Benign tumours of larynx

1. BENIGN TUMOURS OF
LARYNX
Department of Otorhinolaryngology
J.J.M. Medical College

2. BENIGN TUMOURS OF
LARYNX
• These are uncommon
• Divided into
I. Non neoplastic
II. neoplastic

4. NON-NEOPLASTIC
• These are not true neoplasms
• These are formed as a result of
infection, trauma or degeneration

5. NON-NEOPLASTIC- SOLID
LESIONS
• Vocal nodules (singer’s nodules/screamers
nodules)
 Appear symmetrically In the free edge of the vocal
cord at the junction of anterior 1/3 rd and posterior
2/3rd, as this is the area of maximum vibration and
thus subjected to maximum trauma
 Usually they measure less than 3mm
 They are results of vocal trauma
 Mostly seen in teachers, actors, singers, vendors

7. Vocal nodules- pathology
• Trauma to the vocal cords in the form
of vocal abuse or misuse causes
oedema and hemorrhage in the
Submucosal space
• This undergoes hyalinization and
fibrosis
• Underlying epithelium also undergoes
hyperplasia forming a nodule

8. Vocal nodules- clinical features
• Patient complains of hoarseness, vocal
fatigue and pain in neck on prolonged
phonation
• On examination the nodule appears
soft, reddish and oedematous swelling,
later becomes grayish or whitish in
colour

9. Vocal nodules- Treatment
• Voice rest
• Surgery for larger nodules and long
standing nodules in adults
• Excised by Microlaryngeal surgery
• Speech therapy and re-education in
voice production is necessary to
prevent recurrence

10. Vocal polyp
• Result of vocal abuse or misuse
• Allergy and smoking are other contributing factors
• Mostly affects men in age group of 30-50
• Typically its unilateral and arising from same
position as vocal nodule
• Its soft smooth and often pedunculated
• It may flop up and down during phonation or
respiration
• Its caused by sudden shouting resulting in
haemorrhage in the vocal cord and subsequent
submucosal oedema

12. Vocal polyp- clinical features
• Hoarseness is a common symptom
• Large polyp may cause dyspnoea,
stridor or intermittent choking
• Some patients may complain of
diplophonia due to different vibratory
frequencies of two vocal cords
• Treatment: surgical excision under
operating microscope and speech
therapy

13. Reinke’s oedema
• This is due to collection of the oedema fluid
in the subepithelial space of reinke
• Usual cause is vocal abuse and smoking
• Both vocal cords show diffuse symmetrical
swellings
• Treatment is vocal cord stripping preserving
enough mucosa for epithelisation
• Only one cord is operated at a time
• Cessation of smoking is important to
prevent recurrence

15. Contact ulcer
• This is again due to faulty voice production
• Vocal process of arytenoid hammer against each
other resulting in ulceration and granuloma
formation
• Some cases are due to laryngopharyngeal reflux
• Complaints are hoarseness, constant desire to clear
the throat and pain in the throat which worsens on
phonation
• Examination reveals unilateral or bilateral ulcers
with congestion of arytenoid cartilages
• There may be granuloma formation

16. Intubation Granuloma
• It results from injury to vocal processes of
arytenoids due to rough intubation
• Use of large tube or prolonged intubation are
the common causes
• Mucosal ulceration followed by granuloma
formation over the exposed cartilage
• Usually these are bilateral involving posterior
third of true cords
• They present with hoarseness, if large dyspnoea
• Treatment is voice rest and endoscopic removal
of granuloma

18. Leukoplakia (keratosis) larynx
• This is localized form of epithelial hyperplasia
involving upper surface of one or both vocal
cords
• It appears as white plaque or warty growth on
cord without affecting its mobility
• Its regarded as pre cancerous condition because
carcinoma in situ frequently supervenes
• Hoarseness is common presenting symptom
• Treatment is stripping of the vocal cords and
histopathological examination to rule out
malignancy

19. Amyloidosis of larynx
• Mostly affects men aged between 50-
70 years
• Tumour presents as smooth plaque or a
pedunculated mass
• Diagnosis is only on histology
• Treatment is endoscopic surgical
excision

20. Cystic lesions of larynx
• There are 3 types of cysts in larynx
 Ductal cyst: they are retention cysts due to
cyst
blockage of ducts of the seromucinous
glands of laryngeal mucosa. They are seen
in vallecula, aryepiglottic folds, false cords,
ventricles and pyriform fossa. They remain
asymptomatic if small, or cause hoarseness,
cough, throat pain and dyspnoea if large.
Sometimes a intracordal cyst may occur on
true cords. It is similar to epidermoid
inclusion cyst

21. Epidermoid inclusion cyst

22. Cystic lesions of larynx
 Saccular cyst: obstruction to the orifice of
cyst
the saccule causes retention of secretions
and distention of the saccule which presents
as cyst in the laryngeal ventricle. Anterior
saccular cysts present in the anterior part of
the ventricle and obscure part of the vocal
cord. Lateral saccular cysts which are larger
extend into the false cord, AE folds and
may even appear in the neck

23. Cystic lesions of larynx
• Laryngocoele: it is an air filled cystic swelling
Laryngocoele
due to the dilatation of the saccule
• It may be internal, external or combined (mixed)
• Internal laryngocoele: it is confined within the
larynx and present as distension of the false cord
and AE fold
• External laryngocoele: here distended saccule
herniates through the thyrohyoid membrane and
present in the neck
• Mixed laryngocoele: here both internal and
external laryngocoeles are seen

24. Laryngocoele
• Laryngocoele is supposed to arise from raised transglottic air pressure
as in trumpet players, glass blowers and weight lifters
• Clinical features: presents with hoarseness, cough and if large
obstruction to the airway
• External laryngocoele presents as reducible swelling in neck, which
increases in size on coughing and on performing valsalva
• Diagnosis can be made by indirect laryngoscopy and x-ray soft tissue
AP and lateral views of the neck with valsalva
• CT scan helps to find the extent of the lesion
• Surgical excision through external neck incision
• Marsupialisation of internal laryngocoele can be done by
laryngoscopy, but chances of recurrence are high
• Laryngocoele in an adult may be associated with carcinoma

27. Neoplastic laryngeal lesions
• Squamous Papillomas: can be juvenile or adult onset type
• Juvenile laryngeal Papilloma: They are viral in origin and
multiple, often involving infants and young children who
present with hoarseness and stridor
• They are mostly seen on the true, false vocal cords and
epiglottis, but they may involve other sites in larynx and
trachea
• Clinically appear as glistening white irregular growths,
pedunculated or sessile, friable and bleeding easily

28. Juvenile laryngeal Papilloma
• They are known for recurrence after removal,
therefore multiple laryngoscopies may be
required
• Tend to disappear spontaneously after puberty
• Treatment: endoscopic removal with cup
forceps, Cryotherapy, microelectrocautery
• CO2 laser is preferred these days
• Interferon therapy to prevent recurrence

29. Juvenile laryngeal Papilloma

30. Adult onset Papilloma
• Usually single, smaller in size, less aggressive
and does not recur after surgical removal
• It is common in males in age group of 30-50
years
• Usually arises from anterior half of the vocal
cord or anterior commissure
• Treatment is same as for juvenile type

31. Chondroma
• Arise from cricoid cartilage and present in
subglottic area causing dyspnoea
• May grow outward posterior plate of
cricoid and cause sense of lump in the
throat and dysphagia
• Mostly affect men in age group 40-60
years

32. Haemangioma
• Infantile haemangioma involves subglottic area and presents
with stridor in first six months of life, about 50% of such
children have haemangioma elsewhere in the body, particularly
in the head and neck
• Tend to involute spontaneously but tracheostomy may be needed
to relieve respiratory obstruction if airway is compromised
• Most of them are of capillary type and can be vaporized with
CO2 laser
• Adult haemangiomas involve vocal cord or Supraglottic larynx,
they are cavernous type and can not be treated by laser, they are
left alone if asymptomatic
• Larger ones causing symptoms steroid or radiation therapy may
be employed

33. Granular cell tumour
• It arises from the Schwann cells and is
often submucosal
• Overlying epithelium shows
pseudoepitheliomatous hyperplasia, which
may on histopathology resemble well
differentiated carcinoma

34. Glandular Tumour
• Pleomorphic adenoma or oncocytoma are
rare tumours
• Other rare tumours include rhabdomyoma,
neurofibroma, neurilemmomas, Lipoma or
fibroma