Case Presentation
A 41-year-old female with a history of asthma and gastroesophageal
reflux presented to the Emergency Department with 2-3 days of a choking
sensation and shortness of breath. She also reported 4 months of voice
changes and aspiration of thin liquids. There was no tobacco or alcohol
use history. At presentation the patient had stridor, and fiberoptic
laryngoscopy revealed a large, pink, ball-valving polypoid lesion
pedicled on the glottis anteriorly and obstructing 75% of the airway.
Oxygen saturation levels were normal. Pre- and post-contrast computed
tomography (CT) of the neck revealed an approximately 1.5cm well-defined
partially enhancing soft tissue mass arising from the anterior
commissure of the larynx with moderate compromise of the laryngeal lumen
(Figure 1A-C ). The patient was admitted to a step-down unit for
continuous respiratory and pulse-oximetry monitoring.
The next day the patient was taken to the operating theater by the
otolaryngology service. General anesthesia was induced, and the patient
was quickly and carefully intubated under direct laryngoscopy. The mass
was resected using cold microlaryngeal techniques. The mass was found to
be broadly attached along the anterior commissure of the larynx
(Figure 1D ). Frozen section biopsies suggested a neoplasm, but
the lesion could not be further characterized. The mass was fully
excised up to the lesion’s anterior glottic and subglottic attachments.
Care was taken to avoid significant trauma to the true vocal cord mucosa
and glottic ligaments. Final pathology characterization showed the
specimen was positive for anaplastic lymphoma kinase (ALK) and SMA, and
was negative for cytokeratin, desmin, MSA, nuclear myogenin, nuclear
myoD1, S100, CD34, p63, p40, and CK903. Mitotic activity was present
without atypical mitosis (Figure 2 ).
Follow up contrast enhanced CT at 2 and 6 months (Figure 3A and
B ) revealed no evidence of recurrence. The patient returned to the
operating room 8 months after initial presentation for a direct
follow-up evaluation. No evidence of recurrent disease was found, but a
small anterior laryngeal web was identified (Figure 3C ).