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Laryngeal Biopsy or Other Small ENT Biopsy

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IntroductionEdit

  • In general, done for visually identifiable lesion
  • Rarely done blind when searching for squamous cell carcinoma of unknown origin.
  • Most malignant lesions will be squamous cell carcinomas
  • Most benign lesions will be vocal cord polyps and papillomas
  • Other lesions are very rare: sarcoma, lymphoma…

Fresh HandlingEdit

  • Occasionally these specimens will be sent up as “rule out lymphoma”, in which case immediately process for hematopathology before fixing.
  • Fix in formalin.

Grossing InEdit

  • Describe size, number of fragments, color and texture.
  • If polypoid, ink base, bisect and submit to maintain orientation on slide.

SectioningEdit

  • For most ENT biopsies, request three H&E levels.
  • Occasionally, small resections such as partial laryngectomies may get misaccessioned as biopsies. As a rule, a single H&E level suffices for these: the patient already has a diagnosis and the lesion will be present on any given level.
  • Specimens taken as margins as part of a large resection require a single H&E level.

Review and SignoutEdit

The main tasks when reviewing these biopsies are to classify the lesion (usually squamous dysplasia/carcinoma, but need to exclude reactive changes, lymphoid hyperplasia, infection), determine and its severity (grading of dysplasia; in situ or invasive carcinoma).

1. Larynx, subsite, biopsy:


2. Tongue, subsite, biopsy:


3. Oropharynx, subsite, biopsy:

Squamous mucosa, no tumor seen.
Mild squamous dysplasia, no in situ or invasive carcinoma seen.
Squamous cell carcinoma, (non-)keratinizing, (well, moderately, poorly) differentiated, (in situ vs. invasive), in background of squamous dysplasia and squamous carcinoma in situ.



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