Small biopsies can present diagnostic challenges to the surgical pathologist. The lack of wider architecture can limit interpretation. Small biopsies from the larynx can be divided into two categories: mucosal lesions and submucosal lesions.

Mucosal biopsies range from squamous papillomas to intraepithelial dysplasia to invasive squamous cell carcinoma and variants of squamous cell carcinoma.

Biopsies of submucosal lesions can present two challenges. Not only can the lesion cause overlying epithelial changes, but the limited nature of the specimen can also make diagnosis of the underlying lesion difficult. Submucosal lesions discussed include vocal cord polyps/nodules, amyloidosis, granular cell tumor, rhabdomyoma, neuroendocrine neoplasms, salivary gland tumors, and cartilaginous tumors.

In this paper we discuss the specific entities seen in small biopsies of the larynx as well as the differential diagnosis, immunohistochemical profile (IHC), and any tips to help interpretation.