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 ).