Determine the type of laryngectomy procedure performed:
Total laryngectomy: entire larynx and one or more tracheal rings
Partial laryngectomy: must specify which type
Hemilaryngectomy: left or right half of larynx including thyroid cartilage, false cord, ventricle, and true vocal cord
Supraglottic laryngectomy: part of larynx superior to the true vocal cord (transection through the ventricles)
Supracricoid laryngectomy: part of larynx from the cricoids cartilage to the hyoid bone, with sparing of at least one of the arytenoids cartilages
Measure the overall specimen and the individual components (three dimensions), including the thyroid gland, parathyroid glands, tracheostomy, base of tongue, and neck dissection soft tissue.
Remove the radical neck dissection tissue, if present, and set aside, retaining its orientation. Process according to Radical Neck Dissection.
Ink the resection margins (trachea, mucosa, base of tongue, other soft tissue).
Open the larynx by cutting through the posterior midline (if applicable). Pin to a board or insert a small wooden stick (a swab handle works well) horizontally, avoiding the tumor, to hold it open. Note the color of the unfixed tumor. Count the number of tracheal rings.
Take photographs. Submerge in formalin overnight.
Measure and describe the tumor (exophytic vs. endophytic, ulceration, borders). Determine the location of the tumor (supraglottic, glottic, subglottic, transglottic) and measure any subglottic extension, beginning at the superior edge of the true vocal cord, if applicable. Measure the distances to the resection margins.
Laterality: left, right, bilateral (note whether the tumor crosses the midline and, if so, which side has the greater involvement).
Subglottis: beginning 1 cm inferior to the apex of the ventricle and ending at the inferior margin of the cricoid cartilage.
Examine the uninvolved mucosa (color, ulceration, plaques, other lesions).
Section the whole specimen longitudinally in parallel slices, unless extremely large or cartilage is heavily calcified, in which case you should focus on the portion containing the tumor. Consecutively number the slices in the order in which you plan to submit them.
Measure the maximum depth of invasion, and determine which structures are involved/invaded by tumor: epiglottis (suprahyoid, infrahyoid), epiglottic cartilage, hyoid bone, aryepiglottic folds, false cords, ventricles, pyriform sinus, pre-epiglottic space, pre-epiglottic folds, thyroid-hyoid membrane, true vocal cords, anterior commissure, posterior commissure, cricothyroid membrane, arytenoid/thyroid/cricoid cartilage, thyroid gland.
Tumor: submit entirely in longitudinal strips. If extremely large, submit representative sections, including area of maximal depth of invasion and all adjacent structures (involved or uninvolved). Submit sections in sequential order from left to right (or similarly). Decalcify cartilage sections if necessary.
Uninvolved larynx: representative longitudinal strips, including epiglottis, aryepiglottic folds, anterior and posterior commissures, false cords/ventricles/true vocal cords, if not included with tumor sections.
Resection margins: submit entirely, unless extremely large specimen or previously submitted for frozen section. Discuss with the pathology attending the best way to submit margins for each case. The following general rules apply:
Trachea: en face margin.
Mucosa: en face margins unless involved or close to tumor, in which case submitted in longitudinal strips with tumor sections.
Base of tongue and soft tissue (not including thyroid gland margins unless grossly involved): perpendicular margins.
Hyoid bone: one section closest to tumor.
Thyroid: two sections (one right and one left) if uninvolved by tumor.
Parathyroid(s): entirely submit.
Tracheostomy: one section.
Lymph nodes: entirely submit. If a node is large and obviously replaced by tumor, submit two or three representative sections from areas with the greatest degree of suspected extranodal extension (seeLymph Nodes: Radical Neck Dissection).
Received without fixative/in formalin, labeled _____ and " _____ “, is a total/hemi /supraglottic/supracricoid laryngectomy specimen measuring __ x __ x __cm overall, with attached attached __ x __ x __cm hyoid bone and __ x __ x __ cm left/right/total thyroid lobe/gland. A __ x __ cm tracheal stoma is __ cm from the distal margin anteriorly. There is a _____ (color, shape, ulceration) supraglottic/glottic/transglottic/subglottic mass, __ x __ cm in surface area and __ cm in elevation, involving the left/right _____ and _____. It does/does not cross the midline, focally/extensively involving the left/right _____. The left/right aryepiglottic fold/arytenoid mucosal margin is __ cm from the mass. __ (#) of a total __ (#) tracheal rings are involved by the mass. The mass is __ cm from the distal (tracheal) margin. The mass appears _____ (restricted to the mucosa, focally/extensively invasive) and infiltrates _____ (thyroid cartilage, anterior soft tissues, left/right thyroid). The _____, _____, and _____ are not involved by the mass. There is a __ x __ cm _____ (color, ulcer, plaque) involving the mucosa of the _____, distinct from/adjacent to the tumor. The thyroid gland has a _____ (color, consistency) cut surface. One left/right superior/inferior _____ (color) parathyroid gland measuring __ x __ x __ cm is identified. The tracheal stoma is involved/uninvolved by tumor. Resection margins are inked as follows: tracheal margin = ___ (color), left/right mucosal margins = ___ (color), left/right base of tongue margin = ___ (color), left/right anterior/lateral/posterior soft tissue margins = ___ (color).
#__ = tracheal margin, en face; 1 piece in each.
#__ = left aryepiglottic folds mucosal margins, en face; __ pieces.
#__ = right aryepiglottic folds mucosal margins, en face; __ pieces.
#__ = left arytenoid mucosal margins, en face; __ pieces.
#__ & #__ = right arytenoid mucosal margins, en face; __ pieces.
#__ = epiglottis with ulcerated mucosa; __ pieces.
#__ - #__ = entire mass from left to right, including soft tissue perpendicular margins:
#__ & #__ = slice 1, superior and inferior; 1 piece in each.
#__ & #__ = slice 2 left cords and ventricle, superior and inferior; 1 piece in each.
#__ - #__ = slice 3 left cords and ventricle (__M for decal), superior, inferior mucosal, and inferior deep; 1 piece in each.
#__ & #__ = slice 4 midline, superior and inferior; 1 piece in each.
#__ & #__ = slice 5 right cords and ventricle, superior and inferior; 1 piece in each.