How to handle laryngeal specimens?

Abstract

Laryngohypopharyngectomies encompass the larynx with a dorsal covering of the mucosa of the hypopharynx subdivided in left and right piriform sinus and the median postcricoid area. Cranially, the specimen may include parts of the base of the tongue and caudally a varying number of tracheal rings. Endolaryngeally, one discerns between (1) supraglottic, (2) glottis, and (3) subglottic tumors. For examination of endolaryngeal tumor position and extension, the larynx has to be opened through a median vertical dorsal incision. For hypopharyngeal cancers, the larynx should not be opened to avoid compromising assessment of tumor margins in this area. For gross sampling, specimens are cut in horizontal slices. Margin assessment depends on location: base of the tongue for supraglottis, trachea for endolarynx and postcricoid region for hypopharynx. Postcricoid cancers may extend into the adjacent cervical oesophagus. Piriform sinus cancers may extend cranially into the oropharynx or craniomedially into the supraglottic larynx, thereby crossing the aryepiglottic fold. Issues of special interest are perforation of laryngeal cartilages with extralaryngeal soft tissue spread, endolaryngeal extension of a hypopharyngeal tumor that may involve the tracheal margin and hypopharyngeal cancers growing submucosally into the caudal surgical margin through the postcricoid area. Glottic cancers may spread dorsally into the submucosal soft tissues of the postcricoid area.