Saccular Cyst

A saccular cyst (SC) is a mucus-filled dilatation of the laryngeal saccule that has no communication with the laryngeal lumen [80, 161]. Most SCs are congenital in origin; some may also appear as acquired lesions caused by various inflammatory processes, traumatic events, or tumours [1, 161, 257]. SCs, which may occur at any age, are divided into anterior and lateral. The former spread medially and posteriorly, and protrude into the laryngeal lumen between the true and false vocal cord. The latter are generally larger and extend towards the false vocal cord and aryepiglottic fold. They may rarely spread through the thyrohyoid membrane [10, 80, 161, 357]. SCs may be asymptomatic, but the most common symptoms are progressive cough, dysphagia, hoarseness, dyspnoea and foreign body sensation. Diagnosis is often made by laryngoscopy combined with CT scan [69].

Histologically, SCs are lined with ciliated respiratory epithelium. An increased number of goblet cells may be present. Rarely, the cysts are partially or entirely lined by metaplastic squamous or oncocytic epithelium. Subepithelial stroma, i.e. the cyst wall, usually contains focal lymphocytic infiltrates [177].

Treatment is surgical, the decision on an endoscopic or an external approach depends on the type and size of the cyst, as well as the individual patient's condition.

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