Abstract

A total of 359 cases of malignant tumors of the larynx (including 87 resected cases) obtained from the pathology file of the Department of Pathology, College of Medicine, Seoul National University during a period of 10 years from 1976 to 1985 were studied by histopathologic and gross investigation with analysis of clinical records, with following results. 1) Out of 359 cases, 356 cases were primary and 3 cases were metastatic. The primary malignant tumors consisted of 348 cases (97.8%) of squamous cell carcinoma, each 2 cases of verrucous carcinoma, malignant lymphoma and undifferentiated carcinoma, a case of adenoid cystic carcinoma and a case of unclassified sarcoma. The metastatic malignant tumors were each one case of renal cell carcinoma, malignant schwanoma and esophageal squamous cell carcinoma. 2) In primary squamous cell carcinoma, the ratio of male to female was 7.8:1 and mean age was 58.2 years (35-87 years). The location was in order of the supraglottic (54.1%), the glottic (25.0%), the transglottic (18.0%), and the subglottic (2.9%). The degree of histologic differentiation was in order of well (72.7%), moderate (23.6%) and poor (3.7%). The tumor stage was stage I in 7.8% of cases, stage II 19.7%, stage III 38.5%, and stage IV 34.0%, and the supraglottic tumors were relatively higher grade than the glottic tumors. 3) The chief complaints of the primary squamous cell carcinoma were mostly hoarseness (70.9% in total case, 49.2% in the supraglottic, 90.9% in the transglottic, and 100% in the glottic and the subglottic), and were variable in the supraglottic cases in order of sore throat, neck mass, throat pain, dyspnea, swallowing difficulty, and foreign body sensation. The duration from the time of first symptom to vistiation was average 7.34 months and was less than 3 months in 45.6% of cases, and showed two peaks, major in 1-2 months and minor in 10-12 months. 4) In the 87 resected cases of primary squamous cell carcinoma, the gross pattern was the ulcerofungating type in 49.4% of cases, the ulceroinfiltrative in 47.1% and flat in 3.5%. The size of tumor was up to 1.5 cm in 30% of cases and more than 1.6 cm in 70%. The extent of invasion was to the submucosa in 40.7% of resected cases, to the laryngeal skeletal muscle(s) 16.3%, to the laryngeal cartilage(s) 33.7%, to the perilaryngeal soft tissue 9.3%. In the 65 cases of lymph node dissection out of these 87 cases, 25 cases (38.5%) showed metastatic lesion(s). With relation to tumor location, lymph node metastases were frequent in the supraglottic, the transglottic and the subglottic region (50-60%) and less common in the glottic region (13.8%). With relation to gross pattern, the metastases were most frequent in ulceroinfiltrative type and none in flat type. And the metastasis rate was increased according to the increase of the tumor size and to the decrease of the tumor differentiation. 5) Smoking history in 140 recorded cases revealed only 8 nonsmokers and average 35.39 pack-years of cigarettes in smoker group with peak in 20-40 pack-yeas (57.2%). 6) Distant metastases were found in 8 cases. The organs were the lung in 5 cases, brain 4 cases, liver 1 case (Three cases were positive in two foci, the lung and the brain). The coexistant primary malignant tumors were found in 8 cases which were 5 bronchogenic squamous cell carcinomas, 2 gastric adenocarcinoma, 1 pancreatic head adenocarcinoma and 1 thyroid papillary carcinoma (Triple primary cancers in one case, of the larynx, the lung and the stomach). 7) Follow-up of 6-53 months (mean 25.8 months) in 115 cases resulted in NED in 62 cases (53.9%) and expired or less resulted in NED in 62 cases (53.9%) and expired or loss of follow-up after recurrence or distant metastasis in 53 cases (46.1%). The recurrence was detected in 2-34 months (average 12.0 months) after treatment.