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Clinical Problem Solving: Pathology
January 2004

Pathology Quiz Case

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2004;130(1):115. doi:10.1001/archotol.130.1.115

A 48-year-old African American woman presented with a 15-year history of sarcoidosis, which had been confirmed by a Kveim test, and a 6-year history of episodic intervals of upper airway obstruction, which had required tracheostomy. Steroid therapy had stabilized her airway condition, and she was no longer tracheostomy dependent. Recently, she had experienced increasing shortness of breath and exertional dyspnea, which were not relieved by steroid therapy.

A computed tomographic scan demonstrated laryngotracheal stenosis. Videolaryngoscopy revealed a supraglottic laryngeal mass with glottic and subglottic extension (Figure 1). Physical examination revealed a cushinoid pattern of obesity. Chest examination demonstrated obvious inspiratory stridor with transmitted breath sounds. Laser microlaryngoscopy was performed, the laryngeal lesion was excised, and a corticosteroid(methylprednisolone acetate, 20 mg) was locally injected. Histologic examination demonstrated multiple epithelioid granulomas, some of which were surrounded by extensive fibrosis with hyalinization (Figure 2 and Figure 3). There was also diffuse interstitial fibrosis but no necrosis. Special stains for fungi and acid-fast bacilli were negative. The patient's postoperative course was uneventful, and she was discharged home with a tracheostomy tube in place. Marked clinical improvement was seen at the follow-up visits.

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