Nonneoplastic Conditions

Polyps and nodules: mucosal polyps are uncommonly detected in the nasopharynx and oropharynx and are likely to represent florid lymphoid proliferations in association with adenoid or tonsillar enlargement. Localised thickenings of the vocal cords usually arise at the junction of the anterior and middle one-thirds and may be unilateral or bilateral. They are due to trauma or voice abuse (hence the alternative term singer's node) but are also associated with smoking. Nodules are broadly based sessile lesions that are usually bilateral and arise in females while the pedunculated polyps are unilateral and predominate in males. Myxoid degeneration of Reinke's space (Reinke's oedema) arises in older females, affects both cords along their length and is associated with smoking and not voice abuse. All are characterised by mild hyperplasia of the stratified squamous epithelium, accumulation of myxoid matrix in the lamina propria, increased vascularity and fibrin deposition. Similar lesions may arise in the myxoedema of hypothyroidism. Contact granuloma or contact ulcer occurs posteriorly between the vocal processes of the arytenoid cartilages and consists of granulation tissue and ulcer slough; voice abuse and recent laryngeal intubation are common causes. Amyloid may present with laryngeal nodules or diffuse submucosal thickening but usually affects the ventricle or false cords; only rarely is there associated systemic amyloidosis. Post-radiation spindle cell nodules can mimic spindle cell carcinoma.

Cysts: tonsillar cysts arise in the oropharynx and hypopharynx. They represent accessory tonsillar tissue and are composed of a crypt of stratified squamous epithelium distended by squames and abundant lymphoid tissue in the wall. Laryngeal cysts may contain mucus or air. Mucus-filled cysts are the commonest and usually represent mucous retention cysts of the accessory glands in the supraglottic larynx, usually the ventricle or false cords. They are lined by ductal epithelium. Laryngocoeles and saccular cysts are both due to obstruction of the saccule in the laryngeal ventricle, the former containing air and the latter mucus. Both are lined by respiratory epithelium.

Tonsillar enlargement: tonsillitis is a common disorder of childhood characterised by frequent episodes of sore throat, dysphagia and otitis media. Although it tends to resolve with age, persistent exacerbations may be treated by tonsillectomy with or without concomitant adenoidectomy. Tonsils may be removed in adults for chronic tonsillitis or if a neoplasm is suspected, particularly if there is asymmetrical or unilateral enlargement. Lymphoid follicles with well-formed germinal centres are seen; there may be fibrosis. Actinomyces colonies (sulphur granules) may be present within the crypts. Florid tonsillar follicular hyperplasia may occur bilaterally in HIV infection.

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