22628              SQUAMOUS CARCINOMA OF EPIGLOTTIS

This patient was a man aged 64 who had smoked 30 cigarettes/day for 40 years.  For the last 3 months there had been a productive cough with mucoid sputum.  This was followed by pain in the left side of the chest, breathlessness, and a small haemoptysis.  X-ray showed a shadow in the left upper lobe.  On examination the left upper lobe was consolidated and there was a left pleural effusion.  The sputum and pleural aspirate were positive for malignant cells.  Surgery and radiotherapy were felt to he contra-indicated and he was treated by repeated aspiration of the pleural fluid and instillation of nitrogen mustard.  He died after 4 weeks in hospital.  At postmortem massive right bronchogenic carcinoma was found spreading to the supraclavicular nodes, mediastinal nodes, the liver and the right adrenal.  In addition a tumour was found in the posterior surface of the epiglottis.

The specimen is of the base of the tongue, the larynx, and upper trachea opened from behind to display a nodular fungating carcinoma 2 cms in diameter arising from the body of the epiglottis and projecting posteriorly over the entrance to the larynx.  Inferiorly the tumour extends downwards to within half a centimetre of the left false vocal cord.  Histology shows a well differentiated squamous-cell carcinoma.