Framework invasion by laryngeal carcinoma.

Invasion of the laryngeal framework by cancer implies a tumor that has spread beyond the bounds of the organ of origin, which may affect the outcome of the disease. Framework invasion almost invariably takes place in ossified or calcified cartilage, and the reason for this has never before been adequately explained. The finding of increased density on some computerized tomography scans where the tumor was invading the framework stimulated this study of the mechanisms of this type of spread. One hundred fifty-eight consecutive laryngeal specimens were examined by a serial sectioning method to elucidate this. Several laryngeal specimens were examined for alkaline phosphatase in the tissues, and two specimens were examined for collagenase. A method of tetracycline labeling was used to measure the amount of osteoblastic activity in another two specimens. Framework invasion occurred mainly at the glottic level and exclusively in ossified or calcified cartilage. This type of invasion was associated with osteoblastic activity which appeared to be at least partially mediated by tumor-produced alkaline phosphatase. Osteoclastic activity took place hand-in-hand with the former process, and at this stage, tumor remained outside the perichondrium. Tetracycline labeling confirmed active bone deposition in these areas and appeared to explain the finding of increased ossification seen on computerized tomography scans where early invasion was taking place.