Page 535 - Textbook of Pathology, 6th Edition

The prognosis is usually fatal. Undifferentiated TUMOURS 519
carcinoma is radiosensitive.
Both benign and malignant tumours occur in the larynx. The
EMBRYONAL RHABDOMYOSARCOMA. Also termed as common examples of benign tumours are papillomas and
botyroid rhabdomyosarcoma, this is one of the common polyps, while laryngeal carcinoma is an important example
malignant tumours in children but can also occur in adults. amongst malignant tumours.
The lesion is highly cellular and mitotically active. Other LARYNGEAL PAPILLOMA AND PAPILLOMATOSIS.
locations include vagina, orbit, middle ear, oral cavity, Juvenile laryngeal papillomas are found in children or
retroperitoneum and bile duct. It is discussed in detail on adolescents and are often multiple, while the adults have
page 867.
usually a single lesion. Multiple juvenile papillomas may
MALIGNANT LYMPHOMA. The lymphoid tissue of the undergo spontaneous regression at puberty. Human
nasopharynx and tonsils may be the site for development of papilloma virus (HPV type 11 and 6) has been implicated in
malignant lymphomas which resemble similar tumours the etiology of papillomas of the larynx.
elsewhere in the body.
Grossly, the lesions appear as warty growths on the true
vocal cords, epiglottis and sometimes extend to the trachea
LARYNX and bronchi.
Microscopically, papillomas are composed of finger-like
NORMAL STRUCTURE
papillae, each papilla contains fibrovascular core covered
The larynx is composed of cartilages which are bound by stratified squamous epithelium (Fig. 18.15).
together by ligaments and muscles and is covered by mucous
membrane. The cartilages of the larynx are of 2 types— LARYNGEAL NODULES. Laryngeal nodules or polyps are
unpaired and paired. seen mainly in adults and are found more often in heavy
The unpaired laryngeal cartilages are epiglottis, thyroid smokers and in individuals subjected to vocal abuse.
cartilage (Adam’s apple) and cricoid cartilage. Therefore, they are known by various synonyms like singers’
The paired cartilages are the arytenoid cartilages which nodes, preachers’ node, and screamers’ nodes. The patients
play important part in the movement of vocal cords. have characteristic progressive hoarseness. CHAPTER 18
The larynx as well as trachea are lined by respiratory Grossly, it is a small lesion, less than 1 cm in diameter,
epithelium, except over the true vocal cords and the rounded, smooth, usually sessile and polypoid swelling
epiglottis, which are lined by stratified squamous epithelium.
on the true vocal cords.
Microscopically, the nodules have prominent oedema
INFLAMMATORY CONDITIONS
with sparse fibrous tissue and numerous irregular and
ACUTE LARYNGITIS. This may occur as a part of the
upper or lower respiratory tract infection. Atmospheric
pollutants like cigarette smoke, exhaust fumes, industrial
and domestic smoke etc predispose the larynx to acute The Eye, ENT and Neck
bacterial and viral infections. Streptococci and H. influenzae
cause acute epiglottitis which may be life-threatening. Acute
laryngitis may occur in some other illnesses like typhoid,
measles and influenza. Acute pseudomembranous
(diphtheric) laryngitis occurs due to infection with C.
diphtheriae.
CHRONIC LARYNGITIS. Chronic laryngitis may occur
from repeated attacks of acute inflammation, excessive
smoking, chronic alcoholism or vocal abuse. The surface is
granular due to swollen mucous glands. There may be
extensive squamous metaplasia due to heavy smoking,
chronic bronchitis and atmospheric pollution.
TUBERCULOUS LARYNGITIS. Tuberculous laryngitis
occurs secondary to pulmonary tuberculosis. Typical
caseating tubercles are present on the surface of the larynx.

ACUTE OEDEMA OF THE LARYNX. This hazardous
condition is an acute inflammatory condition, causing
swelling of the larynx that may lead to airway obstruction
and death by suffocation. Acute laryngeal oedema may occur Figure 18.15 Squamous cell papilloma. There is papillomatosis;
due to trauma, inhalation of irritants, drinking hot fluids or papillae are covered with well oriented and orderly layers of squamous
may be infective in origin. cells.