A CASE OF LARYNGEAL CYST COMPOSED OF ONCOCYTES AND THE APPEARANCE OF ONCOCYTES IN THE MUCOUS MEMBRANE OF THE NOSE AND THE LARYNX

Laryngeal oncocytic cystadenoma mimicking a combined laryngomucocele

Laryngeal oncocytic cystadenomas are rare benign tumours lined by oncocytic epithelium and arising from the salivary glands; they usually present as a supraglottic mass. Oncocytic changes are very uncommon in the larynx and occur mainly in ventricles and false vocal cords, where seromucinous glands predominate. The authors present the case of a 62-year-old woman who reported a 6-month history of hoarseness associated with a soft and non-compressible upper left side neck swelling. Transnasal fiberoptic laryngoscopy revealed a left submucosal supraglottic mass involving the false vocal fold and the vallecula, partially obstructing the airway. CT scan showed a homogeneous isodense cystic lesion centred at the left laryngeal ventricle, with extension through the thyrohyoid membrane. The patient was successfully managed by a lateral thyrotomy approach. Histopathological examination of the specimen revealed a papillary oncocytic cystadenoma and excluded malignancy. There was no evidence of recurrence after 9 months of follow-up.

A sudden death case of laryngocele accompanied by infarction of the dorso-lateral portion of the medulla oblongata

A 70-year-old man, who had a laryngeal tumor discovered by otolaryngological examination during admission for suspicion of facial nerve paralysis was found dead in his bed on the seventh hospital day. Clinical doctors aspirated a large amount of mucous sputum from his larynx during their attempt at resuscitation. Although the direct cause of death was clinically unknown, an autopsy revealed an internal type laryngocele, a type of laryngeal cyst, in the right larynx and infarction of the left dorso-lateral portion of the medulla oblongata. Suffocation resulted from mucous sputum filling his larynx, which had been narrowed by a laryngocele from the right, in an unfortunate association with movement disturbance of the left larynx caused by the infarction of the left dorso-lateral portion of the medulla oblongata. We assumed this to be the direct cause of death, because the heart and lungs showed no remarkable changes that could be ascribed to it. This case offers important suggestions concerning the risks of suffocation due to laryngeal cysts, especially in patients with complications.

Oncocytoma of the larynx

A case of oncocytoma of the larynx is presented. These lesions are rarely found in the larynx, and have been more commonly described in the salivary and thyroid glands. The histopathological diagnosis is often difficult and the light microscopy can be unreliable for oncocytic lesions. For a more accurate definition of these tumours, the use of histochemical stains together with electron microscopy are advocated. With adequate surgery, the prognosis is excellent, and tumours are unlikely to recur. This paper discusses the management of a patient with a benign oncocytoma of the true vocal cord, and presents a review of the world literature.

Oncocytic lesions of the larynx

Three cases of oncocytic lesions of the larynx diagnosed at the Section of Pathology, Dep. of Otolaryngology, Padua University from November 1974 until December 1980 are reported. The lesion is uncommon but not exceptional and occurs in elderly people. Problems connected with pathology and the clinico-therapeutic approach are dealt with. The pathogenesis of the lesion is also discussed, with particular stress on whether it is a true neoplasm or a process of metaplasia-hyperplasia from the ductal epithelium in connection with senile involution of the upper respiratory tract.