LARYNGEAL DYSPLASIA - A CLINICOPATHOLOGICAL STUDY

Background. Histologic changes that may predict irreversible neoplasti c transformation remain poorly defined for lesions of the larynx. To d ate, more than 20 schemes for the classification of laryngeal dysplasi a have been proposed, yet no one system has gained wide acceptance. Th is has led to considerable confusion in defining the pathogenesis of t his process and controversy in selecting the optimal management strate gy of patients with premalignant changes of the larynx. Methods. A det ailed and systematic review was made of 125 laryngeal biopsies from 62 patients with laryngeal squamous cell dysplasia who received long ter m followup (mean, 74 months). Various histopathologic parameters were assessed in an attempt to define the prognostic importance of each par ameter for progression from atypia to invasive carcinoma. Results. Fiv e parameters were found to be significantly different when comparing l esions that progressed to carcinoma with those that remained stable or resolved: abnormal mitotic figures, mitotic activity, stromal inflamm ation, maturation level, and nuclear pleomorphism. Surface morphology, nucleolar prominence, and koilocytosis were not significantly differe nt when comparing the two groups. Surface keratin formation did not su ggest improved prognosis for patients with lesions with other features of dysplasia. Conclusions. These findings suggest that within the lar yngeal glottis, severe keratinizing dysplasia occurs more frequently t han does classic carcinoma in situ, and both entities likely represent intraepithelial neoplastic transformation.