SESSION TYPE: Airway Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Extranodal laryngeal lymphomas are exceedingly rare, with less than 100 cases described in literature.#3We present a case encountered in clinical practice.
CASE PRESENTATION: A 56 y/o non smoking Caucasian male with history of Hashimoto’s thyroiditis, coronary artery disease with multiple coronary stent procedures, presented with a 6 weeks of hemoptysis, voice hoarseness, dysphagia and foreign body sensation in throat. Labs showed microcytic hypochromic anemia and markedly elevated TSH levels. CT scan of the chest did not reveal any focal infiltrates or masses. An echocardiogram confirmed an EF of 15-20% with global hypokinesis. Direct laryngoscopy did not demonstrate a supraglottic lesion. Flexible fiberoptic bronchoscopy revealed a circumferential submucosal, subglottic mass protruding into the lumen with partial airway obstruction.No other endobronchial lesions were appreciated. Endobronchial biopsies, although suspicious for squamous cell carcinoma, did not immunostain with neuroendocrine or squamous markers but were positive for CD20 and HLA markers, confirming the diagnosis of diffuse large B cell lymphoma with aggressive features. A PET scan confirmed only laryngeal involvement. The patient subsequently underwent tracheostomy followed by chemotherapy with R-CVP. Doxorubicin was held because of his history of ischemic cardiomyopathy and recommendations made for consolidative radiation therapy. PET/CT scan post chemotherapy showed complete resolution of the subglottic mass.
DISCUSSION: Differential diagnoses for this patient included thyroid lymphoma given his history of Hashimotos thyroiditis. Extranodal NHL of larynx account for less then 1% of laryngeal neoplasms.#3.Symptomatology includes, hoarseness, dysphagia, dysphonia, cough, haemoptysis, forgein body sensation and stridor. Diagnosis is by biopsy, immunohistostaining and flow cytometry. If required, airway should be secured followed by definitive management with chemotherapy or radiation. Resection as in most other cases of submucosal laryngeal lesions, is relatively contraindicated, unless sever airway obstruction encountered on diagnosis.
CONCLUSIONS: Malignant laryngeal lymphomas are a rare cause of airway compromise, however they should be considered among differentials, as management is different from other laryngeal lesions. Radiation and chemotherapy are most commonly advocated therapies for laryngeal lymphomas worldwide.#2
1) Ansell SM,Habermann TM, Hoyer JD, Strickler JG, Chen MG, Mc Donald TJ:Primary laryngeal lymphoma:The Laryngoscope 107:November1997
2) Rosenthal EL;Primary laryngeal lymphoma:reoprt of 3 cases and review of literature;Head and Neck-DOI April 2010
3) Word R, Urquhart AC, Ejercito VS:Primary laryngeal lymphoma:case report:ENT-Ear,Nose and Throat Journal:Volume 85 ,Number 2,Febuary 2006.
DISCLOSURE: The following authors have nothing to disclose: Nirav Patel, Kala Davis-McDonald
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