Management of Laryngeal Leiomyoma
Complete surgical excision is the definitive treatment for laryngeal leiomyoma, with endoscopic resection preferred for small, well-circumscribed tumors to minimize tissue damage and optimize functional outcomes. 1, 2, 3
Diagnostic Confirmation
- Laryngeal leiomyomas present as submucosal masses, most commonly in the supraglottic region (58%), followed by glottic (29%) and subglottic (13%) locations 3
- The tumor appears as a smooth, encapsulated mass covered by normal mucosa with dilated vessels on the surface 2, 3
- Histopathologic confirmation is essential, showing well-differentiated smooth muscle bundles with numerous variform blood vessels, lacking mitosis, and positive immunoreactivity for smooth muscle actin and desmin 2, 3, 4
- Tissue sampling via FNA or FNB can be useful to distinguish leiomyoma from GIST, as asymptomatic leiomyomas generally do not require surveillance or resection 5
Surgical Approach Selection
For Small, Well-Circumscribed Tumors
- Endoscopic complete surgical excision with dissection along the capsule is the gold-standard treatment 1, 3
- CO2 laser technology is preferred for transoral resection, resulting in reduced bleeding, adequate hemostasis, less tissue damage, and good functional outcomes 1
- Direct laryngoscopy with tumor removal under general anesthesia is effective for accessible lesions 2
For Larger or Less Accessible Tumors
- External incision approach effectively prevents intraoperative hemorrhage and postoperative recurrence 3
- Preoperative embolization can be considered to facilitate transoral resection by reducing vascularity 3
Critical Surgical Principles
- Complete tumor removal with careful attention to the fibrous capsule is mandatory 2, 3
- Meticulous hemostasis is essential due to the vascular nature of these tumors 2, 3
- Surgical excision should aim for tumor-free margins while preserving laryngeal function 5
Postoperative Management
- Recurrence is rare after complete excision 2
- Long-term follow-up is necessary, particularly for epithelioid variants which have shown occasional malignant behavior in other anatomic sites 4
- No adjuvant radiation therapy is indicated for benign leiomyomas 5
Important Caveats
- Do not confuse benign leiomyoma with leiomyosarcoma, which requires aggressive surgical management and postoperative radiation, though it has poor prognosis with high metastatic potential 6
- Avoid incomplete excision, as this may lead to recurrence 3
- The male-to-female ratio is approximately 4:1, with peak incidence between ages 40-60 years 3
- Hoarseness is the most common presenting symptom, though patients may also report pharyngeal narrowing or positional dyspnea 2, 3