Cartilaginous Nodules

Metaplastic elastic cartilaginous nodules (MECN) are small (less than 1 cm) fibroelastic lesions occurring most frequently in the posterior and mid-portions of the glottis and ventricular bands. Cartilaginous nodules are composed of a peripheral rim of fibroblasts with transition into fibroelastic cartilage towards the centre [112]. Aetiologically, an association with laryngeal trauma has been suggested [277]. The development of MECN shows a smooth transition from the initial accumulation of acid mucopolysaccharides between the collagen bundles and their separation, to transition of fibroblasts to enlarged, rounded cells resembling chondrocytes. Aggregates of elastic fibres are present in the centre of the lesions [156]. Nodules are usually covered by intact mucosa.

Metaplastic elastic cartilaginous nodules are rarely clinically relevant [277]. We should be aware of their possible existence and distinction from chondroma and low-grade chondrosarcoma. Chondroma has a characteristic lobular pattern and low cellularity, which is not the case with MECN. Low-grade chondrosarcomas differ mainly from MECN in their locations, and cellular and structural atypia [277].

7.5.5 Amyloidosis

Amyloidosis is a heterogeneous group of disorders associated with extracellular deposition of an abnormal fibrillar protein with pathognomonic tinctorial properties. It may be hereditary or acquired, localised or systemic in distribution. The current classification of amy-loidosis is based on the biochemical composition of its peptide subunits [131].

Laryngeal amyloidosis (LA) is rare and is mostly a localised disease. In the majority of LA cases, the amyloid is composed of immunoglobulin light chains (AL amyloid). LA may occasionally be part of systemic disease or can be associated with a tumour, such as neuroendocrine carcinoma of the larynx or medullary carcinoma of the thyroid [359].

Laryngeal amyloidosis primarily affects patients between 40 and 60 years of age, more frequently males [298]. A few cases have been reported in children [273]. All parts of the larynx can be affected [359], but in some studies the supraglottis was the most common site of involvement [159]. It can affect the larynx multifocally, and can also extend to the tracheobronchial tree. The main symptom is hoarseness, in some patients accompanied by dysphagia, dyspnoea, or haemoptysis [159].

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