Differential diagnosis of laryngeal cancer

Laryngeal cancer should be differentiated from the following diseases:

1. Nodular laryngitis

Also called vocal nodules, they are characterized by small intermittent hoarseness, which is aggravated at night and lighter in the morning, dryness and slight pain in the throat, and increased laryngeal secretions. They are more likely to occur at the junction of the front and middle 1/3 of the vocal cords. They are symmetrical mucosal nodules at the free edge, edema-like, smooth in surface, as big as rice grains, and with a wide base. Congestion during rest can reduce voice production, nebulization inhalation, ultrashort wave physical therapy, and appropriate antibiotic treatment are effective. Larger ones must be removed under laryngoscope.

2. Tuberculosis

Patients with laryngeal tuberculosis have varying degrees of sore throat, and most of them have tuberculosis lesions in the lungs. The lesions are granular, pink or pale edematous, often accompanied by shallow ulcers covered with purulent secretions. The posterior joint is a common site for laryngeal tuberculosis, while laryngeal cancer is rare. Anti-tuberculosis treatment is effective, and biopsy cytology and secretion smears to find acid-fast bacilli are helpful for diagnosis.

3. Laryngeal keratosis and laryngeal leukoplakia

The symptoms are hoarseness and discomfort in the throat. It is more common in middle-aged men. Laryngoscopy shows thickened vocal cords, which appear as pink or white patches. The surrounding tissues often have inflammatory reactions, which are mostly unilateral but can also affect both sides of the vocal cords. It is easy to relapse and has a tendency to become malignant. Pathological biopsy can confirm the diagnosis.

4. Laryngeal papilloma

This disease is common in children and can be seen in adults. It is currently believed to be caused by viral infection and is often complicated by skin warts, with no difference between men and women. The main manifestation is hoarseness. Laryngoscopy shows that children often have lesions in various parts of the larynx, with pedicles, a relatively wide base, and a cauliflower shape. Adults have a single pedicle, often in the vocal cords, with no restrictions on movement. It is more common in men, and the lesions are limited. When pathological examination shows severe atypical hyperplasia, it should be completely removed to prevent malignant transformation.

5. Laryngeal amyloidosis

Its clinical manifestations include mild hoarseness and sometimes wheezing-like dyspnea. The lesions often occur in the anterior part of the subglottic larynx, and may also occur in the ventricular zone and vocal cords. They present as single or multiple nodules, or diffuse thickening of the mucosa. The vocal cords are rarely fixed. The course of the disease is long. Pathological examination shows amyloid Congo red is positive, and the diffuse lesions are sensitive to corticosteroids.

6. Wegener's granulomatosis

The clinical manifestations of this disease are hoarseness, laryngeal ulcers, secondary infection, and often accompanied by dyspnea. The pathological tissue is necrotic granulation, vasculitis, and scattered giant cells and inflammatory cell infiltration, often accompanied by lung and kidney lesions. Pathological examination is required for diagnosis.

7. Benign mixed tumor of larynx

This disease is rare and originates from the minor salivary glands, occurring in the aryepiglottic folds or supraglottic region. The surface mucosa is smooth, the borders are clear, the tumor is solid, and the lateral neck X-ray shows a mass shadow with smooth borders. Pathological examination is of great significance for diagnosis.

8. Laryngeal tracheal thyroid gland

Rare, it is the growth of the thyroid gland through the cartilage into the trachea during the embryonic period, and it is more likely to occur in the subglottic area of ​​the trachea, with the tumor part outside the trachea. It often occurs in middle-aged women with endemic goiter, and is manifested as progressive dyspnea, which worsens during menstruation, normal voice, and soft tissue shadows protruding into the tracheal cavity on X-rays. 131 iodine scanning can show iodine absorption in the tumor area.