The Pathological And Clinical Features Analysis Of Laryngeal Nonsquamous Cell Malignant Carcinoma

Laryngeal carcinoma is one of the frequent malignantneoplasms in the head and neck. The commen pathological type issquamous cell carcinoma(SCC) whose proportion is over 98%.Thenonsquamous cell carcinoma (NSCC) in the larynx is relatively rare,including such pathological types as malignant fibrohistiocytoma,fibroma sarcomatosum, hemopoietic tissue carcinoma inlarynx(malignant lymphoma and extramedullary plasmacytoma),small cell carcinoma, malignant changed extramedullaryplasmacytoma, verrucous carcinoma and so on. Every pathologicaltype is different from the squamous cell carcinoma . The reasonswhy the morbidity of NSCC has the increased tendency are following:one is that the above-mentioned information is well known bythe doctors because of the extensive application of theimmunohistochemistry technique and the advanced research of theultramicro-structure;the other reason is the clinical doctors areenhancing their cognition for these diseases. As for NSCC , becauseof its insidious onset and earlier clinical manifestation lacking ofspecificity, it is easily to be ignored by the doctors and the patients. Itis difficult to diagnose NSCC in the earlier period. It is possibleno positive results through repeated biopsies , so it is easy to bemisdiagnosed and missed diagnosed .We selected 19 cases of NSCC as the research objectsand 20 cases of SCC in the random from the homeochronous897 cases of laryngeal SCC as the control group in No2 hospitalof JILIN university from January,1996 to January,2006. Wedesigned 19 cases of SCC as A group and 20 cases of NSCC asB group.At first, we cut sheet from the filed paraffin blocks of the 19cases of NSCC and observed their pathologic characteristic afterHE staining and definited the tissue resource of different pathologictypes by immunohistochemistry. We summarized morphologicalfeatures of NSCC, typical pathologic changes andimmunohistochemistry phenotype features by microscope observing.We also contrasted the morbidity conditions , clinical manifestation,clinical stage ,treatment process , lymph node metastasis in theneck of the two groups and studied above-mentioned factors andprognosis correlation by statistics method. At last , we analyzedclinical and pathologic misdiagnosis cases . The consequences are asfollowing:By contrasting the document of two groups ,we can find thesignificant difference(p <0.05) in the following aspects : constituentratio in age , tumorous appearance and primary position of thecarcinoma .There are not significant difference(p>0.05)in sex ,TNMclinical stage and lymph node metastasis in the neck. The complaintof the pharyngeal portion and swallowing pain are the twopredominant symptoms in NSCC , while hoarse voice is thepredominant symptom in the SCC .The typical pathologic changes and immunohistochemistryphenotype features of NSCC through microscope observing are asfollowing : malignant fibrohistiocytoma(MFH) is composed offibroblasta and tissue cell;fibroma sarcomatosum is composed offibroblast;malignant lymphoma is composed of malignant changedlymphocytets;extramedullary plasmacytoma is composed ofplasma cell carcinoma cells;small cell carcinoma is composed of oatscells and small circle cells. At the surface of verrucous carcinoma arehyperplastic squamous cells which are good differentiation types;malignant changed extramedullary plasmacytoma: its epithelial cell islike glandular tube. Cell immunohistochemistry phenotypes areas following: MFH: CK (-), vimentin (+) and AACT ( α-1-Antichymotrysin) (+), which is located in the carcinoma cellcytoplasm;EMA (+) and CK(+)are located in the cytoplasm of smallcell carcinoma. CK(+)is located in the cytoplasm of malignantchanged extramedullary plasmacytoma.The treatment conditions of the two groups are as following: thetherapy method of the NSCC are divided into follwing types :operation, operation plus radiotherapy , radiotherapy pluschemotherapy, chemotherapy and combined therapy radiotherapy,chemotherapy. The primary therapy method of the SCC isoperation ,while radiotherapy after operation is the subsidiarymethod . The patients in two groups all have the phonatory capabilityafter operation.The rate of uprooting the tracheary canula are 56.2%(9/16)and 73.7%(14/19)respectively. We can not find thesignificant difference(p >0.05).We can draw an conclusion from the foregoing research : themutual characteristics are as following : ① the onset condition : Themorbidity age of NSCC is under 50 years old;②the supraglotticregion is the primary morbidity location and the morbidity of hoarsevoice is lower than SCC's. Mucous membrane of the carcinomasurface is lubricous and nodulous appearance is the primaryform . Lymph node metastasis in the neck rarely happen and theminority pathological types have the recidivation tendency;③ Itis difficult to make the correct clinical and pathologicaldiagnosis.Cell immunohistochemistry staining can help to makeright diagnosis;④It is suitable to choose combined therapy to treatNSCC .NSCC in the larynx is relatively rare. Because its earlier clinicalmanifestation is lack of specificity, it is easily to be misdiagnosis andmissed diagnosis. There are 3 cases of pathological misdiagnosiscases in 19 cases of NSCC. We can find following reasons throughanalyzing 4 misdiagnosis cases : ① The onset of NSCC is insidiousand its earlier clinical manifestation is lack of specificity;② Methodof biopsy is not proper and materials are not disposedexactly.③Technologists are negligent when they observe pathologicalcut sheet by microscope. In order to decrease the rate of misdiagnosis ,we should integrate laryngeal CT or MRI .It is essential to performbiopsy in the deep position through the direct laryngoscope andperforming laryngofissure, which can draw a correct conclusion toguide the clinical treatment .