•  Portion of larynx opened from posterior side.

•  The lumen of the larynx is markedly narrowed. White arrows show the path of air through the lumen.

•  Epiglottis (black arrow) is distorted by neoplasm.

•  Enormous granular neoplasm highlighted by yellow arrows fills right pyriform sinus.

•  Lymph nodes containing neoplasm (blue arrow) press on left pyriform sinus.

• Strongest association is with cigarette smoking

• Human papillomavirus genome has been detected

• Asbestosis another cofactor

• • whether same mechanism of BPDE (catabolite of benzo[a]pyrene in cigarette smoke) binds p53 mutational hot spots as in lung carcinoma

• p53 mutation affects cell replication and centromere replication

• Usually men with long cigarette smoking history

• Age generally >50 years

• Present with hoarseness and/or airway obstruction

• All neoplasms spread to the regional lymph nodes

• Eventually spread to lungs and other distant sites

• Extensive morbidity and mortality due to local disease with airway obstruction, hemorrhage, infection

• Treatment modalities include surgery and radiation

• Best prognosis for glottic neoplasms

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• Granular, gray white, exophytic or ulcerated neoplasm

• Glottic if involves the true vocal cords

• Supraglottic above cords

• Infraglottic below cords

• Although pyriform sinus is part of hypopharynx, generally grouped with supraglottic carcinomas

• Frequently keratinizing with pearl formation

• Hyperchromatic nuclei with irregular outlines

• Prominent nucleoli

• Can range from well to poorly differentiated

• May be accompanied by dysplastic or in situ changes in adjacent squamous mucosa

• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 745-6.

• Sternberg SS ed. Diagnostic Surgical Pathology, 2d edition, Lippincott-Raven; Philadelphia. 1996, pp. 897-911.

• Current literature from PubMed at National Library of Medicine