FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
Fifteen years earlier, a 63-year-old white man with no significant medical history and no tobacco, alcohol, or radiation exposure presented with a 3-month history of hoarseness. He was noted to have a subglottic mass and underwent direct laryngoscopy and biopsy, with pathologic findings that were similar to those shown in Figure 1 and Figure 2. He also underwent conservative excision of the lesion and had no evidence of disease until 10 years after the initial procedure. Direct laryngoscopy and a biopsy were performed at that time, and the findings were consistent with a recurrence of the lesion. The patient underwent a second conservative excision, which, similar to the initial procedure, consisted of a tracheotomy, a laryngofissure, and excision of the mass as well as the inner table of the cricoid cartilage. Two years later, in 2000, he again presented with hoarseness, and a computed tomographic scan was obtained (Figure 3). He then underwent a total laryngectomy for definitive control of the lesion. The gross specimen is shown in Figure 4.
Shah RK, Gnepp DR, Nigri PT. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2004;130(3):367. doi:10.1001/archotol.130.3.367