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Laryngeal granuloma: characteristics of the covering epithelium
1Institute of Pathology, Medical Faculty, University of Ljubljana, Slovenia. luzar@ibmi.mf.uni-lj.si
Insights
The epithelium covering laryngeal granulomas shows reactive, reversible hyperplasia, not precancerous changes. Histological examination is crucial for accurate diagnosis of laryngeal lesions.
Area of Science:
- Laryngology
- Surgical Pathology
- Oncology
Background:
- Laryngeal granulomas are benign lesions.
- Epithelial changes overlying these lesions require characterization.
- The Ljubljana classification aids in reporting epithelial hyperplasias.
Purpose of the Study:
- To assess the biological behavior of the marginal epithelium in laryngeal granulomas.
- To evaluate the utility of the Ljubljana classification for reactive epithelial hyperplastic lesions.
- To determine if precancerous epithelial changes occur in laryngeal granulomas.
Main Methods:
- Retrospective analysis of 149 laryngeal granuloma biopsies.
- Histomorphological evaluation of epithelial changes.
- Classification using the Ljubljana system (normal, simple, abnormal, atypical hyperplasia, carcinoma in situ).
- Assessment of atrophic epithelium.
Main Results:
- Simple hyperplasia was the most common finding (65.8%).
- Atrophic epithelium was observed in 16.1% of cases.
- No atypical hyperplasia or carcinoma in situ were detected.
- Epithelial proliferation was reactive and reversible.
Conclusions:
- Epithelial changes in laryngeal granulomas are benign and reactive.
- The Ljubljana classification is applicable for reporting these lesions.
- Histological examination is essential to rule out malignancy mimicking granulomas.
Abstract:
The purpose of the present study was to evaluate the biological behaviour of the marginal epithelium, that proliferates and eventually covers laryngeal granulomas, and to reveal the applicability of the recently re-introduced Ljubljana classification when reporting reactive epithelial hyperplastic lesions. A retrospective clinical and histomorphological analysis was performed on 149 laryngeal granuloma biopsies. Epithelial changes were classified according to the Ljubljana classification into normal epithelium; simple, abnormal, or atypical hyperplasia; and carcinoma in situ. Atrophic epithelium, not evaluated separately in the Ljubljana classification, was additionally assessed. Simple hyperplasia was found in 98 cases (65.8 per cent), abnormal hyperplasia in seven (4.7 per cent), atrophic epithelium in 24 (16.1 per cent), and normal squamous epithelium in 20 (13.4 per cent). Atypical hyperplasia and carcinoma in situ were not observed. The results of our study clearly showed that the proliferation of the covering epithelium mostly in the form of simple hyperplasia, is entirely reactive and therefore reversible. No epithelial hyperplastic lesions were found that were previously described to be associated with an increased risk of malignant alteration, namely atypical hyperplasia and carcinoma in situ. However, since an initial growth of an invasive malignant neoplasm might macroscopically imitate the appearance of laryngeal granuloma, a histological examination in all aetiological forms of laryngeal granulomas is required. By clearly discerning the benign nature of epithelial changes in laryngeal granulomas, the recently re-evaluated and further formulated Ljubljana classification may also influence the clinical handling of patients.