Salivary Gland Choristoma of the Larynx

Address for Correspondence: Dr. Recep Bedir, Department of Otorhinolaryngology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey Phone: +90 464 213 04 91 e-mail: [email protected] Received: 27 May 2016 Accepted: 12 December 2016 • DOI: 10.4274/balkanmedj.2016.0657 Available at www.balkanmedicaljournal.org Cite this article as: Yılmaz R, Bedir R, Şehitoğlu İ, Dursun E. Salivary Gland Choristoma of the Larynx. Balkan Med J 2017;34:288-9 ©Copyright 2017 by Trakya University School of Medicine / The Balkan Medical Journal published by Galenos Publishing House. To the Editor, Choristoma is defined as the presence of histologically normal cells in abnormal locations due to defects during embryological development (1). The criteria for the diagnosis of choristoma are a tumour-like growth, an ectopic tissue with a normal pattern and without neoplastic features histologically, and a mislocated tissue topographically. It is different from hamartoma because the hamartoma appears in normal locations. Laryngeal choristomas are rare lesions and are usually relevant to glial or thyroid tissues (2). Salivary gland choristomas (SGC) in the cheek, middle ear, neck, jaw, thyroid gland, pituitary gland, mediastinal lymph nodes, breast, anterior chest wall, oesophagus, duodenum, jejunum, rectum and amygdala have been reported (3). However, SGC of the larynx is very rare (4). A 43 year-old male patient was referred to our hospital with the complaint of hoarseness and productive coughing for six months. The patient had been smoking cigarettes for 15 years (20 cigarettes per day), but did not consume alcohol. There was neither intubation history nor any other previous history of laryngeal trauma in the patient's past. Written informed consent was obtained from the patient. Laryngoscopic examination was performed, which revealed the presence of a lesion on the anterior region of the left vocal cord. The lesion was 0.5 cm in size and had a polypoid appearance (Figure 1). The lesion was completely removed by direct suspension laryngoscopy. Macroscopically, the lesion was about 0.5 cm in diameter, soft and polypoid. Microscopically, the mucosa was intact and there were no dysplasia, mitoses or any other signs of malignancy in the squamous epithelium. A choristoma-heterotopic salivary gland tissue was found under the normal epithelium (Figure 2). The lesion was composed of salivary gland acini (Figure 3). With these morphological findings, the case was reported as a SGC. SGCs are infrequent benign lesions. Only two cases have been described in the literature to date (2,4). The pathogenesis of this entity is still uncertain and is related to developmental anomalies. The differential diagnoses of these masses in the larynx comprise benign lesions such as laryngeal cyst, laryngeal nodules, contact ulcers, squamous papilloma, amyloidosis or granulomatous lesions such as Wegener's granulomatosus, sarcoidosis and tuberculosis (2). These conditions can be excluded by careful histopathological examination. Simple excision is sufficient for the treatment of these lesions. SGC should also be differentiated from some infrequent malignant lesions. Some of these lesions are primary laryngeal adenocarcinomas, metastatic adenocarcinoma, salivary glandular tumours like acinic cell carcinoma, mucoepidermoid carcinoma or adenoid cystic carcinoma of the larynx. These uncommon tumours are also located in other areas (5). Surgical excision is 1Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey 2Department of Otorhinolaryngology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey Rukiye Yılmaz1, Recep Bedir1, İbrahim Şehitoğlu1, Engin Dursun2