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Clinical Challenge
September 30, 2021

Hoarseness and Stridor Following Stem Cell Transplant

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
  • 2Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2021;147(11):1003-1004. doi:10.1001/jamaoto.2021.2448

A 59-year-old man presented with progressive hoarseness and dyspnea over a 2-month period. Fifteen months previously, he had undergone allogeneic stem cell transplant (allo-SCT) with a matched related donor for treatment of fms-like tyrosine kinase (FLT3) internal tandem duplication–mutated acute myeloid leukemia (AML). The patient had been diagnosed with chronic gastrointestinal graft-vs-host disease after a workup for diarrhea. Results of a restaging bone marrow biopsy 2 weeks prior to presentation showed no evidence of leukemia. Physical examination findings revealed no neck masses or abnormalities, but the patient was noted to be severely dysphonic and stridulous. Flexible laryngoscopy findings demonstrated a right vocal fold neoplasm crossing the posterior commissure with associated bilateral vocal fold motion impairment and obstruction of the glottic airway (Figure, A). Awake tracheostomy was performed for airway protection, and biopsy of the neoplasm was obtained via operative microlaryngoscopy (Figure, B). Histologic findings demonstrated diffuse infiltrate of large cells with irregular nuclear contours, vesicular chromatin, and prominent nucleoli (Figure, C). Immunohistochemical stains showed CD33, CD43, and CD117 positivity, with a subset positive for CD7 and myeloperoxidase. Stains were negative for CD3, CD20, and cytokeratin expression.

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