal Cord Polyps

3Usually single
3Middle third of true vocal cord, but
may originate from the ventricular
area
3Any age group
3Sessile, raspberry-like,
pedunculated
3Related to chronic voice abuse,
26infection, ETOH, smoking,

Vocal Cord Polyp

27

Edematous-Myxoid Type

3 Submucosal
accumulation of
pale blue to pink
material admixed
with sparsely
cellular and
variably
vascularized
stroma
28

Vascular-Hyaline Type

3 Dilated
submucosal
vascular spaces and
deposition of
dense
eosinophilic fibrinlike material
29

Vocal Cord Polyp: Fibrous

Type
3 Moderately
cellular
submucosal
proliferation of
uniform oval to
spindle-shaped
cells with varying
amount of
fibrous tissue
deposition
30

Laryngocele
3Abnormal dilatation of the saccule
(appendix of the ventricle) containing
air and maintaining an open
communication with laryngeal lumen
3Men >women
3Bilateral - 25%
3Hoarseness, lateral neck mass,
dyspnea, dysphagia, laryngopyocele
31(pain)

Laryngocele: Types
3Internal:
laryngocele confined to the
intrinsic larynx
3External:
dilated sac projects upward and
laterally
3Combined
32

Laryngocele: Etiology
3Acquired:
increased
intralaryngeal
pressure
(glassblowers,
musicians, weight lifters)
3Congenital
3SCC in 15% of cases
33

Laryngocele

3Smooth -surfaced, sac-like structure

usually
filled
34with

Laryngocele
3Respiratory
epithelial- lined
(ciliated,
columnar) cyst
with a fibrous wall
3Squamous
metaplasia
3Oncocytic
metaplasia
35

Laryngocele:
Differential
Diagnosis
3Branchial cleft
cyst
3Oncocytic
papillary
cystadenoma
3Laryngeal cysts
36

Contact Ulcers of the Larynx

(Pyogenic Granuloma of the
Larynx)
3Benign, tumor-like condition, occurring
most commonly along the posterior
aspect of one or both vocal cords
3Men>Women, usually adults
3Hoarseness, dysphagia, sore throat,
dysphonia, difficulty breathing, choking,
pain
3Etiology: vocal abuse, acid
regurgitation, postintubation trauma
37

Contact Ulcers of the Larynx

(Pyogenic Granuloma of the
Larynx)

3Ulcerated,
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)

3 Ulcerated lesion with associated fibrinoid

necrosis,
39 granulation tissue, acute and chronic
inflammation

Contact Ulcers of the Larynx

(Pyogenic Granuloma of the
Larynx)

40

3Giant cells, vascular

proliferation,
and
spindle

Contact Ulcers of the

Larynx: Differential
Diagnosis

41

3Infectious diseases
3SCC
3Spindle cell carcinoma
3Vascular neoplasms: lobular
capillary
hemangioma,
angiosarcoma,
Kaposis
sarcoma

Laryngeal Amyloidosis
3Extracellular accumulation of
fibrillar proteins
3Systemic or localized
3Primary or secondary
3Men > women, in the 5th and 6th
decades
3Polypoid mass (glottis and
supraglottis) or diffuse mucosal
swelling (subglottis)
42
3Hoarseness

Laryngeal Amyloidosis
3 Extracellular,
eosinophilic,
amorphous material
deposited randomly
throughout
submucosa;
depositions around or
within the walls
3 Disappearance of
the seromucous
glands,
3 Mixed chronic
43
inflammatory

Laryngeal Amyloidosis

3Congo red: apple-green birefringence

polarized
44 under

Subglottic Stenosis
3Congenital or acquired
3Rare; acquired > congenital
3Progressive respiratory difficulty,
stridor, dyspnea, air hunger,
hoarseness, abnormal cry,
aphonia, dysphagia
3Etiology: trauma, neoplasms,
infectious or autoimmune diseases,
45idiopathic

Subglottic Stenosis
3Narrowing of the endolaryngeal
diameter with mucosal or submucosal
mass or bulging
3Histologic picture depends on the cause
3Idiopathic stenosis: submucosal fibrous
proliferation with associated non-specific
chronic inflammation
3Differential diagnosis: infectious
diseases, Wegeners granulomatosis,
46collagen vascular diseases, neoplasms

Idiopathic
Subglottic
Stenosis

47

Terminology of Epithelial
Changes
3Leukoplakia:
white lesion on a mucosal membrane
(clinical)
3Erythroplakia:
red lesion on a mucosal membrane (clinical)
3Hyperplasia:
thickening of epithelial surface as a result
of an absolute increase in the number of
cells.
3Pseudoepitheliomatous hyperplasia:
malignan reactive or reparative overgrowth
48exuberant

Terminology of Epithelial
Changes
3Keratosis:
presence of keratin on an epithelial
surface
3Parakeratosis:
presence of nuclei in the keratin layer
3Dyskeratosis:
abnormal keratinization of epithelial
cells
3Ulceration:
erosion or loss of surface epithelium
anoth
49 3Metaplasia:
er

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

Hyperplastic
Epithelial
Changes
3Reactive or reparative benign process,
reflecting the epithelial response to a
stimulus or an injury
3Men > women
3Occurs anywhere, but mainly along
the true vocal cords
3Hoarseness
3Etiology: smoking, ETOH, voice abuse,
chronic inflammation
51

Hyperplastic
Epithelial
Changes
3Flat, papillary, or verrucoid lesion with a
white (leukoplakic) or red (erythroplakic)
appearance
3Small or diffuse
3Thickening of epithelial surface as a result
of an absolute increase in the number of
cells
3Presence of superficial keratin layer
(keratosis) or nuclei in the superficial
52
keratin layer (parakeratosis)

Hyperplastic
Epithelial
Changes
3Presence of keratohyaline granules
in the granulosa cell layer
3Presence of koilocytosis
3Presence of cytologic atypia
3Presence of dyskeratosis
3Differential diagnosis:
contact ulcer, verruca vulgaris,
verrucous carcinoma, welldifferentiated
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
3Men > women
3Occurs anywhere, but mainly
along the anterior portion of the
true vocal cords, 25% bilateral
3Hoarsen
ess
3Etiology:
smoking,
ETOH,
chronic
57

Dysplastic
Epithelial
Changes

58

3Localized, circumscribed flat or

papillary area with white, red or
gray appearance
3Cytologic alterations:
hyperchromasia, increase of
nuclear/cytoplasmic ratio,
mitoses, crowding of cells with
loss of cellular polarity
3Begins in basal or parabasal
areas

Dysplastic Epithelial
Changes:
Grading
3Mild:
lower 1/3 of the thickness of
epithelium
3Moderate:
lower 2/3 of the thickness of
epithelium
3Severe:
from 2/3 to almost complete thickness
59

Dysplastic
Epithelial
Changes

3Normal maturation of the superficial

layers of the epithelium
3Intact basement membrane
3May be associated with keratosis or
dyskeratosis, or other hyperplastic
changes
3Full-thickness dysplasia (carcinoma in
situ) is not a prerequisite prior to the
development of an invasive CA
3Differential
diagnosis: reactive
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
3Benign, exophytic neoplastic growth
composed of branching fronds of
squamous epithelium with
fibrovascular cores
3The most common benign
laryngeal neoplasm
3No sex predilection
3Changes in phonation, dyspnea,
cough, dysphagia, stridor
653HPV types 6 and 11

Laryngeal Papilloma
3Juvenile type:
multiple lesions with extensive
growth and rapid recurrence, may
remit spontaneously or persist into
old age
3Adult type:
more often single, recurs less
often, less likely to spread
66

67

3Exophytic, warty, friable, tan-white

to red growths

68

3 Papillary fronds of multilayered benign

squamous epithelium containing
cores
3fibrovascular
Little or no keratin

Laryngeal Papilloma
3Absence of
stromal
invasion
3Certain
degree of
cellular atypia
3Koilocytic
changes
69

Laryngeal Granular
Cell Tumor
3Men > women
3Hoarseness
3Along the posterior aspect of
true vocal cord ( but also in
supraglotic and infraglotic
areas)
79

Granular

3Solitary,
polypoid,
sessile,
papillary, or
cystic lesion,
measuring up
to
3.0
71 cm in

Cell Tumor

Granular
3 Poorly
circumscribed
subepithelial lesion
with syncytial,
trabecular, or
nested growth
pattern
3 Round to polygonal
cells with round to
vesicular nuclei and
coarsely granular
cytoplasm. Poorly
defined cell borders.
3 Variable degree of
72 cellular pleomorphism

Cell Tumor

S-100 Protein
Immunostain

73

Pseudoepitheliomatous
hyperplasia

74

Granular

Cell Tumor

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

Malignant Granular
Cell Tumor
3Rare ( 1% of all GCT)
3Do not occur in
newborns 3Size > 4
cm
3Increased
cellularity,
pleomorphism,
necrosis,
prominent nucleoli, spindle
shaped
cells
and
>
2
mitoses/10
vessel
76
HPF
s

Chordoma
3Uncommon
3Males >
females
3Dyspnea,
strydor, and
hoarseness
3May originates from epiglottis,
cricoid, arytenoid, or thyroid
cartilages
77

Chordoma
3Lobulated,
normally
looking
chondrocytes
3Absence of
pleomorphism
, binucleated
chondrocytes,
or mitotic
activity
78

Rhabdomyoma
3Benign tumor of striated muscle
3Adult type:
3less common
3Males > females; > 40 y/o
3Hoarseness, dyspnea
3Well-defined, lobulated, red-brown
mass, up to 5 cm in diameter
79

Rhabdomyoma: Adult
Type

3 Large polygonal to
round cells with
abundant deeply
eosinophylic cyroplasm
and one or two
periphery placed
vesicular nuclei
3 Nucleoli,
cytoplasmic
vacuolization
3 Cross-striation
3 Absent mitoses
3 Abundant
80cytoplasmic
glycogen (diastase

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

Rhabdomyoma: Fetal
Type
3 Spindle cells and
immature muscle
fibers with in a
myxoid stroma
3 Cross-striation
rarely discernible.
Mature muscle
fibers can be
seen in the
periphery
3 Absence of mitoses,
82 necrosis, and
significant

Malignant
Laryngeal
Neoplasms

83

In Situ Squamous
Cell
Carcinoma

84

3 Males > females

3 6th 7th decades
3 Most often involves anterior portion
of true vocal cord
3 Hoarseness
3 May coexist with invasive SCC
3 May be isolated or multifocal
3 Circumscribed or diffuse lesion with a
white, red, or gray color and smooth
or granular appearance

In Situ Squamous
Cell
Carcinoma

3 Dysplastic process
involves the entire
thickness of the
epithelium
3 Loss of cellular
maturation and
polarity
3 Increase of
nuclear/cytoplaslic
ratio
3 Normal and
85abnormal mitoses

Microinvasive or Superficially
Invasive Squamous Cell
Carcinoma
3 Nests of malignant
cells that have
penetrated the
basement membrane
and invaded
superficially into the
submucosa
3 Capable of
metastasizing
3 Development from
carcinoma in situ or
from epithelium with
86no evidence of CIS

Invasive Squamous Cell

Carcinoma
32.5% of all cancers in men
30.5% of all cancers in
women 395% of all
laryngeal carcinomas
3Etiology: ETOH (supraglottic),
tobacco (glottic), asbestos, nickel,
wood, isopropyl alcohol, radiation
3DD: reactive epithelial
87changes,

Invasive Squamous
Cell Carcinoma

88

Supraglottic
Squamous Cell
Carcinoma
32540% of laryngeal SCC
3Epiglottis (base), false vocal cords
3Changes in the quality of voice,
dysphagia, odonophagia, hoarseness,
hemoptisis, dyspnea
3Marginal carcinomas (suprahyoid
epiglottis, aryepiglottic folds); remain
quiescent for longer period and present at
more advanced stage
89

Supraglottic
Squamous Cell
Carcinoma
3Ulcerated, flat,
exophytic, or papillary
3Tend to be
nonkeratinizing 3In situ
component 3Mitoses
and necrosis
90

Supraglottic
Squamous Cell
Carcinoma
3Large, tanwhite
neoplasm in
the right
supraglottis,
extending
upward toward
epiglottis
91

Supraglottic
Squamous Cell
Carcinoma

92

Glottic SCC
3Early: irregular area of mucosal
thickening
3Advanced: exophytic,
fungatic, endophytic,
ulcerated mass
3More commonly keratinizing,
well to moderately
differentiated
3In
situ component
93

Glottic SCC

94

Glottic SCC

95

Glottic SCC

96

Subglottic Squamous Cell

Carcinoma
3 5% of all laryngeal tumors
3 Tend to remain clinically quiescent, presenting
with advanced stage
3 Airway obstruction (dyspnea, stridor) and vocal
cord fixation (voice changes)
3 Large exophytic, fungating, ulcerating, or
endophytic
3 Tend to be keratinizing moderately to
poorly differentiated
3 In situ component is less common
3 Invasive pattern is predominantly
97
infiltrative

Subglottic SCC

98

Subglottic Squamous Cell

Carcinoma
3Overall 5-year survival rate < 40%
3Spread:
6 Into thyroarytenoid muscle (vocal cord
fixation)
6 Anteriorly: through cricothyroid membrane
into thyroid gland superiorly: glottis and
supraglottis
6 inferiorly: trachea posteriorly: below the
cricoid cartilage and into the esophagus
6
99Lymphatic drainage: upper and lower

Transglottic SCC
3Involves both glottic and
supraglottic structures
3Represents advanced tumor
3Nodal metastases and extranodal
spread
3Overall 5-year survival rate <
40%
100

Transglottic SCC

101

Spindle Cell (Squamous)

Carcinoma (SCSC)
3 Foci of conventional SCC associated with
malignant spindle cell stromal component
3 Synonyms: carcinosarcoma, pleomorphic
carcinoma, metaplastic carcinoma, collision
tumor, pseudosarcoma, Lane tumor
3 Men (85%), 6th 8th decades
3 True vocal cords > false vocal cords and
supraglottis > oral cavity > skin > tonsil and
pharynx
3 Symptoms vary according to site
3 No specific etiology
102

Spindle Cell (Squamous)

Carcinoma (SCSC)

103

Spindle Cell (Squamous)

Carcinoma (SCSC)
3Spindle cell
component
with variable
degree of
pleomorphism,
mitoses
3Fascicular,
storiform, or
palisading
patterns; may
be associated
104
with

Spindle Cell (Squamous)

Carcinoma (SCSC)

105

3Spindle cells are cytokeratinpositive,

but does not exclude the
negativity

Heterologous Elements

106

Spindle Cell (Squamous)

Carcinoma (SCSC)
3Differential diagnosis:
3Reactive (fibroblastic) proliferation
3Malignant fibrous histiocytoma
3Fibrosarcoma
3Malignant melanoma
107

Spindle Cell (Squamous)

Carcinoma (SCSC)
3Controversial histogenesis. Epithelial
derivation is support by:
./ Association with conventional SCC
./ ICH: cytokeratin +
./ Cartilage or bone component have not
been reported in metastases
3Metastases may include conventional
or/and spindle cell component
3Poor prognosis (metastases in lymph
108
nodes and lungs)

Verrucous Carcinoma
3Highly differentiated variant of SCC with
focally destructive, but not metastatic
capabilities
decad
3Men >ofwomen,
6th carcinomas
31-3%
all laryngeal
th
es > sinonasal
7
3Oral
cavity > nasal fossa
tract, nasopharynx
3Larynx: hoarseness
3In the larynx most common in the
glottic area
3Potential
etiologic factors: tobacco,
109
viruses

Verrucous Carcinoma
3 Tan or white, warty, fungating, or exophytic,
firm to hard mass, attached by a broad base
3 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
3 Mixed chronic immflammarory cell
110
infiltrate

Verrucous Carcinoma

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

111

Verrucous Carcinoma

112

Verrucous Carcinoma
3 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
113
3 Mixed chronic

Verrucous Carcinoma
3Differential diagnosis:
./ Keratotic squamous papilloma
./ Reactive keratosis and epithelial
hyperplasia
./ Pseudoepitheliomatous hyperplasia
./ Verruca vulgaris
./ Keratoacantoma
./ Conventional SCC
114

Verrucous Carcinoma
3Metastasis in regional lymph nodes
are rare, and distant metastases do
not occur
3Excellent prognosis after complete
surgical removal
3Anaplastic transformation may result in
distant metastases
3Adequate biopsy material with a good
epithelial- stromal interface is critical for
115the interpretation

Basaloid Squamous Cell

Carcinoma
3An invasive neoplasm,
composed of basaloid cells
3Uncommon
3Men > women, 6th decad
th
es sinus),
7
3Hypopharynx (pyriform
larynx (supraglottis), and
tongue
3Hoarseness, dysphagia, pain,
neck mass
116 3Etiology: ETOH, tabacco
3Cell of origin: unclear

Basaloid Squamous Cell

Carcinoma
3 Firm to hard, tan-white mass, often with
associated central necrosis
3 Patterns: solid, lobular, cell nests, cribriform,
cords, trabeculae, gland-like, or cystic
3 Comedonecrosis
3 Intercellular deposition of a hyaline or
mucohyalin material
3 Focal squamous differentiation or association
with SCC, SCCIS, squamous dysplasia, or spindle
cell component
117

Basaloid Squamous Cell

Carcinoma

3 Infiltrating tumor originating from the surface

epithelium
118with solid growth pattern and

Basaloid Squamous Cell

Carcinoma
3 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

129

Basaloid Squamous Cell

Carcinoma
3 Histochemistry:
PAS+ and Alcian blue + material in the
cystic spaces
3 IHC:
cytokeratin (+), EMA (+), CEA (+),
S-100 (+);
chromogranin (-),
synaptophysin (-), musclespecific actin (-)
3 EM:
basaloid
component:
lamin
121 desmosomes, rare tonofilaments
a

Basaloid SCC:
Differential
Diagnosis
3Adenoid cystic carcinoma
3Neuroendocrine carcinoma
3Adenosquamous carcinoma
3Spindle cell carcinoma

122

Basaloid Squamous Cell

Carcinoma
3Multifocal, deeply invasive,
metastatic
3Metastases: lymph nodes, lung,
bone, skin, brain
3Metastases include both basaloid
and squamous components
3Rapidly fatal
123

Adenosquamou
s
Carcinoma

3 Malignant high grade epithelial neoplasm with

histologic features of adenocarcinoma and SCC
3 Uncommon
3 Men > women, 6th 7th decades
3 Larynx, hypopharynx, oral cavity, sinonasal
cavity
3 Hoarseness, dysphagia, pain, neck mass,
nasal obstruction
3 Etiology: not clear (ETOH, tobacco)
3 Cell of origin: unclear; possible a single
totipotential cell from surface epithelium or
124
seromucous glands

Adenosquamou
s
Carcinoma

3 Exophytic or submucosal, friable, edematous

or granular mass with or without surface
ulcerations
3 SCC component:
./ Well to poorly differentiated, associated in
situ carcinoma or invasive SCC
./ Individual cell keratinization, intercellular
bridges, keratin pearl formation, dyskeratosis
3 Adenocarcinoma component:
./ In the submucosa, glandular differentiation,
3 Both components can be admixed
invasio
125
3 Cellular
pleomorphism, mitoses, necrosis,
n

Adenosquamou
s
Carcinoma

126

Adenosquamou
s
Carcinoma

3Histochemistry: PAS/d (+) and

mucicarnine (+) intraluminal
material
3IHC: cytokeratin (+)
3Behaves very aggressively,
irrespective of the size of neoplasm
3Early lymph node metastases, lung,
liver
127
3Poor
prognosis: 5-year survival rate

Neuroendocrine
Carcinoma:
Classification
3Carcinoid
(well differentiated)
3Atypical carcinoid
(moderately differentiated)
3Small (oat) cell
carcinoma
(poorly differentiated)
128

Neuroendocrine Carcinoma

3Submucosal
nodular
or
polypoid
mass with tanwhite appearance and up
to 4 cm in diameter
3Surface ulceration may
present in moderately or
well-differentiated
neuroendocrine
carcinoma
129

Carcinoid

3 Organoid or
trabecular growth
pattern with
fibtovascular
stroma
3 Glands or
squamous
differentiation can
be seen
3 Absence of
130
surface

Carcinoid
3 Uniform cells with
centrally located
round nuclei,
vesicular
chromatin, and
eosinophilic
cytoplasm
3 Absence of
pleomorphism,
mitoses,
necroses
131
3 Low

Carcinoid
3
Histochemistr
y: PAS/d +
mucin,
argyrophilia
3 IHC:
Cytokeratin +,
Chromogranin +, NSE
+, synaptophysin +
3 EM:
neurosecretory
132
granules, cellular

Atypical Carcinoid
3 Organoid, trabecular,
cribriform, or solid
gowth pattern
3 Mild to marked
cellular
pleomorphism
3 Nucleoli may be
prominent 3 Mitoses and
focal necrosis 3 Variable
nuclear:cytoplasmic
ratio
3 Surface ulceration
133
and
lymphovascular

Small Cell Carcinoma

3 Solid nests,
sheets, or ribbons,
with absence of
fibrovascular
stroma
3 Surface ulceration
3 Lymphovascular
and perineural
invasion
3 Glandular or
squamous
rarely
134differentiation

Small Cell Carcinoma

3 Marked cellular
pleomorphism,
crush artifacts,
necrosis,
hyperchromatic oval
to spindle nuclei,
abundant mitoses
3 High
nuclear:cytoplasmic
ratio
3 IHC:
cytokeratin,
chromogranin,
synaptophysin,
135NSE positive

Chondrosarcoma
3Rare
3Males >Females, 4th - 7th
decades
3Cricoid > thyroid cartilage
> arytenoid
3Smooth, lobulated, hard
submucosal mass larger than 2
cm

136

Chondrosarcom
a (high
grade)
3 Lobulated
hypercellular tumor
with
hyperchromatic,
pleomorphic nuclei
and prominent
nucleoli
3 Binucleate or
multinucleated
cells
3 Mitoses: usually
uncommon
137

Synovial Sarcoma

138

Synovial Sarcoma

139

Synovial Sarcoma

140