Localization

Precursor lesions appear mainly along the true vocal cords. Two thirds of vocal cord lesions are bilateral {243}. They can extend over the free edge of the vocal cord to the subglottic surface. An origin in, or extension along the upper surface

Fig. 3.38 Microlaryngoscopic view of laryngeal leukoplakia. Both vocal cords are moderately thickened; an exophytic, well-circumscribed, white plaque is seen in the left vocal cord.

Fig. 3.39 Squamous cell hyperplasia (simple hyper-plasia). There is an increased number of ordinary-arranged, otherwise normal cells in the spinous layer. A keratin layer is present on the surface.

of the vocal cord is less common

Table 3.6 Criteria used for diagnosing dysplasia

Architecture

Cytology

Irregular epithelial stratification

Abnormal variation in nuclear size (anisonucleosis)

Loss of polarity of basal cells

Abnormal variation in nuclear shape (nuclear pleomorphism)

Drop-shaped rete ridges Increased number of mitotic figures

Abnormal superficial mitoses

Abnormal variation in cell size (anisocytosis) Abnormal variation in cell shape (cellular pleomorphism) Increased nuclear-cytoplasmic ratio

Premature keratinization in single cells (dyskeratosis)

Increased nuclear size

Keratin pearls within rete pegs

Atypical mitotic figures

Increased number and size of nucleoli Hyperchromasia

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