Carcinoma of Pyriform Fossa Model – Erler Zimmer

Carcinoma of Pyriform Fossa - Erler Zimmer

Clinical History

A 60-year-old male presented with a 6-week history of globus (feeling a lump in the throat) and dysphonia, accompanied by enlarged cervical lymph nodes. Subsequent investigations revealed a laryngeal tumor, leading to a laryngectomy and cervical lymph node dissection. Fortunately, the patient made a full recovery.

Pathology

The specimen, viewed from behind, represents the amputated larynx displaying an irregular fungating tumor arising from the left pyriform fossa. Distortion and edema of the laryngeal tissues are evident. Histologically, the tumor was identified as a squamous cell carcinoma (SCC).

Further Information

Over 95% of laryngeal cancers are SCC, typically originating on the vocal cords but potentially occurring in various laryngeal regions. The cancer usually begins as carcinoma in situ, progressing to ulcerated, fungating invasive carcinoma with ongoing exposure to carcinogens.
The primary risk factors for laryngeal cancer are tobacco smoke and alcohol consumption. Additional factors include Human Papilloma Virus (HPV) infection, asbestos exposure, and irradiation, with a higher incidence in males, most frequently presenting in the 6th decade of life. Laryngeal cancer may spread by invading surrounding structures, via lymphatics (usually to local cervical nodes), or hematogenous metastasis (commonly to the lungs). Common symptoms include dysphonia, dysphagia, odynophagia, globus, and cough. Less commonly, haemoptysis, stridor, dyspnea, and halitosis may be present. Treatment varies based on the disease stage, with smoking and alcohol cessation crucial at all stages.

Early-stage treatments may involve laryngeal preservation methods like laser therapy, microsurgery, and radiotherapy. Later-stage disease treatments may include a combination of laryngectomy, radiotherapy, and chemotherapy. HPV-related HNSCC has better outcomes than non-HPV positive tumors. HPV vaccination programs have been introduced in various countries, including Australia and the UK, aiming to reduce the risk of HNSCC in both boys and girls.