Larynx contact ulcer.A larynx contact ulcer, also known as a pyogenic granuloma, is a benign lesion that is most common among adult men. Patients present with hoarseness and/or throat pain, and they often experience chronic throat-clearing or habitual coughing. Contact ulcer is associated with vocal abuse, intubation intubation /in·tu·ba·tion/ (in?too-ba´shun) the insertion of a tube into a body canal or hollow organ, as into the trachea. endotracheal intubation , and acid regurgitation regurgitation /re·gur·gi·ta·tion/ (re-ger?ji-ta´shun) 1. flow in the opposite direction from normal. 2. vomiting. . Intubationinduced contact ulcer is more common among females, especially in an emergent setting when an inappropriately sized endotracheal tube has been placed. Gastrolaryngeal reflux or gastroesophageal reflux disease gastroesophageal reflux disease (GERD) Disorder characterized by frequent passage of gastric contents from the stomach back into the esophagus. Symptoms of GERD may include heartburn, coughing, frequent clearing of the throat, and difficulty in swallowing. (GERD GERD gastroesophageal reflux disease. GERD abbr. gastroesophageal reflux disease GERD ) is frequently missed because physicians do not correlate the nonspecific gastric symptoms with the laryngeal symptoms. A hiatal hernia, peptic esophagitis, or gastritis can cause acid reflux, usually during sleep, thereby leading to the development of a contact ulcer without the cause being obvious to the patient. Contact ulcer usually appears as an ulcerated Ulcerated Damaged so that the surface tissue is lost and/or necrotic (dead). Mentioned in: Adenoid Hyperplasia , polypoid, or nodular mass (figure, A), and it most often involves the posterior vocal fold. Lesions are red to tan-white, as large as 3 cm, and frequently involve both vocal folds ("kissing ulcer"). [FIGURE A OMITTED] The surface is ulcerated and covered by fibrin and/ or fibrinoid necrosis overlying overlying suffocation of piglets by the sow. The piglets may be weak from illness or malnutrition, the sow may be clumsy or ill, the pen may be inadequate in size or poorly designed so that piglets cannot escape. an exuberant granulation tissue. The vessels in the granulation tissue are lined with plump reactive endothelial cells, which are surrounded by acute and chronic inflammatory cells and histiocytes (figure, B). With the progression of time, the chronic phase of the disease may include the development of an irregular hyperplastic epithelium resulting from the regenerative surface reepithelialization. A residuum That which remains after any process of separation or deduction; a balance; that which remains of a decedent's estate after debts have been paid and gifts deducted. offibrinoid necrosis is still identified below the surface (figure, C). [FIGURE B-C OMITTED] The diagnosis of contact ulcer is usually based on both clinical and pathologic findings, as the histologic findings are often nonspecific. The correct diagnosis allows for the appropriate identification and removal of the specific cause, which can obviate the morbidity associated with surgery. Suggested reading Thompson LD. Diagnostically challenging lesions in head and neck pathology Head and Neck pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the neck, scalp, face, ears, paranasal sinuses, nasal cavity, oral cavity, salivary glands, pharynx, and larynx. . Eur Arch Otorhinolaryngol 1997;254:357-66. Wenig BM, Heffner DK. Contact ulcers of the larynx. A reacquaintance with the pathology of an often underdiagnosed entity. Arch Pathol Lab Med 1990; 114:825-8. From the Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, Calif. |
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