Benign tumors of the larynx: causes, symptoms, diagnosis, treatment

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Chondroma of the larynx

Laryngeal chondroma is a very rare disease in otolaryngology, localized almost always on the plate of the cricoid cartilage, from where, growing, it penetrates into various areas of the larynx. Romanian otolaryngologists have established that in 1952, only 87 cases of this disease were described in world literature. Less often, laryngeal chondroma develops on the epiglottis and thyroid cartilage.

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Pathological anatomy of laryngeal chondroma

When chondromas develop on the thyroid cartilage, they usually penetrate the anterior surface of the neck and become accessible to palpation. Usually, these tumors are well demarcated from the surrounding tissues, have a rounded shape, are covered from the inside by normal mucous membrane, and from the outside (thyroid cartilage chondroma) by normal skin that is not fused with it; they are characterized by significant density, which prevents biopsy, therefore, for biopsy, they often resort to thyrotomy with simultaneous surgical treatment. With indirect laryngoscopy, it is possible to examine only chondromas of the upper larynx. Their detailed visualization is possible only with direct laryngoscopy.

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Symptoms of laryngeal chondroma

The symptoms of laryngeal chondroma depend on the location of the tumor and its size. Chondromas of the cricoid cartilage plate cause breathing and swallowing disorders, as they narrow the subglottic space and compress the laryngopharynx. Laryngeal chondromas can degenerate into malignant tumors - chondrosarcomas. Thyroid cartilage chondromas, with their endophytic growth, cause a violation of voice formation and, if significant in size, breathing. With chondromas of the epiglottis, its locking function may be impaired when swallowing, with the occurrence of choking.

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Diagnosis of laryngeal chondroma

In case of chondromas of the larynx, an X-ray examination of the larynx is mandatory to determine the location and extent of the tumor.

Treatment of laryngeal chondroma

Treatment of laryngeal chondroma is surgical in all cases. In the case of endolaryngeal chondromas, preliminary tracheotomy and general anesthesia are indicated during tracheal intubation through a tracheostomy. The tumor is removed by external access (thyrotomy) iodoperichondrially, observing, if possible, the principle of sparing the laryngeal tissues necessary to maintain its respiratory lumen and vocal function. Some authors recommend performing X-ray therapy after surgery to prevent relapses that may occur with incomplete removal of the tumor.

Lipoma of the larynx

Lipoma of the larynx occurs extremely rarely, can be localized on the epiglottis, aryepiglottic folds, in the ventricles of the larynx; in other cases, it originates from the laryngeal part of the pharynx, from where it spreads to the vestibule of the larynx; it can be multiple. Lipoma of the larynx has the appearance of a rounded formation with a smooth or lobed surface of a bluish color.

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Symptoms of Laryngeal Lipoma

Symptoms of laryngeal lipoma depend on the location and size of the tumor; respiratory failure is more common than phonation.

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Diagnosis of laryngeal lipoma

Diagnosis of laryngeal lipoma is possible only after removal of the tumor and its histological examination.

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Treatment of laryngeal lipoma

Small tumors are removed using cauterization or laser. Large ones - from external access (pharyngotsmia, thyrotomy).

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Laryngeal adenoma

Laryngeal adenoma is an extremely rare tumor, the diagnosis of which can only be established after its removal and histological examination.

The structure of the tumor is represented by multiple glandular tissues and, by its appearance, can be mistaken for a glandular polyp or adenocarcinoma.

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Treatment of laryngeal adenoma

Treatment of laryngeal adenoma is surgical.

Myxoma of the larynx

Myxomatous elements may be present in some forms of laryngeal polyps and, depending on their relative volume, may be called myxomatous polyps, laryngeal myxoma, or fibromyxoma. In most publications, this type of tumor is not distinguished as a nosological and morphological form.

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Treatment of laryngeal myxoma

Treatment of laryngeal myxoma is surgical.

Fibromyoma of the larynx

Laryngeal fibromyoma is an extremely rare tumor; it originates from the muscle tissue of the internal muscles of the larynx and is most often located on the posterior or lateral surface of the cricoid cartilage, from where it spreads into the arytenoid folds and the vestibule of the larynx.

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Symptoms of laryngeal fibroids

The tumor can reach the size of a walnut and sometimes penetrate into the lateral region of the neck at the level of the thyrohyoid membrane. In its appearance, it can resemble a cyst, aberrant goiter, chondroma. Laryngeal fibromyoma can degenerate into myosarcoma.

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Treatment of laryngeal fibroids

Treatment of laryngeal fibroids is surgical.

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Laryngeal neuroma

Laryngeal neuroma is a tumor originating from the superior laryngeal nerve and localized above the vocal folds, at the entrance to the larynx. The tumor has the appearance of a rounded formation with a smooth surface, from pink to dark red in color.

Laryngeal neuroma may occur as a single formation as a result of proliferation of lemmocytes of the specified nerve (benign schwannoma), but it may be a systemic disease such as Recklinghausen's neurofibromatosis, which is a hereditary disease of undifferentiated nervous tissue (autosomal dominant inheritance).

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Symptoms of laryngeal neuroma

The disease usually manifests itself in childhood; pigment spots of the color of "café au lait", multiple painless neurofibromas (symptom of the "bell button"); neurogliomas are observed in the area of nerve bundles (especially the neck and arms); elephantiasis of the eyelids is common. The occurrence of fibromatous nodes in the spinal cord and brain give the corresponding symptoms. Multiple fibromatous foci in the bones are combined with general degenerative changes and anomalies, especially of the skeletal system. The disease can be combined with visual and hearing impairment, dementia, curvature of the spine.

The nodes can compress adjacent organs, causing dysfunction. Thus, if localized on the neck or mediastinum, respiratory, circulatory, and lymphatic disorders may be observed. Men get sick twice as often.

The presence of these symptoms or some of them helps to suspect the presence of a laryngeal neuroma when “laryngeal” symptoms appear.

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Treatment of laryngeal neuroma

In the presence of a solitary neuroma in the larynx, not associated with systemic neurofibromatosis and causing functional disorders, its removal is indicated. In case of a systemic disease, the removal of a laryngeal neurofibroma should be radical, since its remnants can quickly recur or even degenerate into a malignant tumor.

What is the prognosis for laryngeal neuroma?

The prognosis is usually favorable, malignancy occurs rarely. In malignancy, the node quickly increases in size, compresses the surrounding tissues and grows into them, causing the clinical picture of a malignant tumor of the larynx.

Laryngeal amyloidosis

Laryngeal amyloidosis is a rare disease, the etiology of which is not entirely clear. In some cases, it is combined with amyloidosis of other organs. In 75% of cases, it affects males. Amyloid formations are isolated rounded formations that shine through the mucous membrane of the larynx as a bluish color; they do not disintegrate and do not cause pain; when localized on the arytenoid cartilages, they cause a violation of voice formation. Giant multinucleated cells agglomerate around the amyloid formations - a reaction to a foreign amyloid substance.

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Diagnosis of laryngeal amyloidosis

Diagnosis of laryngeal amyloidosis is not difficult, but requires confirmation by a histological method. A. T. Bondarenko (1924) proposed an original method for diagnosing laryngeal amyloidosis by intravenous administration

10 ml of 1% Congo red solution. The amyloid tumor turns orange after 1 hour and intensely red after 2 hours.

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Treatment of laryngeal amyloidosis

Treatment of laryngeal amyloidosis is surgical. Relapses are very rare.

What is the prognosis for laryngeal amyloidosis?

Laryngeal amyloidosis has a favorable prognosis. In case of systemic amyloidosis, the prognosis is serious due to impaired liver and kidney function and the resulting cachexia.