Histopathological study of cancer of the piriform sinus by whole-organ serial sectioning.
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概要
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Hypopharyngeal cancer is one of the most dreaded and distressing diseases in the head and neck region with respect to the aggressive treatment modalities employed and its poor prognosis. It is significant for obtaining a better prognosis to estimate histopathologically the modes of growth and spread of this tumor. Twenty surgical specimens removed for piriform sinus cancer were studied histopathologically by whole-organ serial sectioning.1) The modes of extension of tumor to the laryngeal cartilages were classified into two groups, contact and invasion. Invasion of the cartilage occurred in the ossified parts.2) The tumor frequently extended laterally outside the thyroid ala with invasion of the thyroid cartilage (25%) or around the thyroid cartilage without invasion (40%). Therefore, the thyroid cartilage did not seem to be a barrier against lateral extension of cancer.3) When tumor extended medially to invade laryngeal structures, vocal cord fixation occurred in 70%. Vocal cord fixation was due mainly to involvement of the intrinsic laryngeal muscles and not to involvement of the arytenoid cartilage or the cricoarytenoid joint.4) Upward growth was usually extensive because of the lack of any barrier. Invasion of the false vocal cord occurred by the direct retrograde submucosal route beyond the aryepiglottic fold.5) Downward extension was relatively slight compared to upward extension.6) A satisfactory margin of normal pharyngeal mucosa must be removed with the specimen at the time of operation. In piriform sinus cancer at least 2cm is thought to be necessary, in view of the submucosal extension.
- 耳鼻咽喉科臨床学会の論文