Laryngology benign neoplasms Flashcards
Laryngeal chondromas arise most commonly from
what anatomical site?
Posterior cricoid plate
According to the Myers-Cotton grading system, what grade is a subglottic stenosis with 90% obstruction of the tracheal lumen?
Grade III
What is the mechanism of injury for laryngotracheal stenosis caused by endotracheal intubation?
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.
True or False. Approximately 80% of cartilaginous
tumors of the larynx are chondromas.
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%.
What is the treatment for laryngeal chondromas?
When possible, complete excision to negative margins alone
Approximately what percentage of all benign
laryngeal lesions are neurogenic in origin?
0.1 to 1.5%.
What are the most common benign neurogenic
laryngeal neoplasms?
Laryngeal schwannoma (most common), neurofibroma, and granular cell neoplasms. Schwannomas and neurofibromas most commonly arise from the internal branch of the superior laryngeal nerve.
Where are endolaryngeal neurofibromas most
commonly found?
Arytenoid complex and aryepiglottic fold
Although they can occur in patients with neurofibromatosis
type I (von Recklinhausen disease), isolated laryngeal neurofibromas are more common.
Which neurogenic laryngeal neoplasm is often associated with pseudoepitheliomatous hyperplasia of the overlying mucosa, which can often be misdiagnosed as squamous cell carcinoma?
Granular cell neoplasm
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?
● 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
What is the likely cell of origin for granular cell tumors?
Schwann cell
How should benign neurogenic laryngeal neoplasms be managed?
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.
What is the most common benign neoplasm of
the larynx?
Recurrent respiratory papillomatosis (RRP)
Of the most common human papillomavirus (HPV) subtypes causing RRP, which has a more aggressive clinical course?
HPV 11: More frequent surgical intervention and a higher incidence of airway obstruction. HPV subtypes 6 and 11 are the most common in RRP.
Does juvenile- or adult-onset RRP tend to have a more aggressive course?
Juvenile RRP tends to be more diffuse, exophytic, and often
recurs rapidly after intervention.
What is the standard of care for treatment of symptomatic RRP?
Surgical excision without damaging normal structures
Describe the type and structure of the virus
responsible for RRP.
HPV is a papillomovirus of the Papovavirus family, with a nonenveloped icosahedral capsid and a doublestranded
circular DNA genome.
What is a laryngeal lymphatic malformation?
● A collection of lymph vessels filled with serous fluid
centered in the larynx
● Rarely confined solely to the larynx
How do laryngeal lymphatic malformations
present?
● Asymptomatic versus stridor, dyspnea on exertion, and
respiratory distress
● Worse during infections
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?
Lymphatic malformation
What treatment options are available for laryngeal
lymphatic malformations?
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.
True or False. Both cystic hygromas and cavernous/microcystic lymphangiomas respond well to surgical excision.
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.
Although laryngeal hemangiomas in adults are rare, how do they manifest?
Airway symptoms including bleeding, stridor, dysphonia,
mild dyspnea, dysphagia, and snoring
True or False. Laryngeal hemangiomas are more common on the left side of the larynx than on the right.
True
How are laryngeal hemangiomas diagnosed, and
what is their natural history?
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.
What is the treatment of choice for an asymptomatic laryngeal hemangioma in an otherwise healthy adult patient?
Hemangiomas in adults should not be actively treated
unless they are symptomatic. Corticosteroids or radiotherapy may be considered if necessary.
At what age do infantile hemangiomas typically begin to involute, and at what age is involution likely to be complete?
Infantile hemangiomas begin to involute between 12 and 24 months of age; 50% will have involuted by age 5 and 70% by age 7.
