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Clinical Challenge
July 2016

Laryngeal Mass in an Elderly Man

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 2Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora
JAMA Otolaryngol Head Neck Surg. 2016;142(7):703-704. doi:10.1001/jamaoto.2015.3796

A man in his 70s with a history of acute myeloid leukemia (AML), diabetes, hypertension, and coronary artery disease presented with a 3-month history of hoarseness, throat pain, dysphagia, and odynophagia, which began after he was intubated for 13 days for neutropenic sepsis. Twenty-nine months prior to presentation, the patient had been diagnosed as having myelodysplastic syndrome, which 7 months later progressed to AML. During treatment for AML with low-dose cytarabine, his course was complicated by neutropenic sepsis requiring intubation, resulting in his head and neck symptoms. His physical examination was notable for a “breathy” voice with no respiratory distress or cervical lymphadenopathy. Flexible nasal endoscopy revealed an immobile right vocal fold with broad submucosal fullness on the right false vocal cord and arytenoid. Computed tomography (CT) demonstrated a right-sided laryngeal mass extending from the level of the free margin of the epiglottis to the level of the glottis (Figure, A). In the operating room, during direct laryngoscopy a polypoid mass was seen based on the right arytenoid, also involving the right false vocal cord (Figure, B). Frozen section confirmed polypoid ulcerated tissue with granulation consistent with an inflammatory process, and histopathologic analysis demonstrated a mixed infiltrate containing numerous mononuclear myeloid cells positive for myeloperoxidase, CD34, CD68, and CD33 but negative for CD117 (Figure, C and D). There are small numbers of scattered CD3+ T-cells and CD20+ B-cells.

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