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Clinical Problem Solving
February 2015

Laryngeal Mass

Author Affiliations
  • 1Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
JAMA Otolaryngol Head Neck Surg. 2015;141(2):179-180. doi:10.1001/jamaoto.2014.3009

A woman in her 60s presented with exacerbation of shortness of breath, cough, sore throat, bloody sputum, and dysphagia, which she had been experiencing for 18 months. Her medical history was significant for head irradiation for tinea capitis in childhood and heavy smoking. Fiber-optic laryngoscopy revealed a white, bulging nonulcerative submucosal mass involving the lingual aspect of the epiglottis on the left and causing a deviation of the epiglottis to the right. The vocal folds were free of lesions, with intact motion. There were no palpable neck masses or other findings on the head and neck examination. A magnetic resonance imaging scan of the larynx and neck demonstrated a left epiglottic expansile homogenic mass abutting the left pyriform sinus. There was no neck lymphadenopathy. The patient underwent direct microlaryngoscopy, which revealed a submucosal, white stiff mass involving the lingual aspect of the epiglottis and causing a narrowing of the supraglottic airway. Biopsy specimens were obtained and sent for histopathologic examination. On hematoxylin-eosin staining (Figure) the epiglottic mass was composed of small, uniform basaloid epithelial cells, with small to moderate cytoplasm containing nonpleomorphic, small, or inconspicuous nucleoli. The lumens of the tubules contained secretions. Perineural and cartilage invasion were demonstrated.

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