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Clinical Problem Solving: Radiology
August 2005

Radiology Quiz Case 3: Diagnosis

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(8):743-744. doi:10.1001/archotol.131.8.743

The clinical diagnosis in the present case was carcinoma of the supraglottic larynx. The diagnosis was supported by the CT findings (Figure 1 and Figure 2) and by the histopathology report. The CT scan revealed a supraglottic lesion that was highly suggestive of a neoplasm. The pathologist suspected a squamous cell carcinoma but requested a second biopsy for final confirmation because the specimen from the initial biopsy was inadequate. The second biopsy specimen revealed features of tubercular invasion rather than a carcinoma. Laryngeal TB is relatively uncommon, accounting for 0.79% of the TB cases.1 The most common presenting symptom is hoarseness.24 A history of smoking along with a recent onset of progressive hoarseness and an ulceration or a mass on mirror examination of the larynx should suggest the possibility of malignancy.2,3 Moreover, the presence of pseudoepitheliomatous hyperplasia, which mimics squamous cell carcinoma, may raise the suspicion of carcinoma in laryngeal TB.5 An alert pathologist in the present case averted a possible medical misadventure.

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