Laryngology benign neoplasms

Question 1

Laryngeal chondromas arise most commonly from

what anatomical site?

Answer 1

Posterior cricoid plate

Question 2

According to the Myers-Cotton grading system, what grade is a subglottic stenosis with 90% obstruction of the tracheal lumen?

Answer 2

Grade III

Question 3

What is the mechanism of injury for laryngotracheal stenosis caused by endotracheal intubation?

Answer 3

Ischemic necrosis of the mucosa secondary to pressure of the cuff or the tube itself
Healing by secondary intention leads to fibrosis and scar contraction.

Question 4

True or False. Approximately 80% of cartilaginous

tumors of the larynx are chondromas.

Answer 4

False. Chondroma was initially thought to represent
approximately 80% of cartilaginous laryngeal tumors, but
this was later determined to be an overestimation resulting from misdiagnosed low-grade chondrosarcoma. The true number of cartilaginous tumors that are chondromas is much less than 80%.

Question 5

What is the treatment for laryngeal chondromas?

Answer 5

When possible, complete excision to negative margins alone

Question 6

Approximately what percentage of all benign

laryngeal lesions are neurogenic in origin?

Answer 6

0.1 to 1.5%.

Question 7

What are the most common benign neurogenic

laryngeal neoplasms?

Answer 7

Laryngeal schwannoma (most common), neurofibroma, and granular cell neoplasms. Schwannomas and neurofibromas most commonly arise from the internal branch of the superior laryngeal nerve.

Question 8

Where are endolaryngeal neurofibromas most

commonly found?

Answer 8

Arytenoid complex and aryepiglottic fold
Although they can occur in patients with neurofibromatosis
type I (von Recklinhausen disease), isolated laryngeal neurofibromas are more common.

Question 9

Which neurogenic laryngeal neoplasm is often associated with pseudoepitheliomatous hyperplasia of the overlying mucosa, which can often be misdiagnosed as squamous cell carcinoma?

Answer 9

Granular cell neoplasm

Question 10

Because granular cell tumors present a risk for malignant conversion (2 to 3%), they should be
resected. What confirmatory findings for benign tumor should be looked for on pathology?

Answer 10

● Large polyhedral cells that may contain significant
collagen, granular eosinophilic cytoplasm, and centrally
located vesicular nuclei
● (+) periodic acid-Schiff (PAS), (+) S-100, (+) neuron
specific enolase, (+) NK1-C3

Question 11

What is the likely cell of origin for granular cell tumors?

Answer 11

Schwann cell

Question 12

How should benign neurogenic laryngeal neoplasms be managed?

Answer 12

Endoscopic evaluation and biopsy
● Small lesion: complete endoscopic resection
● Large lesion: complete resection via an external approach
These are benign lesions; therefore, conservative complete
excision with voice preservation should be the goal.

Question 13

What is the most common benign neoplasm of

the larynx?

Answer 13

Recurrent respiratory papillomatosis (RRP)

Question 14

Of the most common human papillomavirus (HPV) subtypes causing RRP, which has a more aggressive clinical course?

Answer 14

HPV 11: More frequent surgical intervention and a higher incidence of airway obstruction. HPV subtypes 6 and 11 are the most common in RRP.

Question 15

Does juvenile- or adult-onset RRP tend to have a more aggressive course?

Answer 15

Juvenile RRP tends to be more diffuse, exophytic, and often

recurs rapidly after intervention.

Question 16

What is the standard of care for treatment of symptomatic RRP?

Answer 16

Surgical excision without damaging normal structures

Question 17

Describe the type and structure of the virus

responsible for RRP.

Answer 17

HPV is a papillomovirus of the Papovavirus family, with a nonenveloped icosahedral capsid and a doublestranded
circular DNA genome.

Question 18

What is a laryngeal lymphatic malformation?

Answer 18

● A collection of lymph vessels filled with serous fluid
centered in the larynx
● Rarely confined solely to the larynx

Question 19

How do laryngeal lymphatic malformations

present?

Answer 19

● Asymptomatic versus stridor, dyspnea on exertion, and
respiratory distress
● Worse during infections

Question 20

Laryngoscopy shows a soft, smooth, painless,
compressible mass in the larynx. Imaging shows
fluid filled areas enveloped by connective tissue.
What is the likely diagnosis?

Answer 20

Lymphatic malformation

Question 21

What treatment options are available for laryngeal

lymphatic malformations?

Answer 21

For symptomatic or disfiguring lesions, surgical debulking is
the treatment of choice. Sclerotherapy may be considered
for macrocystic lesions. Up to 50% of patients with
extensive disease of the head and neck will require
tracheostomy.

Question 22

True or False. Both cystic hygromas and cavernous/microcystic lymphangiomas respond well to surgical excision.

Answer 22

False. Cystic hygromas are composed of large cysts that are amenable to surgical excision. Cavernous/microcystic lymphangiomas, however, are composed of very small cysts that are difficult to resect and tend to recur after surgery.

Question 23

Although laryngeal hemangiomas in adults are rare, how do they manifest?

Answer 23

Airway symptoms including bleeding, stridor, dysphonia,

mild dyspnea, dysphagia, and snoring

Question 24

True or False. Laryngeal hemangiomas are more common on the left side of the larynx than on the right.

Answer 24

True

Question 25

How are laryngeal hemangiomas diagnosed, and

what is their natural history?

Answer 25

They are seen on examination covered by thin, friable
mucosa overlying a vascular stroma. T2-weighted MRI can
be helpful to delineate extent. These are most commonly
seen in the supraglottis in adults and generally do not
spontaneously regress.

Question 26

What is the treatment of choice for an asymptomatic laryngeal hemangioma in an otherwise healthy adult patient?

Answer 26

Hemangiomas in adults should not be actively treated

unless they are symptomatic. Corticosteroids or radiotherapy may be considered if necessary.

Question 27

At what age do infantile hemangiomas typically begin to involute, and at what age is involution likely to be complete?

Answer 27

Infantile hemangiomas begin to involute between 12 and 24 months of age; 50% will have involuted by age 5 and 70% by age 7.