Carcinoma in Situ and Severe Dysplasia of the Vocal Cords: A Clinic pathological and Photometric Investigation

Abstract

Premalignant lesions of the vocal cords vary in their gross appearance. and diagnosis invariably relies on microscopic examination. This retrospective clinicopath-ological and photometric study of 20 cases of severe dysplasia and carcinoma in situ showed that various degrees of squarnous cell differentiation may he recognized for laryngeal premalignant lesions and that such distinction may be of prognostic significance. Carcinoma in situ is widely accepted as a premalignant lesion. while there has been an uncertainty about the histological criteria and the biological nature of severe dyasplasia. None of the cases of carcinoma in situ of classic type recurred. whereas well differentiated severe dysplasia had a high recurrence rate and development of invasice carcinoma. A classitlcation of severe dysplasia into well and moderately, to poorly differentiated is proposed. Photometric examination proved to be of value in the assessment of nuclear atypia. which was sometinies masked. and especislly in the case of well differentiated lesions. Well differentiated severe dysplasia and lesions in which the nuclear atypia was pronounced—greatly increawd nuclear DNA content and size—were prognostically the most serious with a high rate of recurrence and development of invasive carcinoma. There was no prognostic difference betmeen lesions with gross leukoplakia or erythroplasia. Of 9 patients given radiotherapy. 3 later developed invasive car cinema. as did 2 out of the 11 patients in whom minor-turgical measures were performed. hoth of them with diffuse lesions. Excision or stripping of the vocal cords seems to be the treatment of choice. especially for localized premalignant lesions. All patients with severe dys plasia and carcinoma in situ should he followed up as carefully as those patients treated for invaaive carcinoma.