Report of a Case of Epithelioma 
and of one of Sarcoma of 
the Larynx. 
BY 
ARTHUR AMES BLISS, A. M., M. D., 
PHILADELPHIA. 
REPRINTED PROM THE 
Neto ¥orft jfHetJfral .Journal 
for November 10, 1894• Reprinted from the New York Medical Journal 
for November 10, 189If. 
REPORT OF A CASE OF 
EPITHELIOMA AND OF ONE OF SARCOMA 
OF THE LARYNX* 
By ARTHUR AMES BLISS, A. M., M. D., 
PHILADELPHIA. 
Case I. Squamous E2>ithelioma of the Larynx.—William B., 
aged forty-six years, married ; printer. The family history of 
this patient was good, nor was there evidence of syphilitic in- 
fection. Tobacco, in the form of pipe-smoking, had been used 
in great excess. 
The first symptoms which called the patient’s attention to 
disease within the larynx originated about two years ago. It 
was then noted that the voice was slightly hoarse. This 
hoarseness increased steadily and was associated with slight 
soreness, which the patient could not locate exactly, but which 
he referred to the hyoid and subhyoid region. Gradually, inter- 
ference with respiration developed and the lymphatic glands of 
the neck—most markedly on the left side—became hard and 
swollen. The three conditions of hoarseness, enlargement of 
the lymphatics, and dyspnoea notably increased, until, when 
the patient was first seen by me at the German Hospital, the 
act of inspiration was most difficult and the voice scarcely 
* Read before the American Laryngological Association at its six- 
teenth annual congress. 
Copyright, 18SM, by D. Appleton and Company, 2 
EPITHELIOMA AND SARCOMA OF THE LARYNX. 
above a hoarse whisper. The conditions seen in the laryugeal 
mirror will he described later. 
The patient delayed operative treatment until it was forced 
upon him by the extreme gravity of his condition. I per- 
formed tracheotomy in the high position, opening the first two 
rings of the trachea. This location was selected in preference 
to a lower opening, because of my expectation that consent 
would be gained for the performance of an operation for the 
removal of the growth at some subsequent time. 
The patient’s urine contained a considerable amount of 
albumin but was free from casts. As the heart sounds indi- 
cated atheroma, being weak and irregular, though free from 
valvular murmurs, we used ether as the anaesthetic. At about 
the completion of the first stage of etherization the patient's 
glottis closed tightly. No air entered the chest, the face be- 
came cyanosed, and the man was apparently moribund. This 
rendered a very rapid operation necessary. I am uncertain 
whether the closure of the glottis was due to spasm induced 
by the local irritation of the ether or was caused by accumula- 
tion of secretion from the growth. The patient remained in 
the hospital for about four weeks. At no time during this 
period could we have attempted a radical operation, as he was 
exceedingly weak and was liable to attacks of angina pectoris. 
Respiration was good, the general condition improved, and the 
man was on the point of leaving the hospital. The morning 
before the day chosen for his departure, however, he had an 
attack of angina pectoris and died suddenly from heart failure. 
The view obtained by the laryngeal mirror revealed a large, 
swollen, partly oedematous mass of tissue occupying the seat of 
the left aryttenoid, and involving the ventricular hand of the 
same side. The left vocal cord was not visible, as it appeared 
to lie beneath the swelling. The right cord was seen clearly, 
appeared to be free from disease, and its movements, though 
much restricted by the presence of the swelling on the left side, 
were normal. The swelling itself extended so far beyond the 
median line, howrever, that the right cord was forced into a 
position cf semi-abduction. Below the level of the cords I 
could not obtain a view, and had no exact idea of th e condi- EPITHELIOMA AND SARCOMA OF THE LARYNX. 
3 
tions existing there. Externally, there was no abnormal widen- 
ing or stretching of the thyreoid cartilage. At no time did 
the patient complain of pain during deglutition. 
As a result of the autopsy I am able to present the larynx 
and also a very good photograph of the specimen. A large 
Squamous epithelioma of the larynx. Case I, William B 
area of granulation tissue is to be noted, extending from 
the location of the apex of the left arytsenoid cartilage, over 4 
EPITHELIOMA AND SARCOMA OF THE LARYNX. 
the entire left side of the larynx, extending as low as the in- 
ferior border of the cricoid cartilage. The left vocal cord has 
disappeared entirely. A probe passed through sinuses in the 
posterior part of this area which led into a sac between the 
larynx, in its left postero-lateral part, and the oesophagus. In 
this locality, within the cellular tissue between larynx and 
oesophagus, was a large abscess filled with greenish pus. The 
oesophageal walls appeaaed to be free from disease. 
It would seem that the localization of this lesion to the 
left half of the larynx, and the fact that the wall of the 
oesophagus was not involved, would have rendered this case 
a favorable one for partial laryngectomy. The patient’s 
family did not regard this operation with favor, nor was 
his general condition such as to encourage me in attempt- 
ing this procedure. The autopsy showed the lungs to be 
normal. The pericardium was thickened, the heart mus- 
cle fatty, but the valves normal. The kidneys showed 
chronic parenchymatous nephritis. 
Case IT. Small Round-cell Sarcoma.—John H., aged fifty- 
five years, married; laborer. 
Family and personal histories are good. There is no 
evidence of syphilis. Tobacco, in the form of pipe smok- 
ing, he has used in excess, smoking fifteen to twenty “pipe- 
fuls ” daily, using, most commonly, a clay pipe. He has 
been a steady whisky-drinker, but showed no evidence of al- 
coholism. 
About eighteen months before admission to the German 
Hospital the patient began to be annojed by sensations of 
swelling within the throat, associated with hoarseness. Shortly 
after the onset of these symptoms the lymphatics below the 
angles of the jaw became enlarged. Six months before admis- 
sion interference with respiration began to be noted; inspira- 
tion was attended with stridor ; dyspnoea became very marked 
upon exertion; the patient suffered greatly at night from occa- 
sional attacks of suffocation, which increased rapidly in fre- 
quency and severity. EPITHELIOMA AND SARCOMA OF THE LARYNX. 
5 
At my first examination I found the pharynx normal. The 
epiglottis was covered with a large fungoid mass which had 
altered its shape completely, and which caused such enlarge- 
ment of the part as to render a view of the vocal- cords impos- 
sible. Portions of the arytaenoid cartilages could be seen. The 
right arytsenoid was swollen and cedematous. Externally'there 
was no swelling over the thyreoid cartilage, but the suprahyoid 
tissues were much swollen, while the lymphatic glands at the 
angles of the jaw were greatly enlarged and of almost stony 
hardness. This condition was most pronounced upon the right 
side. Much pain was complained of, extending along the 
course of the right Eustachian tube. The patient’s voice was 
reduced to a harsh-sounding whisper, occasionally breaking into 
a hoarse, resonant note. No relief to the symptoms followed 
the use of potassium iodide and mercury. Dyspnoea became so 
severe as to endanger the patient’s life. A radical operation 
was refused, hut the patient consented to tracheotomy. I per- 
formed the high operation, hoping that consent would be ob- 
tained for a more radical procedure later. Naturally, great re 
lief followed the insertion of the cannula, but the patient was 
not to be persuaded to allow an operation for the removal of 
the growth. He lived for a year after the tracheotomy, con- 
tinuing to wear the cannula, and died from exhaustion. His 
family would not allow a post-mortem examination to he made. 
A large piece of the granulation tissue, removed by a Macken- 
zie forceps from the epiglottis, was examined by Dr. Stengel, 
pathologist of the hospital, and the growth was pronounced to 
be a small round-cell sarcoma. 
The patient never showed symptoms suggesting that the 
oesophagus was involved. 
Both of these cases of laryngeal neoplasms, so far as 
the local conditions were concerned, appeared to be favorable 
for partial laryngectomy ; yet how much this operation 
would have prolonged life in excess of that gained by 
tracheotomy is very doubtful. Dyspnoea of an alarming 
degree never occurred in either case after the insertion of 
the cannula. The case of sarcoma appeared to terminate 6 
EPITHELIOMA AND SARCOMA OF THE LARYNX. 
in the normal way for such conditions. From all appear- 
ances the case of epithelioma would have continued living 
for an indefinite number of months had there been no car- 
diac or nephritic disease. My thanks are due to Dr. Sten- 
gel for his examinations and reports and to Dr. Fage and 
Dr. Hand, residents of the hospital; to the former, for 
notes of the case of epithelioma and for preparation of the 
specimen; to the latter, for his excellent photograph of the 
larynx. 
May 24, 1894. The New York Medical Journal. 
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