article information

Shiraz E-Medical Journal: Vol.24, issue 5; e136171
published online: June 13, 2023
article type: Case Report
received: March 23, 2023
revised: May 20, 2023
accepted: May 28, 2023
DOI: https://doi.org/10.5812/semj-136171
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Oncocytic Cystic Lesions of False and True Vocal Cords: An Uncommon Occurrence

authors:

avatar Masoumeh Gharib 1 , avatar Mohadeseh Shahraki 1 , *

Department of Pathology, Faculty of Medicine, Mashhad University of Medical, Mashhad, Iran

how to cite: Gharib M, Shahraki M. Oncocytic Cystic Lesions of False and True Vocal Cords: An Uncommon Occurrence. Shiraz E-Med J. 2023;24(5):e136171. https://doi.org/10.5812/semj-136171.

Abstract

Introduction:

Oncocytic cysts of the larynx are benign, uncommon, and slow-growing lesions that usually occur in elderly people, especially in those with a history of smoking and chronic irritation. These lesions cause various clinical symptoms depending on their location and size, requiring physicians to consider a wide range of symptoms.

Case Presentation:

Here we present two men who were referred to us because of prolonged voice hoarseness.

Conclusions:

Medical assessments led us to the diagnosis of oncocytic cysts in the false and true vocal cords. Both patients were followed up after removing their laryngeal cysts and have had no clinical complaints since then.

1. Introduction

Oncocytic cysts of the larynx are benign, uncommon, and slow-growing lesions that mostly or exclusively consist of oncocytes (1-4). The most common locations of these lesions are false vocal cords and laryngeal ventricles (5). These cysts most frequently occur in middle-aged and elderly people (6-8) and cause various clinical symptoms depending on their location and size (9, 10). We present two male patients referring with the chief complaint of prolonged voice hoarseness, who were finally diagnosed with oncocytic laryngeal cysts.

2. Case Presentation

2.1. Case 1

The first patient was a 61-year-old man with the chief complaint of voice hoarseness from six months prior to referral. He was a heavy smoker (150 packs per year) but did not report any history of other respiratory symptoms, medical illnesses, or surgery. Video laryngoscopy revealed a laryngeal mass in the right false vocal cord (Figure 1). Laryngeal Computerized Tomography Scan (CT scan) showed a 14 * 26 * 28 mm mass with a density equivalent to cystic lesions in the right false vocal cord, extending beyond the supraglottis to the level of the hyoid.

Video laryngoscopic view of a cyst in the right false vocal cord of a 61-year-old man
Video laryngoscopic view of a cyst in the right false vocal cord of a 61-year-old man
Figure 1.

Video laryngoscopic view of a cyst in the right false vocal cord of a 61-year-old man

After excision, the mass appeared as a creamy-brown tissue with dimensions of 2.1 * 1.2 * 1.1 cm, a diameter of 3.2 cm, and a thickness of 1.5 cm covered by mucosa. The pathological assessment revealed the false vocal cord epithelium with seromucinous glands and multiple cysts lined by bland oncocytic columnar cells. The final diagnosis was a benign oncocytic cyst. The patient had no hoarseness or other clinical symptoms six months after the procedure (Figure 2).

The cyst lining by bland oncocytic columnar cells (H&E, 400×)
The cyst lining by bland oncocytic columnar cells (H&E, 400×)
Figure 2.

The cyst lining by bland oncocytic columnar cells (H&E, 400×)

2.2. Case 2

The second patient was a 76-year-old man referred due to voice hoarseness for three months. He did not report any other respiratory symptoms, past medical history, undergoing surgery, or smoking. A neck CT scan without contrast showed hypodense and homogenous foci with a dimension of 37 * 20 * 17 mm and a mass in the lateral side of the left false vocal cord. So, the radiologic diagnosis of a cyst or laryngocele was made (Figure 3). After the surgical removing the mass, the patient had a good condition with no voice hoarseness after three months of follow-up.

Neck CT scan without contrast
Neck CT scan without contrast
Figure 3.

Neck CT scan without contrast

Video laryngoscopy showed three masses on the laryngeal surface of the epiglottis, the right true vocal cord, and the right false vocal cord. A biopsy was performed (Figure 4), and the histopathologic examination showed a cystic structure with papillary growth lined by bland oncocytic cells (Figure 5).

Video laryngoscopic view
Video laryngoscopic view
Figure 4.

Video laryngoscopic view

The microscopic view shows acystic structure with papillary growth lined by bland oncocytic cells (H&E, 100×).
The microscopic view shows acystic structure with papillary growth lined by bland oncocytic cells (H&E, 100×).
Figure 5.

The microscopic view shows acystic structure with papillary growth lined by bland oncocytic cells (H&E, 100×).

3. Discussion

Oncocytes consist of polygonal epithelial cells found in salivary glands and the lining epithelium of the respiratory tract (11). Oncocytic metaplasia in the larynx is uncommon, and oncocytic laryngeal cysts are rare, comprising less than 1% of all benign masses of the larynx (12). The oncocytic lesions of the larynx usually present as solitary lesions; however, some multifocal lesions have been described so far (3), including the second case presented in this paper.

Oncocytic metaplasia is a senile process that commonly appears in the epithelial endocrine cells possessing a high metabolic activity (13). Oncocytic cysts usually occur in ages higher than 50 years, unlike other laryngeal cysts that involve younger individuals (3).

Smoking predisposes to oncocytic lesions of the larynx due to increased oxidative stress and laryngeal inflammation. A long history of heavy smoking is reported in most patients with these lesions (14, 15), including the first case presented here. Consistently, Mettias et al. reported an oncocytic cyst in the vocal cord of a 62-year-old man with a history of smoking 20 cigarettes per day for 50 years (16). Nevertheless, the second patient described in the present paper declared no history of smoking.

The common clinical presentation of these lesions is voice hoarseness; however, lesions of different sizes and locations can present with various symptoms (17). Erfanian et al. reported a case of severe respiratory distress due to two large masses on the false vocal cord, which was identified via video laryngoscopy. This patient had aggravating dyspnea for two years prior to diagnosis and reported dysphonia for more than one year. In physical examination, inspiratory stridor was obvious, and the masses were disclosed by fiberoptic nasotracheal intubation (18).

The management of these lesions is conservative and local excision, where endoscopic removal is considered the treatment of choice (1). Oncocytic laryngeal cysts are benign lesions, but follow-up is recommended due to the risk of recurrence, especially in patients with multiple lesions (2).

3.1. Conclusions

In this paper, we reported two men referring with prolonged voice hoarseness. Medical assessments led to the diagnosis of oncocytic cysts in their vocal cords, which were removed by video laryngoscopy. Both patients were followed up after removing their laryngeal cysts and had no clinical symptoms since then.

References

  • 1.

    Salerno G, Mignogna C, Cavaliere M, D'Angelo L, Galli V. Oncocytic cyst of the larynx: An unusual occurrence. Acta Otorhinolaryngol Ital. 2007;27(4):212-5. [PubMed ID: 17957853]. [PubMed Central ID: PMC2640029].

  • 2.

    Dhingra JK, Aqel NM, McEwen J, Bleach NR. Multiple oncocytic cysts of the larynx. J Laryngol Otol. 1995;109(12):1226-8. [PubMed ID: 8551166]. https://doi.org/10.1017/s0022215100132529.

  • 3.

    Peeters A, Schmelzer B, Beernaert A, Fannes H. Oncocytic laryngeal cysts: A case report and literature review. Acta Otorhinolaryngol Belg. 2001;55(1):71-5. [PubMed ID: 11256195].

  • 4.

    Ugur Kilinc AN, Unlu Y, Yucel A. Laryngeal Oncocytic Cystadenoma with Rare Location and Clinicopathological Aspects. Head Neck Pathol. 2021;15(3):1004-6. [PubMed ID: 33048303]. [PubMed Central ID: PMC8384988]. https://doi.org/10.1007/s12105-020-01232-1.

  • 5.

    Robinson AC, Kaberos A, Cox PM, Stearns MP. Oncocytoma of the larynx. J Laryngol Otol. 1990;104(4):346-9. [PubMed ID: 2196316]. https://doi.org/10.1017/s0022215100112678.

  • 6.

    Holm-Jensen S, Jacobsen M, Thommesen N, Ferreira O. Oncocytic cysts of the larynx. Acta Otolaryngol. 1977;83(3-4):366-71. [PubMed ID: 857607]. https://doi.org/10.3109/00016487709128858.

  • 7.

    Ferlito A, Recher G. Oncocytic lesions of the larynx. Arch Otorhinolaryngol. 1981;232(2):107-15. [PubMed ID: 7271583]. https://doi.org/10.1007/BF00505029.

  • 8.

    Puttasiddaiah PM, Berry S, Whittet HB, Kumar M. Laryngeal oncocytic cyst presenting with an acute onset of stridor. Ear, Nose & Throat Journal. 2009;88(7):1003-4.

  • 9.

    Feinstein AJ, Peng KA, Bhuta SM, Abemayor E, Mendelsohn AH. Laryngeal oncocytic cystadenomas masquerading as laryngoceles. Am J Otolaryngol. 2016;37(1):17-21. [PubMed ID: 26700253]. https://doi.org/10.1016/j.amjoto.2015.09.010.

  • 10.

    Shaik FB, Chowdary KK. A Clinical Study of Laryngeal Cysts. International Journal of Phonosurgery & Laryngology. 2012;6(2):53-6.

  • 11.

    Burgos Sanchez AJ, Lafarga J, Galvan B, Talavera J, Trigueros M. [Presentation of multiple oncocytic type laryngeal cysts. Clinical and histopathological findings]. Acta Otorrinolaringol Esp. 2000;51(4):353-6. [PubMed ID: 10984961].

  • 12.

    Johns ME, Regezi JA, Batsakis JG. Oncocytic neoplasms of salivary glands: An ultrastructural study. Laryngoscope. 1977;87(6):862-71. [PubMed ID: 865204]. https://doi.org/10.1288/00005537-197706000-00002.

  • 13.

    Baris O, Savagner F, Nasser V, Loriod B, Granjeaud S, Guyetant S, et al. Transcriptional profiling reveals coordinated up-regulation of oxidative metabolism genes in thyroid oncocytic tumors. J Clin Endocrinol Metab. 2004;89(2):994-1005. [PubMed ID: 14764826]. https://doi.org/10.1210/jc.2003-031238.

  • 14.

    Newman BH, Taxy JB, Laker HI. Laryngeal cysts in adults: A clinicopathologic study of 20 cases. Am J Clin Pathol. 1984;81(6):715-20. [PubMed ID: 6731351]. https://doi.org/10.1093/ajcp/81.6.715.

  • 15.

    Stenner M, Muller KM, Koopmann M, Rudack C. Squamous cell carcinoma of the larynx arising in multifocal pharyngolaryngeal oncocytic papillary cystadenoma: A case report and review of the literature. Medicine (Baltimore). 2014;93(12). e70. [PubMed ID: 25211046]. [PubMed Central ID: PMC4616269]. https://doi.org/10.1097/MD.0000000000000070.

  • 16.

    Mettias B, Usanov A, Osborne J. Oncocytic cyst of the larynx: Precipitating factors and mode of treatment (case report). Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2012;13(2):91-3. https://doi.org/10.1016/j.ejenta.2012.03.002.

  • 17.

    Pilch BZ. Larynx and hypopharynx. In: Pilch BZ, editor. Head and neck surgical pathology. Philadelphia: Lippincott Williams & Wilkins; 2001.

  • 18.

    Erfanian R, Shakiba S, Nourbakhsh SMA, Sohrabpour S. Laryngeal oncocytic cyst: An uncommon incident. Case Reports in Clinical Practice. 2020. https://doi.org/10.18502/crcp.v4i4.2384.