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Neoplastic infiltration of laryngeal cartilages: histocytochemical study.

The relationship between cartilage and invading neoplastic cells was studied in 32 cases of laryngeal cancer by histological and cytochemical methods. Cartilage invasion was present in 12 cases, 10 of which were in proximity or in contact with areas of calcification and ossification. It was significantly correlated only to tobacco consumption (P less than .05) and, in regard to glottic tumors, to tumor diameter greater than 3 cm (P less than .01). Histologically, neoplastic invasion in cartilage was massive in 2 cases, occurred in areas of ossification in 4, between cartilage and bone in 4, and in epiglottic cartilage in 2. In 3 of the cases with bone invasion, there was also new bone formation. Hyaline cartilage and bone resorption was due to tartrate-resistant acid phosphatase (TRAP)-positive giant cells; in epiglottic cartilage only mononuclear cells were present, some of which were TRAP-positive. These results show that neoplastic cells can promote not only resorption and formation of bone, but also resorption of cartilage, which is considered resistant to neoplastic invasion. The different types of resorbing cells in contact with hyaline cartilage and bone in laryngeal cancer, and elastic cartilage in epiglottic cancer, suggest that the structure of the tissue being resorbed can influence the type of resorbing cells.

Acid Phosphatase↗

Neoplastic invasion of laryngeal cartilage: radiologic diagnosis and therapeutic implications.

Cross-sectional imaging plays an indispensable complementary role to endoscopy in the pretherapeutic workup of laryngeal and hypopharyngeal cancer. Both computed tomography and magnetic resonance imaging are suitable for the detection of neoplastic cartilage invasion. Although MRI, due to its high negative predictive value, is now generally considered to be the most suitable imaging method for pretherapeutic evaluation of cartilage invasion CT continues to be commonly performed in many centers for practical reasons. Recent studies have shown that CT may yield acceptable sensitivity for neoplastic invasion of laryngeal cartilage if the diagnostic criteria are selected and combined appropriately. False positive results are inevitable with both CT and MRI because reactive inflammation may lead to overestimation of neoplastic cartilage invasion.

Arytenoid Cartilage↗

Normal age-related signal change in the laryngeal cartilages.

MRI may be used for detecting cartilage invasion in patients with laryngeal carcinoma. However, the normal laryngeal ossification pattern has not been studied. Our purpose was to examine the normal age-related signal patterns in the cricoid, thyroid and arytenoid cartilages on T1-weighted images. Signal in the cartilages was assessed by two radiologists in a blinded fashion using three-point scales for intensity and symmetry. Statistical analysis consisted of logistic and monotonic regression. There was excellent interobserver agreement (>85%) for all categories. The cartilages predominantly ossify symmetrically and the extent of high signal from all three increases with age. The latter may help in detection of cartilage invasion by tumor in older patients. Normal symmetry may be helpful when comparing sides for tumor invasion.

Adolescent↗

Anatomical routes for cancer invasion of laryngeal cartilages.

The larynx is separated into compartments bounded by connective tissue membranes and cartilages. The membranes and cartilages affect the localization and spread of cancer for a while, but invasion eventually occurs. Histological study of the cartilages in the earliest stages of invasion shows cancer cells growing between the collagen bundles where the connective tissue membranes attach to the cartilages. At these points, the collagen bundles pass obliquely through the perichondrium to anchor into the cartilage and bone like Sharpey's fibers. As the cancer cells multiply, they separate the collagen bundles, forming linear passageways through the perichondrum. This appears to be the mechanism for cartilage invasion. Thus the sites of attachment of the strongest membranes are also the most frequent sites of invasion, i.e., the anterior commissure tendon and the cricothyroid membrane.

Humans↗

Laryngeal carcinoma after radiation therapy: correlation of abnormal MR imaging signal patterns in laryngeal cartilage with the risk of recurrence.

PURPOSE: To correlate abnormal magnetic resonance (MR) imaging signal patterns in cartilage with the effectiveness of radiation treatment. MATERIALS AND METHODS: Eighty previously untreated patients underwent MR imaging and radiation therapy with a curative intent. Cartilage was considered to have an abnormal signal pattern if it had intermediate signal intensity on T1-weighted spin-echo (SE) MR images and high signal intensity on T2-weighted SE MR images. The minimum follow-up was 2 years. RESULTS: Abnormal MR imaging signal patterns of the thyroid cartilage (P < .001; P < .04) were more ominous than those of other cartilage. Abnormal signal patterns in cartilage of patients with small tumors (< 5 cm3 and especially < 1 cm3) were less significant. Abnormal signal patterns in cartilage combined with a large tumor (> 5 cm3) worsened the prognosis significantly (P < .05). CONCLUSION: Abnormal MR imaging signal patterns in cartilage may not indicate a poor prognosis in every case. Abnormal signal intensity in the thyroid cartilage combined with a tumor volume of > 5 cm3, however, appears to indicate an adverse prognosis with regard to tumor recurrence.

Adult↗

Glottic reconstruction by implant of homologous laryngeal cartilages.

This paper describes a case of reconstructive laryngectomy in a patient with epidermoid carcinoma of the glottis. Reconstruction of the skeletal laryngeal architecture was carried out by implanting homologous cartilages, whilst the glottis was reconstructed with sternohyoid muscle. Laryngeal function was restored within 30 days of the operation.

Carcinoma, Squamous Cell↗

Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging.

Forty-two patients with laryngeal carcinomas were examined with computed tomography (CT) and magnetic resonance (MR) imaging. The accuracy of both CT and MR imaging in the depiction of cartilage invasion was evaluated in 16 patients by comparing findings at CT and MR with pathologic findings. Calcified cartilage that has been invaded by cancer is frequently seen on CT scans as having an intact contour. Tumor approaching nonossified cartilage may simulate cartilage invasion. On T1-weighted MR images, invaded marrow of ossified cartilage is of intermediate signal intensity, allowing it to be differentiated from normal bone marrow. On proton-density images, tumor is of increased signal intensity, which allows it to be differentiated from nonossified cartilage. In our experience, the specificities of CT and MR imaging were approximately equal (91% and 88%, respectively), but CT had a considerably lower sensitivity than MR (46% vs. 89%). Gross movement artifacts, which resulted in nondiagnostic images, occurred in 16% of the MR examinations. MR imaging is recommended as the modality of choice in the diagnosis of cartilage invasion.

Aged↗