Epithelial hyperplastic lesions--a challenging topic in laryngology

Adequate diagnosis, treatment and prognosis of particular pathologic entities of the laryngeal mucosa depend entirely on the histological changes of the epithelium. The basis for the classification of epithelial hyperplastic lesions of the larynx (EHLL) is the progression of the histologic features of these lesions to cancer. Considering various criteria thought to be typical for the transformation of benign EHLL to carcinoma, they are most frequently classified into three different groups. However, difficulties begin with the lack of uniformity and inconsistency of terminology, and the fact that the histomorphological features and biological behavior are not always in accordance. It is emphasized that the surface keratosis in laryngeal pathology has no prognostic significance per se and that the term risky epithelium should replace the expression precancerosis. This term does not predict the evolution of the lesion in any way, and it does not exclude any possible future development; but it warns the laryngologist to exercise extreme caution and to follow the patient closely. Present knowledge of laryngeal cancer, its therapeutic options and consequences, force us to pay increasing attention to early detection and adequate treatment of EHLL.