Lymphangioma of the Vallecula

Autor: James T. Castle
Rok vydání: 2010
Předmět:
Zdroj: Head and Neck Pathology. 5:20-22
ISSN: 1936-0568
1936-055X
DOI: 10.1007/s12105-010-0230-2
Popis: HistoryA 47 year-old male presented with a chief complaint ofrecurrent neck pain, as well as a ‘‘shooting pain’’ whichtraveled down his arms whenever he coughed or sneezed.Radiographic FeaturesAn axial T2-weighted magnetic resonance imaging studyof the current case (Fig. 1) revealed a small mucosal basedlesion which appeared to be at the level of the left lingualtonsil and involved the vallecula. This mass appeared to beintruding on rather than arising from the vallecula.DiagnosisThe hematoxylin and eosin stained surgical specimen(Fig. 2) is composed of variably dense fibrovascular stromanotable for numerous ovoid and irregularly shaped vesselscontained within. The vessels are lined by unremarkable,flattened endothelial cells which are widely separated. Thesupporting collagenous stroma along with the thin lining,occasionally form into thin papillations which projectslightly into the luminal space. High power view (Fig. 3)shows thin septations separating the luminal space intocompartments which contains thin, frothy, eosinophilicproteinaceous material as well as numerous lymphocytes.These vascular spaces remain superficially placed and donot dissect deep into the connective tissue.DiscussionLymphangiomas are rare congenital lesions of the lym-phatic system that occur mainly within the head and neck,particularly in the posterior triangle, but are commonlyfound within the oral cavity as well [1]. Based on the sizeof the cavities that are involved in the lesion, classificationis separated into variants termed capillary, cavernous, andcystic hygroma. Multiple patterns are frequently noted tobe within the same lesion. Capillary and cavernous variantsof lymphangioma are confined within dense structural tis-sue areas whereas, cystic hygroma occur where expansioninto large, loculated, cystic spaces can develop, such aswithin the neck [2].Involvement of lymphangioma within the larynx isusually the result of direct extension of a congenital lesionoriginating within the neck, although cases of isolated lar-yngeal lymphangiomas have been reported as rare entitiesarising in children and adults [3–8]. The most commonlocation is in the supraglottis within the epiglottis, aryepi-glottic folds and arytenoids [8]. Being difficult to diagnoseunless the lesion is allowed to grow to a large size, symp-toms are non-specific until dyspnea, dysphagia, or a voicechange signals a need for further clinical investigation.The histologic differential diagnosis would includehemangioma and possibly metastatic papillary cystic thy-roid carcinoma. Great histologic similarity exists betweenlymphangioma and hemangioma as both can be capillarysized and show a thin endothelial lining, but in hemangi-oma, the endothelial cells may appear plumper. Lymphan-giomas occasionally show short papillations projecting a
Databáze: OpenAIRE
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