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Clinical Problem Solving
July 2013

Subglottic Presentation of a Rare Tumor: Primary or Metastatic?

Author Affiliations
  • 1David Geffen School of Medicine at UCLA, University of California, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2013;139(7):739-740. doi:10.1001/jamaoto.2013.3424

A 66-year-old white female ex-smoker presented for evaluation of worsening shortness of breath and dysphagia over the course of 1 week. Her medical history was notable for osteoarthritis, hyperlipidemia, and gastroesophageal reflux disease. She had a 30–pack-year history of smoking cigarettes but had quit smoking 20 years prior. Her social history was notable for occasionally drinking wine.

On office endoscopic examination, there was a large, left-sided exophytic subglottic mass at the level of the cricoid with approximately 50% to 70% obstruction of the subglottic airway (Figure, A). There were no other masses in the oral cavity, oropharynx, or nasal cavity, or distal trachea. There was no cervical neck lymphadenopathy. She was admitted for airway monitoring and then taken to the operating room for direct laryngoscopy, biopsy, and carbon dioxide laser debulking of the mass. Examination at direct laryngoscopy revealed a large, left-sided subglottic mass at the level of the cricoid with approximately 70% obstruction of the subglottic trachea. The mass extended from the left anterior cricoid to the posterior cricoid just inferior to the left arytenoid cartilage.

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