Among benign tumors of the larynx, fibroids, papillomas and angiomas are most common.
Fibroma of larynx
Fibroma (fibrotic polyp) is located on the free edge of the vocal fold, on the border between the anterior and middle third. As a rule, it is mobile and has a thin stem. It grows slowly and basically does not reach large sizes. Depending on the number of vessels, the fibroid may be of a pink color of varying intensity.
Histologically, the tumor consists of fibrous connective tissue, its surface is covered with a flat epithelium. Depending on the relationship between cells and the fibrous base, dense and soft fibromas are distinguished. Fibromas, consisting of a small number of dense parts and a large amount of edematous fluid, are called polyps of the larynx.
In the case of a rich vascularization, the tumor is referred to as angiofibroma. In the presence of a very long leg, the fibroid may shift: when inhaled, it falls below the glottis, during phonation is placed between the vocal folds or lies on them. This leads to a change in the voice.
The main symptom of fibroid of the larynx is hoarseness, sometimes a cough.
Treatment is surgical: fibroma is removed with the help of guttural forceps during an indirect or direct laryngoscopy. In the case of complete removal of fibroids, there is no bleeding or relapse. Like all neoplasms, fibroids are subject to histological examination.
Papilloma of the larynx
Papilloma is a single or numerous papillary outgrowths resembling cauliflower. They are formed mainly in the anterior sections of the vocal folds, but they can spread throughout the surface of the mucous membrane of the larynx. Numerous papillomas of the larynx are called papillomatosis of the larynx.
The color of the tumor, from whitish to dark red, depends on the intensity of the blood supply and the degree of keratinization of the epithelium on its surface. Most often, papillomas are detected in children aged 1.5 to 5 years. An important clinical characteristic of laryngeal papillomatosis is the recurrence of papillomas after they have been removed. But with the onset of puberty, their relapses cease. If the tumor recurs after puberty, then it is considered a precancerous condition.
Histologically, papillomas consist of a connective tissue stroma in which the vessels pass, and a parenchyma consisting of layers of multilayered planar epithelium. The presence of a clearly expressed basilar membrane, which delimits the epithelium from the underlying connective tissue, and the absence of infiltrative growth, allow the papilloma to be considered a benign tumor.
In the initial stages of laryngeal papillomatosis in children, the voice gradually changes from hoarseness to aphonia. Further, the difficulty of breathing through the larynx gradually increases, especially during exercise and sleep, with the possible transition to asphyxia. In adults, stenosis is less common and develops more slowly than in children.
Diagnosis is based on data from endoscopy, as well as the results of histological examination of biopsy material. In adults, a biopsy is performed with the help of laryngeal forceps with indirect laryngoscopy, children often use direct laryngoscopy.
Treatment of papillomatosis of the larynx is surgical: papillomas are removed endolaryngeal, in children with direct laryngoscopy under anesthesia, using an operating microscope. To avoid relapse, the nearby tissue is treated with a high-energy laser, ultrasonic or cryodestruction is used. In recent years, the main anti-relapse therapy is the use of cytostatics - colchamine, prochedin, etc. Cytotoxic drugs are used topically in the form of ointments and inhalants, as well as parenterally. The propensity of papillomas to relapse is individual: in some cases, papillomas are removed several times a year, in others - in a few years. Single papillomas after removal do not recur.
Angiomas of the larynx are formed from enlarged blood vessels (hemangiomas) or lymphatic (lymphangioma) vessels. They can be localized on voice, vestibule or aryepiglottic folds. Grow slowly, there are small sizes. Laryngoscopically visible is a round tumor of red or dark blue color. Lymphangiomas have a pale yellow color. The flow of angiomas of small size is often asymptomatic. In case of their localization, a hoarseness appears on the voice fold. Angiomas of medium and large sizes are subject to endolaryngeal removal.
Cysts of the larynx are relatively rare and localized on the laryngeal surface of the epiglottis, behind its edge, in the laryngeal ventricle. As a rule, they arise as a result of blockage of the mucous glands, increase slowly, do not reach large sizes. Surgical treatment is used in the event that the cyst causes a violation of the larynx.