Follow-up (2019) 5 1/2 yrs after extended supracricoid laryngectomy to include partial left arytenoidectomy
Clinical History
67 yo referred to UIHC Nov 2010. Former 1 pack per day cigarette user with laryngo-pharyngeal reflux developed dysphonia in 2007 leading to treatment elsewhere in 2009 with microdirect laryngoscopy for "two areas of thickening with leukoplakia" on right and left vocal cords with a followup procedure for 'laser fulguration". Initial presentation to our clinic following biopsy elsewhere 2010 November; treated with irradiation completed elsewhere 2011 Feb
First visit in November 2010 after biopsy done elsewhere. Biopsy findings demonstrating "likely carcinoma in situ, severe dysplasia affecting both vocal cords"
Radiation completed elsewhere (started 12-2010 completed 2-2011). Follow-up March 2011
Follow-up April 2011
Follow-up July 2011
Follow-up August 2011
Follow-up in September 2011. Microdirect laryngoscopy with biopsies
Biopsy from anterodorsal portion of the right vocal cord showing cytologic atypia extending into the middle third of the mucosa with increased and mid-level mitoses, sufficient for a diagnosis of moderate squamous dysplasia.
While this biopsy from the posterior portion of the left vocal cord is superficial, it shows disordered architecture and mild cytologic atypia confined to the lower third of the mucosa, warranting a diagnosis of mild squamous dysplasia.
Follow-up December 2011
Follow-up March 2012
Follow-up May 2012
Follow-up April 2012
Follow-up Jan 2013
Follow-up Feb 2013
2013 April: Microdirect laryngoscopy with more extensive resection. Pathology = squamous cell carcinoma in situ (cis) right anterior, mid and posterior vocal cord; invasive to 0.1 cm (1mm) squamous cell carcinoma arising in a background of cis along the left vocal cord; false vocal cord (left) and base of epiglottis = inflammation, no dysplasia
May 2013 supracricoid laryngectomy with partial right arytenoid resection
Low magnification of supracricoid laryngectomy show thyroid cartilage (left), ventricle (V), and extensive squamous cell carcinoma in situ with focal invasion (black box) magnified on next photomicrograph
Intermediate magnification of designated area showing an irregular, invasive nest (black arrows) in the superficial submucosa and a deep keratin pearl (white arrow).
Low magnification of another area of the supracricoid laryngectomy with thyroid cartilage (right),ventricle (V), and a focus of invasive carcinoma arising in obviously atypical mucosa (black box)which is magnified in the next photomicrograph.
Intermediate magnification of boxed area showing infiltrating, irregular nests (black arrows) extending into the superficial submucosa (<0.1 cm depth of invasion).
