Mucous-producing elements in the laryngeal mucosa in smokers with cancer of the larynx.

By a periodic acid-Schiff (PAS)-alcian blue, elective staining method, and a whole-mount technique, morphologic and quantitative studies of goblet cells and mucous glands were done of mucosal biopsies from the subglottis, the entrance to the sinus of Morgagni, and the false vocal cords in 60 smokers with cancer of the larynx. In 30 of the patients the mucosal biopsies were taken at the time of diagnosis, and in the other 30 after radiotherapy. In the nonirradiated group of smokers there was an increased goblet cell density in the sinus of Morgagni and in the subglottis compared with that in the same areas of the larynx from nonsmokers, but only of significance in the subglottis. There was a definite tendency to a lower goblet cell density in the irradiated group of smokers and an increased number of goblet cell-free areas because of epithelial metaplasia to stratified squamous epithelium. This finding was significant in the subglottis only. In the nonirradiated as well as in the irradiated smokers there was a common occurrence of subepithelial mucous glands with mild to appreciable degenerative changes. This morphologic difference between smokers and nonsmokers may represent the toxic action of tobacco on the laryngeal mucosa and may thus enter into the pathogenesis of laryngeal cancer.