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Clinical Problem Solving: Pathology
September 2006

Pathology Quiz Case 2

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2006;132(9):1013. doi:10.1001/archotol.132.9.1013-a

A 44-year-old woman with known type 1 neurofibromatosis was newly diagnosed as having a pheochromocytoma of the right adrenal gland. She underwent a laparotomy for removal of the pheochromocytoma under general anesthesia. During induction of anesthesia, the anesthetist was able to pass only a size 6.0 endotracheal tube. No growth was visible in the supraglottis or glottis. After surgery, the intubated patient was transferred to the intensive care unit, and an otolaryngological opinion was requested. The findings of flexible laryngoendoscopy confirmed that the glottis and supraglottis were normal. The endotracheal tube precluded examination of the subglottis and trachea. A laryngeal computed tomographic scan demonstrated a smooth circumferential subglottic mass (Figure 1). The patient underwent an elective tracheostomy and laryngotracheoscopy, which showed a pink, smooth, submucosal lesion in the posterior subglottis extending inferiorly to the third tracheal ring (Figure 2). Histologic evaluation demonstrated expansion of the submucosa by eosinophilic amorphous material (Figure 3).

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