ICDOcodes

Haemangioma 9120/0

Lymphangioma 9170/0

Haemangiomas of the larynx are divided into juvenile (congenital) and adult types based on age of presentation, histologic appearance, and possibly patient outcome. Pediatric patients present at or within several months of birth with sub-glottic lesions that may result in potentially life-threatening airway obstruction and haemorrhage. In addition, about half of all pediatric patients with subglottic hae-mangiomas may have haemangiomas in other locations, most of which are cutaneous, rarely visceral. Adult haeman-giomas are more often found in the supraglottic larynx. Grossly, haeman-giomas are soft and compressible and range from red to blue, depending on the degree of vascularity. They may be either flat and diffuse or bulging and polypoid. The term 'haemangiomatosis' is sometimes used when the lesion is widespread and involves contiguous or noncontiguous sites. Microscopically, hae-mangiomas are categorized into capillary and cavernous types, and often demonstrate a lobular pattern of growth. Juvenile haemangiomas are usually cellular and of the capillary type while in adults, they are are more often cavernous.

Haemangiomas should be distinguished

Fig. 3.58 Granular cell tumour. A Prominent pseudoepitheliomatous hyperplasia. The granular cells are spindle-shaped and may be confused with a desmoplastic stromal reaction. B Higher magnification of the pseudoepitheliomatous hyperplasia.

Fig. 3.58 Granular cell tumour. A Prominent pseudoepitheliomatous hyperplasia. The granular cells are spindle-shaped and may be confused with a desmoplastic stromal reaction. B Higher magnification of the pseudoepitheliomatous hyperplasia.

from telangiectasia, vascular stage of vocal cord polyps and granulation tissue. The distinction between haemangioma and telangiectasia may be difficult. But in the correct clinical setting of a positive family history of hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome), typical lesions (in any location) and episodic bleeding can help to define the syndrome. Vascular vocal cord polyps occur exclusively on the true vocal cord and are separated from hae-mangiomas by a large amount of extravascular fibrin. Fibrin, if seen in haemangiomas, is always intravascular. The lobular growth of haemangioma distinguishes it from granulation tissue. If the lesion is biopsied rather than excised, unusually excessive bleeding may give a clue as to the type of lesion encountered. Although the preferred treatment is laser excision, therapy has included expectant management, systemic steroids, intralesional sclerosing agents and surgical excision {277,439, 1235,1680,2227,2305,2591}. Lymphangiomas can occur in the larynx, but are extraordinarily rare. The distinction between a cystic hygroma with involvement of the larynx versus a pri mary lymphangioma underscores a semantic and clinical dilemma. The exact anatomic location and neck examination are needed to exclude a primary lymphangioma {659,1194,1235,1487}.

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