larynx


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  • normal

    • mucosa
      • supraglottic and glottic: squamous, occasional patches of respiratory inferiorly
      • false cord: squamous or respiratory
      • true cord: squamous
      • subglottic: respiratory
      • hypopharynx: squamous
      • trachea: respiratory
    • stroma
      • seromucinous glands (except true cords)
      • true cords have loose connective and elastic tissue
    • cartilage
      • hyaline cartilage
      • epiglottis is elastic cartilage with fenestrations
    • age related changes
      • mucosa entirely respiratory at birth
      • oncocytic metaplasia of seromucinous glands at age > 50
      • ossification of thyroid and cricoid cartilage in adults
  • Non-neoplastic

  • WHO neoplasms

    • malignant epithelial
      • SCC
        • verrucous carcinoma
        • basaloid SCC
        • papillary SCC
        • spindle cell carcinoma
        • acantholytic SCC
        • adenosquamous carcinoma
      • lymphoepithelial carcinoma
      • giant cell carcinoma
      • salivary gland type carcinoma
        • mucoepidermoid carcinoma
        • adenoid cystic carcinoma
    • neuroendocrine neoplasm
    • benign epithelial
      • squamous papilloma
      • papillomatosis
      • salivary gland type adenoma
        • pleomorphic adenoma
        • oncocytic papillary cystadenoma
    • soft tissue
      • malignant
        • fibrosarcoma
        • MFH
        • liposarcoma
        • leiomyosarcoma
        • rhabdomyosarcoma
        • angiosarcoma
        • Kaposi sarcoma
        • MPNST
        • synovial sarcoma
      • borderline
        • inflammatory myofibroblastic tumor
      • benign
    • bone and cartilage
    • melanoma
    • metastasis
  • TNM (useful for grossing)

    • supraglottis
      • subsites: epiglottis, arytenoid cartilage, false cord, aryepiglottic fold
      • T1: one subsite of supraglottis, normal vocal cord mobility
      • T2
        • 2 or more subsites of supraglottis
        • outside of supraglottis
          • superior: tongue base, vallecula, medial pyriform sinus
          • inferior: glottis
      • T3: vocal cord fixation or invasion of...
        • postcricoid area
        • pre-epiglottic tissues
        • paraglottic space
        • minor thyroid cartilage erosion
      • T4a: thyroid cartilage invasion or outside of larynx
      • T4b: involves prevertebral space, mediastinum, or encases carotid artery
    • glottis
      • T1: vocal cord limited, normal mobility (may involve commissures)
        • T1a: one cord
        • T1b: both cords
      • T2: involves supraglottis, subglottis, or impaired vocal cord mobility
      • T3: vocal cord fixation or involves paraglottic space or minor thyroid cartilage erosion
      • T4a: involves thyroid cartilage or outside of larynx
      • T4b: involves prevertebral space, mediastinum, or encases carotid artery
    • subglottis
      • T1: subglottis limited
      • T2: involves vocal cords +/- impaired mobility
      • T3: vocal cord fixation
      • T4a: invades through cricoid, thyroid cartilage, or outside of larynx
      • T4b: invades prevertebral space, mediastinum, or encases carotid artery
    • hypopharynx
      • T1: one subsite of hypopharynx, <= 2cm
      • T2: multiple subsites, adjacent sites, or 2-4cm
      • T3: > 4cm or hemilarynx fixation
      • T4a: involves thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophagus, central compartment soft tissue (includes prelaryngeal strap muscles and subcutaneous fat)
      • T4b: involves prevertebral fascia, mediastinum or encases carotid artery
    • outside of larynx means:
      • trachea
      • neck soft tissue, deep/extrinsic tongue muscles
        • genioglossus
        • hyoglossus
        • palatoglossus
        • styloglossus
      • strap muscles
      • thyroid
      • esophagus
  • N

    • N1: single ipsilateral node, <= 3cm
    • N2a: single ipsilateral node, 3-6cm
    • N2b: multiple ipsilateral nodes, <= 6cm
    • N2c: contralateral or bilateral nodes, <= 6cm
    • N3: > 6cm
    • midline considered ipsilateral
  • Staging

    • 0: Tis
    • I: T1
    • II: T2
    • III: T3 or N1
    • IVA: T4a or N2
    • IVB: T4b or N3
    • IVC: M1