Laryngocele

can be found anywhere in the larynx [10, 177]. DCs originate from an obstruction of the glandular ducts, caused mainly by chronic inflammation. They are mainly located on the vocal cords, ventricle of Morgagni, ventricular folds, aryepiglottic folds, and on the pharyngeal side of the epiglottis, where they tend to be larger, even up to 7.5 cm in diameter (Fig. 7.1a) [14, 177].

The origin of a so-called epidermoid cyst of the vocal cord is probably related to microtraumatic inclusion of small fragments of squamous epithelium into the subepithelial tissue or to the remnants of the vocal cord sulcus [251]. These cysts are usually smaller than other laryngeal retention cysts, measuring 1-4 mm and not exceeding 10 mm in diameter [80].

Laryngoscopically, ductal cysts are seen as a sharply delineated spherical protrusion, the overlying mucosa is smooth and stretched. Larger cysts, mainly in newborns or in small children, can obstruct breathing.

The histological picture of DCs is influenced by origin. Laryngeal retention cysts are covered in double-layered cylindrical, cuboidal or flattened ductal epithelium (Fig. 7.1b) . Squamous or oncocytic metaplasia of the ductal epithelium, partial or complete, is frequently present. Classical "epidermoid" or keratinising cysts of the vocal cords are usually lined with atrophic kerati-nising epithelium with intraluminal stratified basophil-ic keratin scales. The therapy of choice for DC is surgical removal.

Although the oncocytic lesions dominate in the parotid gland, they may appear in the minor salivary glands of the upper aerodigestive tract, including the larynx. A whole spectrum of oncocytic laryngeal lesions has been observed, ranging from focal to diffuse oncocytic metaplasia, papillary cystic hyperplastic lesions to benign and malignant tumours (the latter occur mainly in the sinonasal and palatal region) [44]. On the other hand, it has been suggested that all these lesions, variously called oncocytic cyst (OC), oncocytic papillary cystadenoma, oncocytoma, oncocytic adenomatous hyperplasia, more likely belong to non-neoplastic rather than to true neo-plastic lesions [193, 265, 291]. This opinion has been supported by the various extent of oncocytic metaplasia in the laryngeal minor salivary glands, as well as by the occasional appearance of multiple cystic lesions [84, 111, 230, 387].

Oncocytes are enlarged cells with characteristic granular eosinophilic cytoplasm, caused by an increased number of tightly packed abnormal mitochondria, and small, dense, darkly stained nuclei. The exact cause of oncocytic metaplasia remains unknown, but it is related to the process of aging and especially to disturbance of the organisation of the mitochon-drial enzymes [238]. Laryngeal OCs may show focal, inconspicuous or extensive proliferation of oncocytes, mainly with unilocular or multilocular cystic formations with papillary projections, resembling the War-thin's tumour [119].

Laryngeal OCs probably represent a separate clini-copathologic entity, showing typical age group, location and histopathologic features. They occur on the false vocal cords and ventricles in middle-aged to elderly persons with hoarseness or a cough as the leading symptoms [216, 265, 283, 304]. Clinically, OCs appear as solitary polypoid lesions in the subepithelial stroma, while

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