Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Hypopharynx, Larynx, Trachea and Parapharyngeal Space

Abstract

In this article, we review the chapter on tumors of the larynx, hypopharynx, trachea and parapharyngeal space in the new edition of the WHO book, focusing on the new developments in comparison to the previous edition. Squamous cell carcinoma (SCC) and its variants are by far the most common malignancies at these locations, with very limited new insights. The most important is the introduction of new targeted treatment-checkpoint inhibitors, with a new task for pathologists, who may help to predict the response to treatment by analyzing the expression of targeted proteins in biopsy samples. Precancerous lesions remain a controversial topic and, similarly to other organs, it is acceptable to use the terms "dysplasia" or "squamous intraepithelial lesion" (SIL), but there is a slight difference between low-grade dysplasia and low-grade SIL: in the former, mild atypia must be present, while the latter also includes hyperplastic epithelium without atypia. Two approaches have been proposed: a two-tiered system with low- and high-grade dysplasia/SIL and a three-tiered system with an additional category, carcinoma in situ. We are still searching for reliable diagnostic markers to surpass the subjectivity in biopsy diagnosis, with a few potential candidate markers on the horizon, e.g., stem cell markers. Other tumors are rare at these locations, e.g., hematolymphoid, neuroendocrine and salivary gland neoplasms, and are no longer included in Chapter 3. They must be diagnosed according to criteria described in specific chapters. The same holds true for soft tissue tumors, with the exception of cartilaginous neoplasms, which are still included in Chapter 3.

Keywords: Hypopharynx; Larynx; Precancerosis; Trachea; Tumors; WHO.

Fig. 1

a Low grade dysplasia: hyperplastic epithelium with increased basal type cells, with very mild atypia, occupying lower half of epithelium. b High grade dysplasia: hyperplastic epithelium with increased atypical basal type cells, occupying almost entire thickness of epithelium, with preserved polarity. c Carcinoma in situ: parakeratotic, hyperplastic epithelium, with pronounced architectural and cellular abnormalities, with severe nuclear and cellular atypias, occupying the entire epithelial thickness

Fig. 2

a Laryngeal dysplasia: transition from low-grade to high-grade dysplasia. b NANOG immunohistochemistry: weak expression in low-grade dysplasia, and strong expression in high-grade dysplasia

Fig. 3

PD-L1 immunohistochemistry in squamous cell carcinoma of the larynx. a Strong diffuse expression in tumor cells and in some immune cells. b Focal expression in tumor cells and in some immune cells