Missed opportunity for larynx preservation? Failure to distinguish verrucous and squamous cell carcinoma on microlaryngoscopy and biopsy.

The current standard for stage III and selected stage IV squamous cell carcinoma of the larynx includes organ sparing concurrent chemoradiation therapy. Verrucous carcinoma is predominantly treated with surgery, including laryngectomy in selected cases. Expert and appropriate pathologic interpretation of verrucous carcinoma with an ample biopsy specimen of the larynx using microlaryngoscopy can differ from the final pathology (squamous cell carcinoma) in a laryngectomy specimen. This can potentially lead to a failed opportunity for larynx preservation. A 68-year-old African-American male presented with a chief complaint of airway obstruction from a massive obstructing laryngeal tumor. This patient was initially treated with operative microlaryngoscopy and debulking of the laryngeal neoplasm. Computed tomography scan was not interpreted for cartilaginous invasion. Final pathological interpretation of this microlaryngoscopy and biopsy specimen included an "outside the institution" expert second opinion and that interpretation was consistent with verrucous carcinoma. Multidisciplinary head and neck oncology team recommendation was total laryngectomy. Final pathology report of the laryngectomy specimen revealed squamous cell carcinoma with extension through cartilage and anterior soft tissue extension. Expert and appropriate interpretation of an ample biopsy specimen by microlaryngoscopy can result in failure to distinguish verrucous from squamous cell carcinoma, potentially leading to missed opportunities for larynx preservation. In this case, cartilage invasion of a massive larynx squamous cell carcinoma made laryngectomy a reasonable therapeutic option.