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Presented by Dr. Lisa Rooper and prepared by Dr. Tatianna Larman.
A 55 year old man with hoarseness, found to have a laryngeal mass.
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Question 1 of 1
1. Question
A 55 year old man with hoarseness, found to have a laryngeal mass. Choose the correct diagnosis.
Correct
Answer: HYBRID CARCINOMA
Histology: The laryngeal mass consists of a exophytic squamous proliferation with prominent finger-like projections and abundant keratin production. Although superficial tumor cells demonstrate bland cytology, deeper areas demonstrate prominent more marked nuclear pleomorphism and disordered maturation. Additionally, at the base of the lesion, there are irregular nests of atypical squamous cells showing downward extension into the underlying stroma.
Discussion: The spectrum of verrucous lesions in the larynx can present a difficult differential diagnosis, especially on superficial biopsies. Both verrucous hyperplasia and verrucous carcinoma should display uniformly bland cytology. While verrucous hyperplasia should not extend deeper than the surrounding normal epithelium, verrucous carcinoma will demonstrate pushing growth into the stroma. However, verrucous carcinoma should not demonstrate overtly infiltrative growth. Hybrid carcinoma has areas that are identical to verrucous carcinoma but harbors other areas of more conventional squamous cell carcinoma with cytologic atypia and frank invasion. It is essential to distinguish these lesions because verrucous carcinomas lack metastatic potential while hybrid carcinomas behave like conventional squamous cell carcinoma.
Incorrect
Answer: HYBRID CARCINOMA
Histology: The laryngeal mass consists of a exophytic squamous proliferation with prominent finger-like projections and abundant keratin production. Although superficial tumor cells demonstrate bland cytology, deeper areas demonstrate prominent more marked nuclear pleomorphism and disordered maturation. Additionally, at the base of the lesion, there are irregular nests of atypical squamous cells showing downward extension into the underlying stroma.
Discussion: The spectrum of verrucous lesions in the larynx can present a difficult differential diagnosis, especially on superficial biopsies. Both verrucous hyperplasia and verrucous carcinoma should display uniformly bland cytology. While verrucous hyperplasia should not extend deeper than the surrounding normal epithelium, verrucous carcinoma will demonstrate pushing growth into the stroma. However, verrucous carcinoma should not demonstrate overtly infiltrative growth. Hybrid carcinoma has areas that are identical to verrucous carcinoma but harbors other areas of more conventional squamous cell carcinoma with cytologic atypia and frank invasion. It is essential to distinguish these lesions because verrucous carcinomas lack metastatic potential while hybrid carcinomas behave like conventional squamous cell carcinoma.
