Two Cases of the Laryngeal Cystic Lesions.

We experienced two rare cases with laryngeal cystic lesions (laryngocele and laryngeal cyst). In the first case, the laryngocele case was removed by laryngomicrosurgery using an oral approach under general anesthesia. In the second case, the magnetic resonance imaging demonstrated a dumbbell-type cyst with mucus widely extending from the laryngeal lumen to the neck through the thyroid cartilage. The patient had undergone chemotherapy for renal carcinoma with multiple lung and bone metastases. Therefore, we performed only fine needle aspiration rather than aggressive surgery for extirpation of the cyst using an external approach. This fine needle aspiration could improve the quality of life by decreasing both the left laryngeal swelling and the resulting pain, which were the chief complaints.

Introduction

DeSanto[1] studied 238 cases with laryngeal cystic lesions and mainly classified them into two types as follows. The first type, laryngocele, contains air in the cyst, and the second, laryngeal cyst, has mucus. Since both laryngoceles and laryngeal cysts are rare in Japan,[2,3] we present the results of physical examination, image findings and treatment.

Case Reports

Case #1: Laryngocele

The patient was a 64-year-old Japanese man who underwent digestive endoscopy at a clinic, where a laryngeal mass was pointed out. He was then referred to our hospital. However, he had no symptom of throat and neck. Laryngeal fiberscope revealed a swelling of the left false cord (Figure 1) that we diagnosed as a laryngocele. Under general anesthesia, the laryngocele was removed by laryngomicrosurgery using an oral approach and the content of the specimen was confirmed to be air. Histopathological examination showed a cystic lesion without malignant cells (Figure 1). The postoperative course was good.

Figure 1.

A) A mass (asterisk) at the left false cord showed a smooth surface. B) Histopathological findings showed pseudostratified epithelia (asterisk) in the lumen cyst (H&E staining).

Case #2: Laryngeal cyst

A 57-year-old Japanese man presented with a one-month history of left laryngeal swelling with pain. He had previously undergone chemotherapy for renal carcinoma with multiple lung and bone metastases. Laryngeal fiber-scope revealed a swelling of the left false cord and laryngeal ventricle. Magnetic resonance imaging demonstrated a dumbbell-type cyst with mucus widely extending from the laryngeal lumen to the neck through the thyroid cartilage (Figure 2). We performed fine needle aspiration and confirmed the presence of mucus (Figure 3). Cytologic examination showed no malignant cells. This fine needle aspiration caused decreases in both the left laryngeal swelling and pain.

Figure 2.

In magnetic resonance imaging, a dumbbell-type cyst with mucus (asterisks) could be observed from the laryngeal lumen through the thyroid cartilage to the neck.

Figure 3.

A specimen obtained by fine needle aspiration revealed mucus.

Discussion and Conclusions

Surgical methods for laryngeal cystic lesions include intraoral and external approaches.[2-4] Small lesions localized at the laryngeal lumen are generally treated by laryngeal microsurgery using an oral approach.

Large cysts growing from the laryngeal lumen to the neck through the thyroid cartilage require extirpation by an external approach, often adding tracheotomy to maintain the air way. It has also been reported that fine needle aspiration is useful for infant cases.[5] Our Case #2 with a laryngeal cyst was under chemotherapy for advanced renal carcinoma with multiple metastases of both lung and bone. Therefore, we performed only fine needle aspiration rather than aggressive surgery for extirpation of the cyst using an external approach. This fine needle aspiration could improve the quality of life by decreasing both the laryngeal swelling and pain.