been recently reported . Aggressive behaviour supports recent observations that at least a subset of IMTs represents true neoplasms rather than reactive myofibroblasts proliferation [124, 165].
Differential diagnosis mainly includes spindle-shaped lesions, such as spindle cell carcinoma, different types of sarcomas and lesions composed of myofibroblasts and fibroblasts. The presence of cytokeratin reactivity cannot reliably distinguish between spindle cell carcinoma and IMT. In contrast, a lack of nuclear atypia and considerable mitotic activity favour a diagnosis of IMT and help to differentiate the lesion from different variants of laryngeal malignant tumours. Compared with myofibroblastic lesions, IMTs are generally larger than nodular fasciitis, tend to occur in younger age groups and are composed of longer fascicles of spindle cells in an inflammatory background rich in plasma cells . In contrast, nodular fasci-itis usually lacks the striking inflammatory infiltrate characteristically present in IMT. The recently described laryngeal myofibroblastoma shares many similarities with IMT, except for a lack of inflammatory infiltrate and could be considered its pure spindle cell proliferation form .
cystic carcinoma and mucoepidermoid carcinoma, need to be excluded.
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