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Clinical Problem Solving: Pathology
February 15, 2010

Pathology Quiz Case 1: Diagnosis

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(2):206-207. doi:10.1001/archoto.2009.227-b

Laryngeal cysts are uncommon, generally benign lesions that can affect all age groups. The cysts, which may be congenital or acquired, are often classified according to the system introduced in 1983 by Newman et al,1who classified them on the basis of the epithelial lining rather than on the anatomical subsite because they believed that the epithelial lining better reflected the cysts' clinical behavior. According to this classification, there are 2 main types of epithelial laryngeal cysts: (1) those lined by ductal epithelium, which arise from the obstruction of a mucous duct and can involve any structure in the larynx except for the free edge of the true vocal cord, and (2) those lined by respiratory epithelium, which most commonly arise in the saccule and are often submucosal and located at the anterior ventricle or the vestibular and arytenoepiglottic folds. Furthermore, Newman and coauthors classified cysts whose epithelial lining was oncocytic as a distinct subtype. It has been suggested that oncocytic epithelium in the larynx is in transition from metaplasia to neoplasia.2However, oncytosis is now recognized as a purely metaplastic change that can develop in any cyst type, sometimes in association with inflammation, a degenerative process, or cellular aging, and probably results from mitochondrial DNA mutation.3In the larynx, oncocytic metaplasia is a common change in seromucous glands as well as in their ducts and the cysts derived from them.4Multifocal oncocytic change with enough cysts to be clinically evident is uncommon.

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