CLINICOPATHOLOGICAL STUDY OF NEOPLASTIC LARYNGEAL LESIONS IN A TERTIARY CARE HOSPITAL IN KASHMIR

Background:The larynx is affected by a range of benign and malignant lesions ,on account of its unique position in the upper respiratory tract which makes it vulnerable to many noxious stimuli. This study was undertaken to explore clinicopathological parameters in laryngeal cancers as laryngeal lesions are coming up to be the most common head and neck lesions in Kashmir. Methods :A one and a half year observational study was done(2015-2017).All layngectomies and biopsies received in the department were studied. Results: A total number of 68 neoplastic lesions were studied .The neoplastic lesions showed a peak after 50 years. Squamous cell

Background:The larynx is affected by a range of benign and malignant lesions ,on account of its unique position in the upper respiratory tract which makes it vulnerable to many noxious stimuli. This study was undertaken to explore clinicopathological parameters in laryngeal cancers as laryngeal lesions are coming up to be the most common head and neck lesions in Kashmir. Methods :A one and a half year observational study was done(2015-2017).All layngectomies and biopsies received in the department were studied. Results: A total number of 68 neoplastic lesions were studied .The neoplastic lesions showed a peak after 50 years. Squamous cell carcinoma was present in 23.5% cases and was the commonest neoplastic lesion ,Moderately differentiated squamous cell carcinoma was the commonest differentiation(66.7%) . The most common site of involvement was the Glottis (62.5%) of cases. Out of the 11 laryngectomies, 3 cases showed perineural invasion,5 cases showed lymphovascular invasion . Conclusion:Light microscopy and histopathological examination remains the mainstay and gold standard in diagnosing benign and malignant lesions in larynx.

…………………………………………………………………………………………………….... Introduction:-
The larynx is affected by a range of malignant tumors arising most commonly from the surface epithelium , malignant tumors can also arise from its associated soft tissue bone and cartilage.. The pathological evaluation of the specimen helps in determining the histopathological type of tumor and accordingly staging the tumor. Moreover, noting the lymphovascular, perineural invasion help to assess prognosis in patients. Due to the limited clinicopathological research done on lesions of larynx and with changing trends and the emergence of laryngeal lesions as the most common head and neck tumors in Kashmir. This study will enlighten us on the occurrence and type of laryngeal tumor in our hospital at Government Medical College, Srinagar.
Demographic data in the form of age, sex, site of biopsy or specimen and other clinical information was0 obtained from the pathology requisition form. History of smoking was asked from the patient. Specimens that were received by the Department of Pathology were properly labelled, numbered and fixed in 10% buffered formalin. After a detailed gross examination of the specimens, multiple slices were taken from representative sites and processed. Sections taken from paraffin embedded blocks and stained with H and E.All cases were classified according to WHO histological classification of tumours of the larynx and staged according to TNM classification of larynx. Histopathological prognostic factors such as lymphovascular and perineural invasion, lymph node status were examined.
A one and a half years observational study was done at Department of Pathology, Government medical college Srinagar.(2015-2017)

Results:-
A total number of 68 neoplastic lesions were studied ,which included 56 biopsies and 12 laryngectomies. The neoplastic lesions showed a peak after 50 years. Maximum number of cases were in 60-69 year age group (29.4%) and > 70 year age group (30.9%), followed by, and 50-59 year age group (25%).Table 1. There was a male preponderance with 91.2% males and 8.8% females in the neoplastic lesions. Table     The neoplastic lesions were slightly more common on the right side (48.5%) as compared to left (35.3%). Bilateral involvement was seen in 16.2% of neoplastic lesions.
Out of the 11 laryngectomies for squamous cell carcinoma, 3 cases showed perineural invasion, 5 cases showed lymphovascular invasion, 3 cases showed no lymphovascular or perineural invasion.    (2010) found majority of patients with carcinoma larynx were in 5th to 8th decade with peak incidence in 7th decade in males and 6th decade in females.

Gender
There was male preponderance in our study . Sharma DK et al (2011) 2 also found benign and malignant tumors to be common in males as compared to females. They suggested that vocal strain, occupation and smoking and drinking alcohol in the males may have played a role. Shinde KJ et al (2013) 78 cases (90.69%) were males and 8 cases (9.3%) were females.

Distribution of study patients as per smoking
In the neoplastic group, 94.1% were smokers and 5.9% were non-smokers.Chaitnaya V et al 5 (2015) found that among neoplastic lesions, 50% patients had history of tobacco smoking in the form of cigarette/ beedi. Shinde KJ et al (2013) 4 showed that 66 out of 86 cases of malignancies had a past history of beedi smoking.

Distribution of study patients according to laterality
The neoplastic lesions were slightly more common on the right side (48.5%) as compared to left (35.3%). Kumar JS et al (2015) found a total of 63.3% of patients had carcinoma on the left side of the larynx and 36.6% had carcinoma on the right side, which is in contrast to our study. The predominance on the right side cannot be explained and needs a larger study.

Distribution of study patients according to diagnosis
Squamous cell carcinoma was present in 23.5% cases and was the commonest neoplastic lesion followed by Squamous cell carcinoma in situ (3.4%),which is similar to Chaitanya V et al (2015)

Study of adverse prognostic factors
Out of the 11 laryngectomies done for squamous cell carcinoma, 3 cases showed perineural invasion, 5 cases showed lymphovascular invasion.3 cases showed no lymphovascular or perineural invasion.
Iovanescu GH et al (2013) studied 95 patients and found perineural and vascular invasion in 15 patients, perineual invasion was discovered in two (13.33%), only vascular invasion in five (33.33%) patients and eight(53.33%) patients presented both with perineural and perivascular invasion, which is similar to the current study. They compared these results with relapses and found that cell differentiation degree and vascular invasion as major prognostic factors. Mesolella M et al (2016) studied 40 patients who had undergone laryngectomy and had perineualinvasion,which included 33 males and 7 females and found that perineural invasion is a valuable prognostic factor that correlates with low survival rate in patients with laryngeal malignancies.

Site of involvement of laryngeal malignancies
The present study found glottis as the commonest site of laryngeal cancer followed by supraglottis. This finding is similar to Markou K et al (2013)

Conclusion
To conclude, moderately differentiated squamous cell carcinoma is the commonest laryngeal malignancy affecting predominantly males and smokers . Light microscopy and histopathological examination remains the mainstay and gold standard in diagnosing benign and malignant lesions in larynx and studying the adverse prognostic factors.