Benign Neoplasms of the Larynx

Laryngeal schwannoma: A case report and literature review

Laryngeal schwannomas are rare benign neurogenic tumors of the larynx. They cannot be detected in the early stages because disease onset is asymptomatic. This case of laryngeal schwannoma provided a reference for clinical diagnosis and treatment strategy. A 24-year-old man presented with a 3-year history of hoarseness and sore throat for 6 months. Laryngoscopy and computed tomography showed submucosal bulging of the right ventricular fold in the right paraglottic space. The patient underwent tracheotomy first, followed by laryngotomy. The edema of the laryngeal mucosa was significantly alleviated, with normal movement of the bilateral vocal cords on the 10th day after surgery. The tracheal tube was removed at the time of discharge. The hoarseness had disappeared at the end of the first month after surgery. The effective treatment of laryngeal schwannoma involves complete resection with surgery while protecting the integrity of the larynx and restoring laryngeal function. The indication for surgery should be strictly controlled to avoid damage to the mucosa and structures of the larynx.

Laryngeal schwannoma masquerading as malignancy

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.

Laryngeal Schwannoma Triggered Life-threatening Acute Airway Obstruction- A Rare Case Report with Review of Literature

Schwannoma in larynx is a rare presentaion. Laryngeal schwannomas are characterstically slow growing benign tumour usually arising from false cord and aryepiglottic fold with globus sensation being the most common presentation. Seldom it can present as stridor which need immediate intervention for survival of the patient. We present a case of 53 year female who presented with stridor at emergency and emergency tracheostomy was done. This patient had a history of dysphagia to solid food, hoarseness of voice and symptoms of aspirations. 70 degree rigid endoscopy and CEMRI of neck was performed to see the extent of the laryngeal lesion causing stridor. Tumor was excised completely by external transcervical approach. Histopathological reports suggested this tumor as schwannoma. Large obstructive laryngeal schwannoma though a unusual presentation but with immediate tracheostomy, proper diagnostic work up and precise surgical approach can give excellent recovery and post operative outcome for the patient.

Glottic Neurofibroma: An Unusual Case Report

Solitary neurofibromas of the larynx occur sporadically and usually tend to involve the aryepiglottic folds. Non-plexiform variants of neurofibromas involving the glottis are extremely rare and may have defined margins versus plexiform subtype which are often unencapsulated and associated with Von Recklinghausen's disease. We report an unusual case of isolated glottic neurofibroma in an elderly male with gradually progressive hoarseness of voice with stroboscopy findings of a right unilateral, bulky subepithelial lesion mimicking a vocal fold cyst. He underwent laser-assisted trans-oral microlaryngeal surgery and excision of lesion in-toto by micro-flap technique following which histopathological examination reported a neurofibromatous lesion. On performing immunohistochemistry the S-100 protein was positive which confirmed the diagnosis. The patient has been recommended regular follow-up to watch for recurrence.

Laryngeal Lipoma: An Uncommon Localization, Case Report and Literature Review

Lipomas are common mesenchymal begin tumors, the head and neck localization accounts for less than 15% of the body lipomas and the laryngeal locating accounting for 0.6%. Laryngeal lipoma can be isolated and intrinsic, submucosal or even pedicled endoluminal mass. Symptoms of the laryngeal localization of this benign tumor is logically determined by its size and location. Surgical excision remains the key treatment as this tumor characterized by its high rates of local recurrence. We thus report a rare localization of this benign tumor in 76-year-old patient admitted to the emergency room for an acute laryngeal dyspnea.

Paraglottic space schwannoma: a case report and literature review

Neurogenic tumors located in the larynx are extremely rare. Among them, schwannoma is a benign encapsulated tumor originating from Schwann cells, which form nerve fiber sheaths in the peripheral nervous system. We herein report a case of a schwannoma arising from a rare subsite of the larynx and review the literature on laryngeal schwannoma. The case involved a woman with a 1-month history of globus pharyngeus and dysphagia without dysphonia. Rigid laryngoscopy and magnetic resonance imaging showed a large submucosal bulge toward the medial wall of the right pyriform fossa, pushing the right false and true vocal cords and aryepiglottic fold inward. A transcervical approach was used to completely excise the tumor without incisional biopsy or preliminary tracheotomy. Histology confirmed a benign schwannoma originating from the right paraglottic space, which was extremely rare. During follow-up, no evidence of recurrence or a residual mass was found. The transcervical approach is a useful and less invasive treatment for laryngeal schwannoma located in the paraglottic space.

Laryngeal Manifestation of Nodular Fasciitis: A Case Report and Literature Review

Nodular fasciitis (NF) are non-neoplastic, fibroblastic lesions, typically located on the trunk and the extremities. The incidence of NF in the head and neck region is 13%-20%. However, a manifestation in the larynx of adult patients is extremely rare. Therefore, the occurrence of NF in this region can lead to diagnostic challenges and a high risk of misdiagnosis as well as potential mishandling when not aware of its possible laryngeal manifestation. Following emergency admission of a 41-year-old woman to the emergency department (ED) due to progressive dyspnea and inspiratory stridor a transnasal flexible laryngeal endoscopic examination revealed a left-lateral, subglottic mass. A subsequently performed CT demonstrated a 2.2 cm x 1.5 cm sized lesion of the subglottic larynx with profound stenosis of the lumen (Myer-Cotton grade III), no extraluminal extension, and no distant metastases. Histopathological processing of a tissue sample obtained by microlaryngoscopy and translaryngeal tracheoscopy revealed a spindle-cell lesion with immunohistochemical and molecular-pathogenic profile of NF. After tumor debulking and steroid infiltration (triamcinolone), a regrowth tendency quickly became apparent, which is why a tracheostomy had to be performed. Laryngectomy was rejected by the patient. After multiple transoral tumor reduction attempts, radiotherapy was performed according to an interdisciplinary tumor board decision to limit regrowth tendency. Subsequently, a substantial reduction of the tumor volume could be seen, although a discreet stenosis of the subglottic tracheal lumen persists in the follow-up. Laryngeal NF poses several challenges due to its rare occurrence in this location. This case report emphasizes the knowledge of this differential diagnosis and also depicts an interdisciplinary therapeutic approach aiming for function-preserving treatment of this benign but potentially relapsing pathology.

Solitary neurofibroma of the larynx: a diagnostic challenge

Solitary neurofibromas of the larynx are extremely rare, with a total of 15 cases described in the literature. Nonetheless, acquaintance with this diagnosis is important, as misdiagnoses can have negative consequences. Presenting symptoms are non-specific and depend on tumour size and location. As well-defined submucosal masses with a broad differential diagnosis, they remain a clinical and radiological challenge. While some characteristics might favour a benign nature and subtle signs might help narrow the differential diagnosis, imaging alone is not sufficient for differentiation and definitive diagnosis requires a biopsy. Complete surgical resection and long-term follow-up is indicated. We share our experience on a case of a solitary laryngeal neurofibroma in a middle-aged woman, presenting with a large well-defined paraglottic lesion.

Partial laryngectomy and reconstruction with rotation of the epiglottis in the treatment of a rare laryngeal schwannoma: a case report

Background

Neurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up.

Case presentation

A 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma.

Conclusion

The definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.

Transoral robotic surgery for oncocytic ductal cyst of hypopharynx: a lesion with a high probability of recurrence

Hypopharyngeal cysts are very uncommon pathology. They are presented in adult people over 60 years. Although oncocytic cysts are benign tumors, an incomplete resection causes recurrence. The symptoms are not specific, but the more frequent are dyspnea and foreign body sensation upon swallowing. Diagnosis usually is under general anesthesia during intubation. A flexible fiberoptic laryngoscopy could be insufficient; the trumpet maneuver during this examination can reveled occult cysts. To perform a total resection, the surgeon must have a complete exposition of the operative field. We present a new case of a patient with a symptomatic hypopharyngeal cyst successfully treated with transoral robotic extirpation; our view was tridimensional magnified and the robotic instruments provided great range of movement that permitted complete and safe removal hypopharyngeal lesion.

Case report: human papilloma virus type 120-related papillomatosis mimicking laryngeal carcinoma

INTRODUCTION

The relationship between human papilloma virus (HPV) and upper respiratory tract pathology was better understood in recent years and represents now an issue of particular interest in carcinogenesis and in immunocompromised host. We describe a case in which a rare genotype HPV-related papillomatosis mimics laryngeal carcinoma in an immunocompromised host.

METHODS

A 54-year-old woman with a history of HIV-HCV coinfection and anal and laryngeal cancer successfully treated some years before was hospitalized for severe dyspnea, cough and dysphagia. Fiberoptic endoscopic evaluation raised the suspicion of tumor relapse showing the presence of a large glottic-supraglottic ulcerated mass. Several laryngeal biopsies demonstrated koilocytosis and p16 expression, according to a possible HPV infection, and focal figures of mild dysplasia of epithelium. 18 F-FDG PET/CT did not show high glycolytic activity at laryngeal level. An invasive upper respiratory tract papillomatosis in an immunocompromised host was suspected because of the patient's clinical improvement after antiretroviral therapy.

CONCLUSION

Pharyngeal swab and oral rinse harboured the same HPV120 genotype sequence, a betapapillomavirus of recent description and not yet related to any similar clinical presentations.

Role of Vascular Endothelial Growth Factor–A in Recurrent Respiratory Papillomatosis

Vascular endothelial growth factor–A (VEGF-A) is known to play an important role in the angiogenic response essential for tumor growth in a variety of human and experimental tumors. This study was designed to investigate whether VEGF-A may play a role in the pathogenesis of recurrent respiratory papillomatosis (RRP). A retrospective study with institutional review board approval was performed at a tertiary care medical center on 12 patients with a history of laryngeal RRP. Their ages at the time of initial diagnosis ranged from 19 to 96 months (mean, 56 months). All patients had involvement of right and left true vocal cords. All patients required multiple endoscopic procedures (range, 4 to 66; mean, 12). Normal pediatric larynx samples from 5 autopsy patients were used as controls. Formalin-fixed, paraffin-embedded sections of laryngeal squamous papillomas from the 12 patients with a diagnosis of RRP and the 5 control patients were examined by in situ hybridization for the presence of messenger RNA (mRNA) for VEGF-A and vascular endothelial growth factor receptor 1 (VEGFR-1) and vascular endothelial growth factor receptor 2 (VEGFR-2). The biopsy specimens were from the true vocal cord (N = 10) or subglottis (N = 2) in the patients with RRP and consisted of large sections of larynx including the true vocal cord in the control patients (N = 5). Strong expression of VEGF-A mRNA was noted in the squamous epithelium of papillomas of all 12 patients. Strong expression of VEGFR-1 and VEGFR-2 was noted in the endothelial cells of the underlying vessels in all 12 patients. Neither strong labeling of VEGF-A mRNA nor labeling of its receptors was noted in the control patients. We conclude that the angiogenic growth factor VEGF-A is strongly expressed in the epithelium of squamous papillomas in RRP. Also, VEGFR-1 and VEGFR-2 mRNAs are strongly expressed by underlying vascular endothelial cells, suggesting an important role in the pathogenesis of RRP.

Laryngeal schwannoma: a systematic review

A large proportion of schwannomas are found in the head and neck region. Schwannoma located within the larynx however is uncommon. The characteristic features, clinical presentations, treatment and the outcomes of patients with laryngeal schwannoma are therefore not clearly understood. The aim of this comprehensive review is to compile, analyze and present the details to develop a consensus and augment the available literature on laryngeal schwannoma. A comprehensive literature search on laryngeal schwannoma was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index using MeSH words. A total of 55 patients were reviewed in this study. 40.7 % of the tumours arose from the aryepiglottic fold or arytenoids. Other areas where tumours were found included the false cord, true vocal cord, epiglottis, subglottis, piriform sinus and the post cricoid area. 64.9 % patients presented with dysphonia. Others typically present with multiple symptoms related to the mass effect and location of the tumour. All patients were managed surgically with different techniques and approaches. Majority of patients were alive with no residual disease. There were five recurrences and no mortality to date. Schwannoma within the larynx can present with a variety of symptoms. Surgical excision remained as the treatment of choice with good overall prognosis.

Transoral robotic surgery for huge spindle cell lipoma of the hypopharynx

Spindle cell lipoma is an uncommon histologic variant of lipoma, and reports at the larynx or hypopharynx are extremely rare. We present our experience with a 53-year-old man with a huge spindle cell lipoma of the pyriform sinus and tried to remove the tumor using a transoral robotic approach. The tumor was successfully removed with 3-dimensional visualization providing an excellent view of the resection margin and the dissection plane. Furthermore, geometric resection could be conducted in the narrow pharyngeal lumen and working space using the articulated robotic arms. We suggest that spindle cell lipoma should be considered for differential diagnosis in benign hypopharyngeal tumors and that transoral robotic surgery may be successfully used in huge benign tumors of the hypopharynx.

Supra-thyroid alar cartilage approach for the complete resection of laryngeal submucosal tumors and postoperative voice quality

Various surgical approaches for the treatment of laryngeal submucosal tumors have been reported. Endoscopic excision is indicated for small lesions, while external approaches are recommended for larger tumors. This report introduces a supra-thyroid alar cartilage approach (STACA), which has strong advantages for the preservation of the laryngeal framework and voice recovery after surgery. Case series with chart review. Four patients with laryngeal submucosal tumors in the paraglottic space underwent complete tumor removal through STACA. Medical charts were reviewed to evaluate patient background, major complaints, tumor type, tumor size, the time period from operation to tracheostomy closure, tumor recurrence, and the difference between pre- and postoperative voice quality. Voice quality was assessed using the GRBAS score, maximum phonation time (MPT) and Voice Handicap Index-10 (VHI-10) 6 months after surgery. All patients were females between 43 and 67 years of age. Two patients had schwannoma, one laryngocele, and one lipoma. Mean tumor size was 3.4 cm. The main complaints were hoarseness in all patients, and dyspnea in one. The periods of time from surgery to oral intake and tracheostomy closure were 3.5 and 7 days, respectively. No patient developed recurrence during a minimum follow-up period of 2 years. The postoperative GRBAS scores, MPT and VHI-10 improved in all patients. STACA has advantages including minimal trauma, no deformity to the laryngeal framework, and good voice qualities after the resection of laryngeal submucosal tumors.

Laryngeal schwannoma: a case report with emphasis on sonographic findings

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

Obstructive laryngeal schwannoma in a young female

Laryngeal schwannomas are rare, benign neurogenic tumors. They normally present as a slow-growing, encapsulated, submucosal mass in the supraglottic region. We describe a 20-year-old female presenting with a 2-year history of hoarseness and progressive worsening dyspnea. Fiberoptic laryngoscopy and computed tomography revealed a round, low-density submucosal mass at right false cord and arytenoepiglottic regions with glottic extension. Microlaryngoscopic biopsy and debulking for this solid tumor were performed without tracheostomy. Schwannoma was confirmed by histopathological study. However, rapidly worsening stridor occurred 2 weeks after the surgery. Fiberoptic laryngoscopy showed an exophytic tumor occupying the right hemilarynx with airway compromise. Definite complete excision of the tumor was performed by right vertical hemilaryngectomy. At 5-month follow-up, the laryngeal wound was clear without signs of recurrence. Rapid occurrence of airway obstruction after debulking and biopsy was demonstrated in this case. Vertical hemilaryngectomy was inevitable to cure this potentially life-threatening laryngeal schwannoma in this young female with postoperative serviceable voice.

The Use of Cryotherapy for Papilloma and Early Laryngeal Cancers: Long-term Results

STUDY DESIGN

Retrospective chart review.

OBJECTIVE

To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis.

SUMMARY OF BACKGROUND DATA

The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis.

METHODS

Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations.

RESULTS

The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23).

CONCLUSION

The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important.

Primary lung and large airway neoplasms in children: current imaging evaluation with multidetector computed tomography

Multidetector computed tomography (MDCT) offers an important noninvasive imaging modality for confirmation and further characterization of primary lung and large airway neoplasms encountered in pediatric patients. Children represent a unique challenge in imaging, not only because of unique patient factors (eg, inability to follow instructions, motion, need for sedation) but because of the technical factors that must be optimized to reduce radiation dose. This article reviews an MDCT imaging algorithm, up-to-date imaging techniques, and clinical applications of MDCT for evaluating benign and malignant primary neoplasms of lung and large airway in infants and children.

Subglottic Schwannoma: a report of a rare case that was treated with medial thyrotomy

We present a rare case of primary subglottic schwannoma in a 51-year-old man. He presented with subacute dyspnea and progressively worsening stridor. Videoendoscopy revealed the presence of a submucosal mass in the subglottic area, which measured 2 cm in diameter and had occluded approximately 80% of the lumen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor arising from the left posterior wall of the subglottis and extending from the level of the cricoid cartilage to the first tracheal ring. After tracheostomy for airway management, subglottic schwannoma was diagnosed via fiberscopy-assisted punch biopsy. We removed the tumor via a medial thyrotomy (laryngofissure), and the post-excisional raw surface of the cricoid and tracheal cartilage was covered with a free buccal mucosal flap, which was attached using absorbable sutures and fibrin glue. No complications including recurrent nerve palsy developed after the procedure, and early postoperative ambulation was successfully performed. The patient is currently well, and the subglottic wound is clear. Although long-term follow-up is required, medial thyrotomy and coverage of the exposed cartilage with a free buccal mucosal flap is more effective for large subglottic schwannomas than laryngeal or tracheal resection with permanent tracheal tunnel formation from the viewpoint of phonation disability and the risk of complications.

Microlaryngoscopic study of 100 cases of Hoarseness of voice

100 patients with hoarseness of voice were studied with the help of microlaryngoscopy along with other conventional methods. The peak incidence of the laryngeal diseases was in the age group between 21 to 30 years (28%). The incidence in males (56%), was more than females (44%). Maximum incidence was found among house-wives (29%). 72% patients had a history of vocal abuse. Commonest disease was vocal nodule (30%). The ratio of unilateral and bilateral affection was near about 5 : 4. Hoarseness of voice due to vocal nodules, Reinke's oedema, vocal polyps or fibroangioma was cured in 88%-100% of the cases by microlaryngeal surgery.

Laryngeal schwannoma: case report and literature review

Neurogenic tumours of the larynx, particularly schwannomas are rare. We report a case report of a schwannoma in a 30-year-old woman which was excised endoscopically. The aim of this paper is to highlight this rare condition and management options to the otolaryngological community.

Schwannoma mimicking laryngocele

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.

Schwannoma of the larynx

Objectives

Neurogenic tumors of the larynx are extremely rare. The goal of this report is to advert to this rare disease, to review and discuss diagnostics, differential diagnoses and treatment options. Study Design: Retrospective case report and review of the literature. Methods: Case report of a schwannoma of the supraglottic larynx and review of the English- and German-language literature regarding neurogenic tumors of the larynx. Results: Neurogenic laryngeal tumors typically involve the supraglottic larynx, rarely the glottis. They can course globus sensation, dysphagia, dysphonia and upper airway obstruction. Imaging does not yield a definite diagnosis. The only curative treatment option is complete surgical resection. Conclusions: A definite diagnosis can only be made histologically. Endoscopic (laser-) resection for smaller lesions and external approaches for larger lesions are recommended treatment options.

Neonatal nodular fasciitis of the larynx

We want to describe a case of neonatal laryngeal nodular fasciitis. A 5-day-old female presented with stridor. Fiberoptic transnasal laryngoscopy identified a smooth ball-valving mass obstructing the glottis. Direct microlaryngoscopy demonstrated a lesion originating from the right laryngeal ventricle. Endoscopic therapeutic and diagnostic subtotal biopsies relieved the airway obstruction. Pathologic analysis established nodular fasciitis as the diagnosis. Follow-up endoscopy showed complete resolution of this reactive lesion, and normal laryngeal function. Nodular fasciitis, rarely described in children's head and neck region, has never been reported in the larynx of a neonate. This patient's successful outcome suggests that conservative resection may be both diagnostic and curative.

Distribution and density of CD1a+ and CD83+ dendritic cells in HPV-associated laryngeal papillomas

BACKGROUND

Respiratory papillomatosis associated with human papilloma virus (HPV) infection is the most common benign laryngeal neoplasm. The age of patients at disease onset, HPV type, number of surgeries are well known prognostic factors of the disease course. The correlation between dendritic cell (DC) density in tumor tissue and clinical prognosis was established.

AIM

The aim of our study was to estimate the density of DC in laryngeal papillomas associated with HPV types 6/11 infection and to evaluate the relationship between the number of DC and the disease severity.

MATERIALS AND METHODS

Our study included 40 randomly selected biopsy specimens from patients with HPV-positive laryngeal papillomatosis aged from 1.7 to 20 year. DC were immunohistochemically labelled with anti-CD1a antibodies and anti-CD83 antibodies. The density of DC was analysed in epithelial layer and lamina propria.

RESULTS

In the epithelial layer of papillomas the number of CD1a+ and CD83+ DC was 86.2 (47.5-119.9) cells/mm(2) and 2.6 (0.6-7.9) cells/mm(2), respectively. In lamina propria - 15.3 (5.1-27.9) and 16.0 (6.7-33.2) cells/mm(2). For subgroups of patients with high number of operations (more than 3), early disease onset (children under 3 years of age) and lingering duration of disease (more than 1 year) we detected an increase of CD83+ DC in the epithelial layer. However, our data did not demonstrate a statistically significant difference in CD1a+ DC count neither in the epithelium nor in the lamina propria. Probably, the increase of CD83+ DC density in epithelial layer of patients with severe course of disease can be an evidence of impaired migration of matured DC.

Acute stridor caused by a previously asymptomatic large oropharyngeal spindle cell lipoma

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. Spindle cell lipoma is a rarer histological variant characterised by mature adipocytes mixed with collagen-forming spindle cells. We present an unusual case of a 62-year-old lady who acutely presented to the emergency department with a large spindle cell lipoma arising from the vallecula. This lipoma was causing intermittent stridor unless traction was applied to it. Despite the size of the lesion, she had been completely asymptomatic prior to this single episode. To our knowledge, only one previous case of a spindle cell lipoma has been reported as specifically arising from the vallecula. This case also appears to be the largest reported from the oropharynx (17 cm length, 4 cm width). The tumour was completely removed endoscopically and the patient made an excellent recovery, returning home 3 days post-operatively. The histology, management and follow up of these lipomas are discussed.

Neuroendocrine neoplasms of the larynx: Advances in identification, understanding, and management

While 85-90% of laryngeal malignancies prove to be squamous carcinomas, the second most common tumour type found in the laryngeal region will prove to be a member of the family of neuroendocrine tumours. Laryngeal carcinoid tumours have a capacity for metastasis, and so are more aggressive tumours than their light microscopic features might imply--5-year survival rates are in the vicinity of 50%. Laryngeal atypical carcinoid tumours are lesions with a well-recognized capacity for local recurrence as well as metastasis, with a 5-year survival of just under 50%. Laryngeal small cell neuroendocrine carcinomas are particularly aggressive tumours, with a 5-year survival of no more than 5-10%. Laryngeal paragangliomas are lesions without any real capacity for metastasizing. Surgical excision is the mainstay of treatment of carcinoid tumours, atypical carcinoid tumours, and paragangliomas. Small cell neuroendocrine carcinomas are chiefly treated by way of radiation and chemotherapy; the role of adjuvant therapy in the treatment of atypical carcinoid tumours remains to be established.

A schwannoma mimicing hypopharyngeal carcinoma

Hypopharyngeal schwannoma is quite rare, with only nine cases presented in the literature to our knowledge. The presentation itself requires a distinction from malignant hypopharyngeal disease, which is usually the initial diagnosis. A transcervical approach and laryngomicrosurgery are two possible operating methods for the treatment of hypopharyngeal schwannoma. The selection of the surgical method depends on the size of the tumor. For this case, we preferred the transcervical approach without tracheotomy. In contrast to previous case reports, we were unable to trace the original nerve.

Solitary subglottic neurofibroma: a report of an unusual manifestation

Neurofibromas of the larynx are extremely rare, especially in the subglottic part. Most of the patients with neurofibromas suffer from neurofibromatosis type 1 (NF1, von Recklinghausen's disease), which is characterized by cafe-au-lait spots and neurofibromas of any type. We present a case of a solitary neurofibroma in the subglottic region that relapsed 4 years after the primary diagnosis. The clinical findings, histological results and therapy are discussed.

Laryngeal hamartoma

OBJECTIVE

Hamartoma is a rare finding in the head and neck area and usually occurs as an age-related tumor in the lung. The aim of this study was to present the results of long-term follow-up of a case of laryngeal hamartoma (LH) and review the relevant literature.

MATERIAL AND METHODS

A case of LH is presented which occurred in a 5-year-old child with a previously unreported change in the histologic pattern at recurrence. The relevant literature is critically reviewed with emphasis on histopathological aspects, clinical signs, age and gender.

RESULTS

A total of 26 patients matched the search criteria, of whom 17 (65%) were male. LH occurred in 10 children (mean age 1.9 years) and 9 adults (mean age 49.6 years). Stridor, dysphonia and hoarseness were the commonest symptoms, occurring in 14 patients in total. In 18 patients the tumor presented as a supraglottic lesion (69%). Two neonates died shortly after the diagnosis was made. The current patient is the first to have presented with a change in the histological subtype.

CONCLUSION

LH should be included in the differential diagnosis of benign laryngeal lesions, particularly in children. Complete surgical removal is the method of choice but should be limited in order to preserve laryngeal function, as the prognosis of patients with LH is excellent.

Pharmacotherapy of recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a disease which affects both children (juvenile-onset RRP) and adults (adult-onset RRP). While a greater amount of information is known about the epidemiology of juvenile-onset than adult-onset RRP, fundamental work is still needed to more fully describe areas such as the mode of transmission. The primary management approach focuses on the removal of the papillomas by surgical debulking, although persistence of the human papillomavirus genome and subsequent recurrence of disease is the typical outcome. In a minority of patients, surgical management must be supplemented with adjuvant medical therapy, with IFN being the best studied and most commonly used. Other adjuvant treatments being employed include photodynamic therapy, indole-3-carbinol, ribavirin and cidofovir. Large controlled trials are lacking for all but IFN, making it extremely difficult to assess clinical benefit and risk in a systematic fashion at the current time. As with surgical management, viral persistence occurs following treatment with these adjuvant modalities, further contributing to the challenge of managing patients with this potentially devastating disease.

Benign laryngeal lesions - a clinicopathological study of eleven years and a case report of pleomorphic lipoma

In a retrospective cohort study, conducted in Department of Oto-Rhinolaryngology, Head and Neck Surgery, M.LX Medical College, Allahabad from January 1989 to December 1999, 81 benign laryngeal lesions were evaluated. Majority (69, 85.2%) presented with hoarseness of voice and stridor was the presenting complaint in 12 ( 14.8%) cases. Vocal cord polyp (33, 40.7%) dominated the non-neoplastic group, while squamous papilloma (18, 22.4%) was the most common neoplastic lesion. Adult unset multiple papiUoma of unilateral vocal cord (4, 4.9%) was an unexpected finding in our series. A rare case of pleomorphic lipoma of larynx in a 68-year-old male patient along with its CT characteristics has been presented. Conservative microlaryngeal surgery offered the most satisfactory mode of treatment without any mortality and with minimal recurrence.

Human papillomavirus in larynx

OBJECTIVES

The core of the present clinical and basic research knowledge of laryngeal human papillomavirus (HPV) infection is described.

STUDY DESIGN

Review.

METHODS

A computer-aided search of MEDLINE database supplemented by hand searches of key journals was conducted.

RESULTS

One of the tumor-promoting factors in the larynx is the HPV found both in normal laryngeal epithelium and in laryngeal tumors. The most important manifestation of laryngeal HPV infection is laryngeal papillomatosis, a rare disease caused by HPV types 6 and 11. In laryngeal carcinogenesis, the role of HPV remains uncertain. The means of transmission of HPV are partly unknown, and the course of laryngeal HPV infection is unpredictable and variable. Treatment of laryngeal papillomatosis is based on surgery, especially on CO2 laser and shaver. Alpha-interferon is the drug of choice in patients whose response to surgery is poor. However, neither interferon nor other antiviral drugs are able to eradicate the virus from laryngeal mucosa. Little is known about immunological mechanisms involved in laryngeal HPV infection, but in defense against HPV cellular immunity is considered a more important mechanism than humoral immunity. A good experimental model of HPV infection is lacking in which the entire viral life cycle can take place. Organotypic cell cultures (collagen rafts) are useful, but the rate-limiting step in this method is the difficulties in culturing HPV-positive epithelial cells.

CONCLUSIONS

Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.

Laryngeal and sinonasal paragangliomas

Laryngeal paragangliomas are classified as supraglottic and infraglottic. This article defines each type of paraganglioma, discusses the clinical features and diagnoses, and covers the surgical management. This article also addresses sinonasal paragangliomas, including their clinical features, diagnosis, and treatment.

Pathogenesis and treatment of juvenile onset recurrent respiratory papillomatosis

Juvenile onset recurrent respiratory papillomatosis is the most common cause of laryngeal tumors in children. This disease is caused by infection of the human papillomavirus, a virus whose complete genetic structure is now known. New, more directed agents show promise for improved control of papillomatosis in preliminary studies. Concurrently, there is an increasing awareness of methods to reduce surgical morbidity. At present, the role of preventive efforts including elective caesarian section remains uncertain.

Juvenile onset recurrent respiratory papillomatosis: possibilities for successful antiviral therapy

Recurrent respiratory papillomatosis (RRP) is a potentially devastating disease that can have significant morbidity, and can even result in mortality due to airway compromise or, less commonly, malignant transformation. Two distinct types of RRP exist: adult-onset RRP (AO-RRP) and juvenile-onset RRP (JO-RRP). Acquisition of human papillomavirus (HPV), the causative agent of RRP, is believed to occur in the peripartum period in the case of JO-RRP, with disease symptoms (primarily hoarseness) becoming apparent during the first several years of life. Treatment currently consists of surgical debulking of the papillomas to relieve airway obstruction. However, numerous antiviral therapies have also been evaluated, albeit primarily under uncontrolled settings. This article will review the biology, natural history and management of HPV infection, with particular emphasis on JO-RRP.