The most frequent form of tumour of the larynx is the Papilloma. This tumour is often preceded by catarrhal conditions, and is particularly common in persons who, from the nature of their profession, use the voice frequently. But it often occurs without either of these predisposing conditions. The tumours most frequently grow from the vocal cords, where the epithelium is flat. They consist, like other papillomas, of a basis of connective tissue forming numerous conical projections covered with epithelium (see Fig. 353). The epithelium may be thick, and the connective tissue dense, so that the tumour is like a hard wart, or the epithelium may be thin and the connective tissue soft, sometimes richly infiltrated with round cells, and so the growth is soft like a soft wart or condyloma. The growth may occupy a small surface of the cord, being partially pedunculated, but it often has a considerable base, forming a shaggy, irregular outgrowth.

Fig. 358. - Papilloma of larynx, e, e, greatly thickened epithelium; h. connective tissue; g, mucous glands; f, a gland at base of tumour atrophied by its pressure, x 20. (Cornil and Ranvier).

A kind of false papilloma occurs, as we have already seen, in some cases of tubercular or syphilitic ulceration of the larynx. Sometimes, also, the surface of an epithelioma has a papillary character.

Next to the papillomas the Fibromas are the commonest tumours in the larynx. Morell Mackenzie has found in one hundred cases of non-malignant tumours, sixty-seven papillomas and sixteen fibromas. They are tumours of slow growth, mostly seated on the cords or at the base of the epiglottis. They consist of firm or soft connective tissue, those of firm consistence being the commoner. They are usually more or less pedunculated, and their surface is generally smooth, although it may be irregular or even furnished with papillae. They are usually small tumours from the size of a split pea to that of an acorn.

Mucous polypi occasionally occur, but are much less frequent than in the nares. They very commonly undergo transformation into cysts, and their most frequent seats are the epiglottis and the ventricles of Morgagni.

Other forms of simple tumours are uncommon, but cases of Lipoma, Myxoma, and Angioma have been recorded. Cartilaginous tumours formed by outgrowth from the normal cartilages have been found. They are usually multiple and sessile. They may project considerably into the larynx, and, being covered with mucous membrane, may be mistaken for one of the commoner tumours mentioned above.

Sarcomas of the larynx are of occasional occurrence. They are usually of the spindle-celled form, but may be round-celled. They may grow to a considerable size, and are, of course, prone to recur unless the whole larynx be removed along with the tumour.

Cancer of the larynx occurs chiefly in the form of flat-celled Epithelioma, growing usually from the ventricular bands, but also originating in other parts. There is first a limited infiltration which extends in area, and gradually advances, involving the parts indiscriminately. Very commonly there is an abundant papillary growth on the surface so that there is a resemblance to the cauliflower cancer or to the papilloma. The central parts of the growth undergo ulceration while the disease is extending at the periphery. In this way great destruction of tissue may result, and the parts present great deformity. An epithelioma may also extend from a neighbouring part, particularly from the tongue.

Tumours are of very rare occurrence in the trachea.

Foreign bodies and parasites are very uncommon in the larynx; they give rise to violent expulsive efforts by coughing. Various articles may pass into the larynx, especially in children, such as buttons, peas, pieces of food, etc. Round worms have been known to lodge there. If a foreign body lodges in one of the pouches of the larynx it will excite inflammation.

Literature

Very full account by Eppinoer, in Klebs' Handb. d. path. Anat.,. Part vii., 1880 (also literature); Ziemssen, Handbuch, iv.; Morell Mackenzie, Dis. of throat and nose, i., 1880; Lennox Browne, Throat and its diseases, 1878. Diphtheria - Home, On Croup, 1765; Bretonneau, Des inflam. du tis. muqueux,. 1826; Virchow, Virch. A»ch., i.; Bartels, D. Arch. f. klin. Med., 1867, ii.; Kindfleisch, Path. hist. (Syd. Soc), 1872, i.; Wagner, Arch. d. Heilk., vii. and viii.; Weigert, Virch. Arch., lxx., lxxii., lxxix.; Trousseau, Clin. med. (Syd. Soc), 1869, vol. ii.; Zahn, Beitr. zur path. Hist, der Diphth., 1878; Mackenzie, Diphtheria, 1879; Barclay, in Holme's Syst. of Surg., 1883; Russell, (Sub-glottic infl.) Glasg. Med. Jour., iii., 1871; Monro and Workman, (Poisoning by gaseous ammonia) Glasg. Med. Jour., vol L, 1898, p. 343. Syphilis and Tuberculosis - Bumstead, in Gerhardt's Handb. d. Kinderkr., iii.; Lang, Vorles. ub. Syph., 1885; Turck, Atlas d. Kehlkopfkr.; Semon, (Congen. syph.) Path, trans., xxxi., 41; Barlow, ibid., 46; Hunter Mackenzie, Edin. Med. Jour., 1883, i.; Coats, Gairdner and Coats, Lect. to pract., 1888. Tumours - Morell Mackenzie, Essay on growths in larynx, 1876, also Dis. of throat and nose; Fauvel, Malad. du larynx, 1877; Bruns, Kehlkopfpolypen, 1873 and 1878; Schrotter, Vorles. tiber d. Krankh. d. Luftrohre, 1896.