Clin Exp Otorhinolaryngol.  2010 Sep;3(3):166-171.

Schwannoma Mimicking Laryngocele

• Park KT
• Ahn Y
• Kim KH
• Kwon TK

Abstract

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.

Keyword

Schwannoma; Neurogenic tumor; Larynx

MeSH Terms

Diagnosis, Differential
Laryngocele
Larynx
Neurilemmoma
Pyriform Sinus
Tracheostomy

Figure

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  Fig. 1 The preoperative laryngsocpic findings. In case 1, there was a bulging mass noted at the left pyriform sinus on laryngoscopy (A). In case 2, a bulging mass at the left false vocal fold was seen (B).

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  Fig. 2 Neck CT and MRI of the laryngeal schwannomas. In case 1, about a 2cm sized low density lesion in the left supraglottic larynx was seen and the lesion contained a small ring-like calcific density. The MRI scan showed an iso-intense signal on the T1-weighted image and a well defined border in the larynx and minimal contrast enhancement on the T2-weighted image (A). In case 2, a 2.2×1.7 cm sized benign-looking mass was noted in the left larynx and the mass showed heterogenic density with focal enhancement on the CT scan. The T1-weighted image showed an iso-intense signal and the T2-wieghted scan showed a well-defined submucosal tumor that was highly enhanced (B).

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  Fig. 3 The intraoperative finding of case 2. The incision was marked on the thyroid cartilage (A). The laryngeal schwannoma was dissected by fingers through the lateral thyroid window (B). The thyroid cartilage was reapproximated (C).

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  Fig. 4 The histologic findings of the schwannoma in case 2. The mass had a yellowish color and it had a well capsulated sursolid form (A). The schwannoma cells were organized in compact bundles with the nuclei arranged in a palisade manner (Antoni type A) and the cells were partly dispersed with loose reticular fibers (Antoni type B) (B: H&E, ×100; C: H&E, ×400). The schwannoma cells showed immunoreactivity for S-100 protein (D: Immunohistochemistry).

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