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Clinical Challenge
Endoscopy
March 2017

A Young Boy With Progressive Dysphonia

Author Affiliations
  • 1Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 3The Royal College of Surgeons in Ireland, Dublin, Ireland
JAMA Otolaryngol Head Neck Surg. 2017;143(3):313-314. doi:10.1001/jamaoto.2016.3219

A young boy referred by his local otolaryngologist presented with dysphonia and abnormal laryngeal examination results. His voice quality had always been husky, with recent mild exacerbation. No stridor or shortness of breath was reported, but he admittedly “hated to run” and was relatively sedentary. His parents noted intermittent stertor while he was sleeping but no apnea. He had no dysphagia or aspiration manifestations. He was overweight (body mass index, calculated as weight in kilograms divided by height in meters squared, 27.2); breathed comfortably at rest; and had a dysphonic, breathy voice. Findings from an otolaryngologic examination were normal other than those from flexible laryngoscopy, which demonstrated 2 laryngeal lesions, 1 in the postcricoid interarytenoid region and 1 at the anterior commissure, the latter of which compromised vocal fold approximation. Vocal fold mobility otherwise appeared normal. Operative laryngoscopy confirmed a midline, firm, posterior cricoid mass (Figure, A), and a midline, firm, anterior subglottic mass extending into the anterior commissure (Figure, A). Tracheobronchoscopy revealed a distal tracheal submucosal mass partially obstructing the left mainstem bronchus (Figure, B). Excisional biopsy of the postcricoid and subglottic masses with the carbon dioxide laser was performed (Figure, C). Histopathologic examination demonstrated mucosal infiltration by a monotonous population of cells with round nuclei and abundant granular cytoplasm (Figure, D), positive for S-100 and lightly positive for CD68, with occasional interspersed more darkly staining cells, consistent with histiocytes and giant cells. Sections stained negative for epithelial, muscle, endothelial, and glial cell immunohistologic markers.

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