Laryngeal cysts in infants and children-A pathologist's perspective (with review of literature)

Objectives: To expose the rarity of the phenomena of congenital laryngeal cysts. Additionally, a discussion is presented in support of the basic similarities between laryngeal duplication cyst and bronchogenic cyst and a proposal to use the term 'bronchogenic cyst' (appended by the location) is put forth. Materials and methods: Three cases of cysts of the larynx, two in the neonate and one, in a child were discovered in the pediatric age group from the archives of the Department of Pathology, Kasturba Medical College, Mangalore. Observations: Laryngeal duplication cyst/bronchogenic cyst in a 6-day-old male infant was lined by predominantly respiratory with focal squamous epithelium. The wall contained fibromuscular bundles within a myxoid stroma studded with seromucinous glands. The fibromuscular bundles were positive for smooth muscle actin (SMA) and negative with desmin. A 3-year-old male child diagnosed of laryngocele had the cyst lined by respiratory epithelium and the wall densely infiltrated with lymphoid cells. A 20-day-old male neonate with laryngomalacia had a small arytenoid cyst lined by squamous epithelium. Conclusion: On morphological grounds, a laryngeal duplication cyst may be called a bronchogenic cyst and published reports do not deny that both these entities are cognate. Hence, pathologists should enjoy the freedom to write 'bronchogenic cyst' as the final impression if the histological features should so indicate. Otolaryngologtists however might term the congenital cyst as Type 1, 2a or 2b (according to Forte's classification) taking into account the laryngoscopic, radiologic, intraoperative and pathological findings.