Sulcus vocalis in laryngeal cancer: A histopathologic study

Abstract

The incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole-mount coronal serial-sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded. A control group of 20 larynges, obtained from autopsies of patients without known laryngeal pathology, were similarly processed, and whole-mount histologic sections were studied. Four of these specimens (20%) also demonstrated sulcus deformities. In the control group, the shape and location of the sulci were similar, but the lesions were smaller than in the cancer group. The sulcus lesions revealed chronic inflammation of the subepithelial tissues with vascular ingrowth and fibrosis of the superficial lamina propria (Reinke's space); in the cancer group the sulcus was usually on the opposite vocal fold, where irritation from the tumor might be anticipated. Although the etiology of the sulci remains controversial, these findings suggest that irritation and inflammation might play a role in the pathogenesis of sulcus vocalis.

Sulcus configurations of vocal folds during phonation

“…On the other hand, the acquired theory was proposed by Van Caneghem [14], who suggested that sulcus could be induced by trauma or infection such as tuberculosis laryngitis. Nakayama et al [15] have also reported that sulcus could be caused by irritation or inflammation, and vocal fold deformity has also been reported in 48% of laryngeal cancer specimens.…”

Sulcus Vocalis (Type III): Prevalence and Strobovideolaryngoscopy Characteristics

“…Rates range from 0% to 9% with the majority of these data coming from cadaver studies. 3,5,[7][8][9][10] In a group of 1200 postmortem larynges, Shin 7 discovered an incidence of only 0.4%. Another autopsy study by Ishii et al 9 found a sulcus incidence of 2.5% in 200 larynges.…”

A clinical classification and histopathological study of sulcus vocalis

“…An acquired theory was developed by Shin [8], who found that sulcus vocalis in adult patients was associated with traumatic or infectious factors. Nakayama et al [7] found a 48% incidence of sulcus vocalis in surgical specimens of patients with laryngeal cancer, suggesting that irritation and inflammation play a significant role in the pathogensis.…”

“…To evaluate the morphological feature of sulcus in specimens we classified the sulcus into three groups based on the classifications of Ford et al [4] and Nakayama et al [7]. Type I was a physiological sulcus, which was a sulcus confined to the superficial layer of lamina propria (Reinke's space).…”

“…Nakayama et al [7] conducted a study of sulcus vocalis in laryngeal cancer using 20 control and 58 whole-mount coronal serially sectioned laryngeal specimens. They found 20% of the control specimens with sulci and 48% in the laryngeal cancer patients.…”