Abstract
BackgroundThe assessment of tumor invasion of underlying benign stroma in neoplastic squamous proliferation of the larynx may pose a diagnostic challenge, particularly in small biopsy specimens that are frequently tangentially sectioned. We studied whether thresholds of an eosinophilic response to laryngeal squamous neoplasms provides an adjunctive histologic criterion for determining the presence of invasion.MethodsEighty-seven(n = 87) cases of invasive squamous cell carcinoma and preinvasive squamous neoplasia were evaluated. In each case, the number of eosinophils per high power field(eosinophils/hpf), and per 10 hpf in the tissue adjacent to the neoplastic epithelium, were counted and tabulated. For statistical purposes, the elevated eosinophils were defined and categorized as: focally and moderately elevated (5–9 eos/hpf), focally and markedly increased(>10/hpf), diffusely and moderately elevated(5–19 eos/10hpf), and diffusely and markedly increased (>20/10hpf).ResultsIn the invasive carcinoma, eosinophil counts were elevated focally and /or diffusely, more frequently seen than in non-invasive neoplastic lesions. The increased eosinophil counts, specifically >10hpf, and >20/10hpf, were all statistically significantly associated with stromal invasion. Greater than 10 eosinophils/hpf and/or >20 eosinophils/10hpf had highest predictive power, with a sensitivity, specificity and positive predictive value of 82%, 93%, 96% and 80%, 100% and 100%, respectively. Virtually, greater than 20 eosinophils/10 hpf was diagnostic for tumor invasion in our series.ConclusionOur study suggests for the first time that the elevated eosinophil count in squamous neoplasia of the larynx is a morphologic feature associated with tumor invasion. When the number of infiltrating eosinophils exceeds 10/hpf and or >20/10 hpf in a laryngeal biopsy with squamous neoplasia, it represents an indicator for the possibility of tumor invasion. Similarly, the presence of eosinophils meeting these thresholds in an excisional specimen should prompt a thorough evaluation for invasiveness, when evidence of invasion is absent, or when invasion is suspected by conventional criteria in the initial sections.
Highlights
The assessment of tumor invasion of underlying benign stroma in neoplastic squamous proliferation of the larynx may pose a diagnostic challenge, in small biopsy specimens that are frequently tangentially sectioned
Spiegel et al recently reported that the presence of eosinophils is associated with invasion in the neoplastic squamous lesions in the female genital tract, and proposed that eosinophilia provided as adjunctive morphologic feature in identifying SC in the cervix and vulva[5,6]
Statistical methods Frequency was computed for each eosinophil category in invasive and non-invasive squamous neoplasia specimens obtained from biopsy and excision
Summary
The assessment of tumor invasion of underlying benign stroma in neoplastic squamous proliferation of the larynx may pose a diagnostic challenge, in small biopsy specimens that are frequently tangentially sectioned. Distinguishing between preinvasive squamous neoplasia (high grade squamous cell dysplaisa/ squamous cell carcinoma in-situ, SCIS) and SC may be difficult in small biopsy specimens, when the tissue is superficial and fragmented, a prominent inflammatory infiltrate obscures the epithelial-stromal interface, and/or there is tangential sectioning of the acanthotic neoplastic squamous epithelium. Spiegel et al recently reported that the presence of eosinophils is associated with invasion in the neoplastic squamous lesions in the female genital tract, and proposed that eosinophilia provided as adjunctive morphologic feature in identifying SC in the cervix and vulva[5,6]. We speculated that the degree of stromal eosinophilia is a pathologic feature that would provide an adjunctive criterion for distinguishing SC from SCIS in the larynx, and undertook a systematic study to test this hypothesis. We focused on a single head and neck region, the larynx, to avoid any potential selection bias, since squamous neoplasia and the associated host response and changes in the head and neck are heterogeneous and varied in different anatomic locations[7]
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