Vascular Leiomyoma of the Larynx:

Background: We conducted a review of the literature to investigate the clinical presentations and histopathologic findings of laryngeal vascular leiomyomas. Method: We retrospectively analyzed 24 cases of vascular leiomyomas of the larynx. Results: Vascular leiomyoma of the larynx is a very uncommon tumor with only 24 cases reported in the literature. Of the 24 cases, the male/female ratio was 19/5. The patients were from 11 to 78 years old, and nearly half of the patients (11/24) were between the ages of 40 and 60. The tumor occurrence sites varied, with the supraglottic region being most common (14/24), followed by the glottic region (7/24) and the subglottic region (3/24). A common symptom of laryngeal leiomyoma is hoarseness of voice. The tumor is submucosal with dilated vessels on the surface. Histopathologically, the tumor cells are composed of numerous variform blood vessels lacking mitosis and well-differentiated smooth muscle bundles. Complete surgical excision is the most commonly recommended treatment. Conclusions: Vascular leiomyoma is a benign tumor. External incision effectively prevents hemorrhage during the operation and reReceived: June 29, 2007 Accepted after revision: October 25, 2007 Published online: May 19, 2008 Shuihong Zhou Department of Otolaryngology, the First Affiliated Hospital College of Medicine, Zhejiang University Hangzhou, Zhejiang 310003 (PR China) Tel. +86 131 8421 5850, Fax +86 571 8723 6628, E-Mail [email protected] © 2008 S. Karger AG, Basel 0301–1569/08/0704–0264$24.50/0 Accessible online at: www.karger.com/orl D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /5 /2 01 7 12 :0 0: 30 P M Vascular Leiomyoma of the Larynx ORL 2008;70:264–267 265 also revealed a same-sized soft tissue mass under the surface of the anterior third of the left true vocal cord. The tumor was resected using semiconductor laser by suspension microlaryngoscopy. Intraoperative bleeding was minimal. The postoperative period was uneventful. Subsequent histopathology demonstrated a vascular leiomyoma. The patient is disease-free after a follow-up of 9 years. Case 2 A 47-year-old male patient, who was admitted in August 1998, complained about a 6-year history of foreign body sensation in his throat and new dysphagia for the 2 months prior to admission. Stroboscopy revealed a pink smooth submucosal mass with many dilated vessels in the right aryepiglottic fold. The right true vocal fold could not be clearly visualized. The remainder of his ENT examination was normal. The patient underwent tracheotomy. Complete excision of the tumor was performed by lateral neck incision ( fig. 2 ). The postoperative course was uneventful. Histopathology demonstrated a vascular leiomyoma. No recurrence or malignant transformation has been detected during an 8-year follow-up. Case 3 A 62-year-old male patient, complaining about a globus feeling in the throat, visited a county hospital in April 2003. Physical examination revealed a red mass on the lingual surface of the epiglottis. An indirect laryngoscopy and biopsy of the lesion was performed on the patient, and a complicated significant hemorrhage from the nutrient artery occurred with a total of 300 ml blood loss. After the bleeding had been controlled by an emergency tracheotomy and local hemostasis, the patient was transferred to our department. Histopathologic report of the biopsy from the county hospital demonstrated a vascular leiomyoma ( fig. 3 ). Another indirect laryngoscopy in our department revealed a 15 ! 10 mm mass with no evidence of active bleeding. Three days after hospital transfer, the patient experienced a sudden hemorrhage of about 500 ml, which induced a hemodynamically unstable situation with blood pressures in the range of 97/67 mm Hg. Fig. 1. Stroboscopy showing the 3 ! 2 mm polypoid mass in the anterior third of the left vocal cord and lack of dilated vessels on the tumor surface. Fig. 2. Intraoperatively, the mass was about 2 ! 3 cm, locating on the right aryepiglottic fold, and was completely removed. Fig. 3. Epiglottis vascular leiomyoma: composed of blood vessels and smooth muscle fibers, which are seen surrounding the vessels, and some mucous degeneration was observed, accompanied by infiltrating of lymphocytes and eosinophil cells. HE. ! 100. D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /5 /2 01 7 12 :0 0: 30 P M Xu/Zhou/Wang ORL 2008;70:264–267 266 An emergency surgery by lateral neck incision was performed to remove the tumor and the patient was discharged 2 weeks later without further complications. No recurrence or malignant transformation has been detected during a 3-year followup.