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June 1986

Resident's Page

Author Affiliations

University of Virginia School of Medicine, Charlottesville

Arch Otolaryngol Head Neck Surg. 1986;112(6):674-677. doi:10.1001/archotol.1986.03780060086015

PATHOLOGIC QUIZ CASE 1  Jamie R. Stern, MD, New Hyde Park, NYA 50-year-old woman presented with progressive hoarseness of three months' duration and exertional dyspnea of six months' duration. The patient denied having cough, hemoptysis, weight loss, otalgia, and dysphagia. The patient did not use cigarettes or alcohol. The medical history was remarkable for arthritis treated with tolmetin sodium and indomethacin.Physical examination revealed a saddle-nose deformity (Fig 1), arthritic changes in the hands at the distal and proximal interphalangeal joints, and polypoid degeneration of the vocal cords. Admission chest roentgenogram, complete blood cell count, electrolyte levels, and electrocardiogram were normal. The antinuclear antibody and rheumatoid factors were normal. Erythrocyte sedimentation rate (ESR) was 45 mm/hr (normal, up to 20 mm/hr). Direct laryngoscopy disclosed a fibrous subglottic mass obstructing the anterior two thirds of the tracheal lumen and bilateral vocal cord polyps. Biopsy specimens were taken of the subglottic