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    Most malignancies of the larynx are squamous cell carcinomas. However malignant salivary gland type tumours, malignant melanoma, neuroendocrine tumours and sarcomas may also occur.1,2

    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.

    External Inspection

    Orientate and identify the anatomical features of the specimen. Complex specimens should be examined and orientated together with the responsible surgeon, if possible. Alternatively the surgeon should orientate the specimen with the use of ties or pin the specimen out and label the cork board.3

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:


    Record as stated by the clinician.

    • Incisional biopsy
    • Excisional biopsy
    • Partial resection, specify site
    • Total resection
      • Trans-oral laser resection
      • Laryngectomy
      • Pharyngolaryngectomy

    Neoadjuvant therapy

    • No
    • Yes

    Anatomical components included (more than one may apply) and specimen dimensions (mm)

    Describe and measure the anatomical components present.

    • Larynx, in three dimensions
      • Epiglottic resection margin
      • Hyoid bone
      • Hypopharynx
      • Tracheal resection margin
    • Tracheostomy site, if present
    • Cervical oesophagus
    • Thyroid see thyroid protocol for more detail
    • Extralaryngeal soft tissues and muscle
    • Other, describe and measure according to the relevant tissue protocol.

    Specimen integrity

    • Intact
    • Opened


    Small fragmented specimens may not require dissection and may be transferred whole to cassettes for processing.4 See protocol for small biopsies.

    See Slootweg5 reference for excellent diagrams to assist with complex head and neck specimens.

    Paint the anterior and posterior surgical margins with ink.4 If present, remove the hyoid bone from the ventrocranial surface (retain for later decalcification and sectioning if microscopic examination indicates possible tumour spread to the bone).5

    Section the remainder of the specimen at 3-4mm intervals horizontally.1,5

    Note that it may be better to leave laryngectomy specimens for hypopharyngeal tumours intact as opening posteriorly may disrupt the post-cricoid area and hamper evaluation of the caudal mucosal margin.

    Examine the slices to evaluate the extent of tumour spread.4

    • Sample any areas of possible extralaryngeal spread.5
    • If the specimen contains a tracheostoma, sample to demonstrate the relationship of the tumour to the stoma and sample the stomal skin margins.5
    • Examine the slices to evaluate the extent of tumour spread. Sample the tracheal margin for possible caudal endolaryngeal spread.5
    • Sample the caudal surgical margin for possible submucosal spread. Note that thin mucosal margins may not be sufficient and ensure adequate submucosal tissue is included.5

    Examine the slices to evaluate the extent of tumour spread. Tumours located dorsally may extend into the postcricoid area. Sample the submucosal soft tissues for possible spread.5

    Supraglottic carcinomas should be examined to evaluate the relationship of the tumour with anterior resection margin at the base of the tongue. Sample the margin using sagittal sections.1

    After opening the specimen may require longer fixation in larger quantity of formalin.

    Internal Inspection

    Describe the internal or cut surface appearance including the following items:


    • Absent
    • Present
      • Number; if more than one tumour, designate and describe each tumour separately

    Laryngeal resections for benign disease are dissected and processed in a similar manner to those with malignant conditions.4

    Tumour size (mm)

    • In three dimensions

    Tumour site of involvement

    Record the site of tumour involvement (more than one may apply).


    • Pyriform sinus -right/left/midline
    • Post-cricoid area -right/left/midline
    • Extends into supraglottic area (crosses aryepiglottic fold)


    • Supraglottis
      • Side –Right/Left/Midline
      • False cord
      • Sinus of Morgagni (laryngeal ventricle)
    • Epiglottis
      • Lingual aspect
      • Laryngeal aspect
    • Glottis
      • True vocal cords –left/right
      • Anterior commissure
      • Posterior commissure
    • Subglottis -i.e. involves the true vocal cords with subglottic extension of >10mm or tumours entirely confined to the subglottic area
    • Other, describe


    • No
    • Yes

    Macroscopic involvement of other tissues

    • Laryngeal cartilage, specify numbers involved
    • Extralaryngeal tissues
    • Other (e.g. thyroid gland etc), describe

    Tumour appearance

    • Polypoid/exophytic
    • Endophytic
    • Ulcer
    • Fibrous thickening

    Distance to margins

    • Distance of tumour to closest surgical margin (mm) and specify margin(s)
    • Distance of edge of tumour to tracheostomy site (mm)

    Retrieved from resection specimen

    • Describe site(s)
    • Number retrieved

    Separately submitted

    • For each specimen container, record specimen number and designation
    • Collective size of tissue in three dimensions (mm)
    • Number of grossly identified lymph nodes submitted
    • Maximum diameter of each (mm)

    Neck dissection

    See neck dissection protocol.

    Non-tumour lesion

    • Describe

    Photograph the dissected specimen, if required.

    Note photographs taken, diagrams recorded and markings used for identification.


    Dissect the specimen further and submit sections for processing according to the illustrations provided.

    Submit all sections of tumour for processing. See small biopsy protocol for more detail.

    Submit representative sections of:

    • Tumour, at least one block per 10 mm of maximum dimension, demonstrating:1
    • Relationship with anterior and posterior surgical margins
    • Deepest point of invasion
    • Relationship with surrounding soft tissue
    • Relationship with laryngeal cartilages1,5
    • For hypopharyngeal tumours; relationship with tracheal and caudal margins
    • For glottic tumours; relationship with submucosal soft tissues
    • For supraglottic carcinomas; relationship with cranial and ventral margins at the base of the tongue (using sagittal sections)1
    • Tracheostomy site, if present
    • Non-lesional tissue, one block
    • Thyroid, if present
    • Normal, one block
    • Abnormal, one or more representative sections. See thyroid protocol and Structured Reporting Protocol6 for more detail.
    • If present and suspicious for involvement
      • Bone
      • Cartilage

    Submit all lymph nodes and identify the site of each.

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id
    No. of pieces
    Tumour, all sections  

    As demonstrated in laryngectomy photographs provided

    Cassette id Site No. of pieces
    A Superior aspect of tumour  
    B-O Representative sections of tumour including full slice of tumour and sections demonstrating relationship with surgical margins  
    P Inferior margin  
    Q+ Lymph nodes if present  


    Prof Alfred Lam for his contribution in reviewing and editing this protocol.


    1. Helliwell T and Woolgar J Dataset for histopathology reporting of mucosal malignancies of the larynx, The Royal College of Pathologists, London, 2013.
    2. Lam KY and Yuen AP (1996). Cancer of the larynx in Hong Kong: a clinico-pathological study. Eur J Surg Oncol 22(2):166-170.
    3. Dahlstrom J, Coleman H, Johnson N, Salisbury E, Veness M and Morgan G. Oral structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2012.
    4. Speight P, Jones A, Napier S, Helliwell T. Tissue pathways for head and neck pathology. The Royal College of Pathologists, London, 2014.
    5. Slootweg PJ. Complex head and neck specimens and neck dissections. How to handle them. J Clin Pathol. 2005;58(3):243-8.
    6. Lam A, Chan JKC, Chong G, Dahlstrom J, McNicol AM and Wight G (2011). Thyroid cancer structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW.

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      Larynx 7

      Larynx with supraglottic tumour spreading into the pharynx

      Larynx 8

      Larynx (closed) with left pyriform sinus tumour lying close to the oesophagus, posterior aspect

      Larynx 1

      Laryngectomy anterior aspect

      Larynx 2

      Laryngectomy opened posteriorly

      Larynx 3

      Laryngectomy anterior aspect inked

      Larynx 4

      Laryngectomy posterior aspect inked and suggested lines of dissection

      Larynx 5

      Laryngectomy dissected horizontally from superior to inferior

      Larynx 6

      Laryngectomy suggested blocks

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