Primary laryngeal lymphoma: report of 3 cases and review of the literature

Extranodal marginal zone lymphoma of the larynx: A case report and scoping review

BACKGROUND

This scoping review aims to review cases of extranodal marginal zone lymphoma (MZL) of the larynx to establish best management practices for this rare clinical entity.

METHODS

In this paper, we report a case of laryngeal MZL, in accordance with CARE guidelines. We then performed a scoping review according to PRISMA-ScR criteria of published cases of MZL involving the larynx. The following data were collected for each case: age, sex, size, location(s) involved, stage, treatment, follow-up, and recurrence duration.

RESULTS

Sixty-six patients with laryngeal MZL, first reported in 1990, were identified. Characterized by its low-grade histological appearance and indolent course, laryngeal MZL is generally confined to the larynx and has an excellent prognosis with radiation used as first-line therapy.

CONCLUSIONS

It is imperative for clinicians to consider lymphoma in the differential diagnosis of a laryngeal tumor from any subsite, as certain pathologies may carry high risks of metastasis.

Laryngotracheal Stenosis Secondary to Mantle Cell Lymphoma

Acute laryngeal dyspnea is a life-threatening emergency often attributed to laryngeal tumors or inflammatory edema in adults. Primary laryngeal lymphomas are especially infrequent. As an aggressive subtype of B-cell non-Hodgkin lymphoma (NHL), mantle cell lymphoma (MCL) cases are particularly complex.  Herein, we present a case of laryngotracheal stenosis secondary to primary MCL. A comprehensive assessment, including in-office flexible laryngoscopy, revealed distinct findings within the supraglottis and subglottis. In the supraglottis, a submucosal lesion with well-defined, rounded edges was observed, while the subglottis exhibited a friable tumor occupying approximately 90% of the airway. This necessitated immediate intervention, leading to microlaryngoscopy, biopsy, and open tracheostomy. Due to the rarity of primary laryngeal lymphomas, they present a significant diagnostic challenge. Timely diagnosis is crucial to enable tailored therapeutic strategies and improved patient outcomes. This case highlights the importance of considering lymphomatous etiologies in the management of laryngotracheal stenosis and emphasizes the need for a multidisciplinary approach to optimize patient care.

[Primary laryngeal lymphoma: a case report]

Primary laryngeal lymphoma is rare, accounting for less than 1% of all laryngeal cancers. Treatment depends on the stage and severity of the disease. We here report the exceptional case of a 64-year-old woman, non-smoker, suffering from dysphagia for solids and a foreign body sensation. Laryngoscopy and biopsies revealed polyploid tumor of the left epiglottic fold. The diagnosis of diffuse large B-cell lymphoma was made. The patient underwent chemotherapy followed by radiotherapy, with significant improvement at 2-year follow-up, with no local recurrence. Due to the rarity of this disease and the variety of symptoms, the optimal management strategy for this type of cancer is controversial, requiring a specific diagnostic and therapeutic approach.

A Case of Subglottic Marginal B-Cell Lymphoma With Laryngeal Amyloidosis

Laryngeal mucosa-associated lymphoid tissue (MALT) is an extra-nodal margin zone B-cell lymphoma (MALT lymphoma) and a low-grade malignant lymphoma with a low incidence, the etiology of the condition remains obscure, and the process of differential diagnosis poses a significant challenge, so it is easy to miss diagnosis and misdiagnosis clinically. The present article presents a clinical case study of a patient who was diagnosed with subglottic MALT lymphoma, which was associated with laryngeal amyloidosis. The patient underwent a successful treatment regimen comprising carbon dioxide laser and radiotherapy. In addition, the article provides an overview of relevant literature that can aid in the diagnosis and management of this rare disease. The study is expected to contribute to the existing body of knowledge on the treatment of subglottic MALT lymphoma and laryngeal amyloidosis.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

Lymphoma recurrence presenting as vocal cord fixation

Lymphomas of the larynx are a rare finding. Those with lymphoma of the larynx often present with symptoms such as vocal hoarseness, throat pain, dysphagia, and weight loss. This is a case of a 74-year-old man who presents with new onset of hoarseness and dysphagia. He has a previous history of diffuse large B-cell lymphoma (DLBCL) but was thought to be in remission at the time of presentation. On nasolaryngoscopy, there was a large, right sided, sub-mucosal mass with right vocal cord fixation. Physical exam and computed topography of the neck did not identify any adenopathy. Biopsy confirmed the recurrence of DLBCL isolated to the larynx at the time of diagnosis. The patient was treated with chemotherapy and fully recovered his vocal cord motion with resolution of his hoarseness and dysphagia. Physicians should consider lymphoma in patients presenting with laryngeal complaints especially in patients with a history of lymphoma.

The Secondary Manifestation of a Marginal Zone Lymphoma in the Larynx: Lessons From a Misdiagnosis

The secondary manifestation of a marginal zone lymphoma (MZL), which is a less common type of B-cell non-Hodgkin’s Lymphoma (NHL), in the larynx is a rarity. We report a case of the secondary involvement of the larynx following MZL in a 72-year-old woman who presented with the sensation of a foreign body in the throat and history of MZL. A fiberoptic laryngoscopy confirmed the presence of a mass in the supraglottic area. The initial clinical evaluation indicated that the mass was benign. Hence, it was removed surgically. However, the histopathological analysis confirmed the diagnosis of MZL. After a systemic evaluation, the patient was classified as stage IV A according to the Ann Arbor staging system for lymphomas. Treatment was initiated with Ibrutinib 520mg/d and Rituximab 375 mg/m² every 28 days. When it comes to tumors of the head and neck, including NHL, the larynx should also be considered as a site for a possible secondary as well as primary involvement.

Acute Laryngeal Dyspnea as the First Presentation of Mantle Cell Lymphoma: A Case Report and Review of the Literature

Introduction

Acute laryngeal dyspnea is a life-threatening emergency, and the causes in adults are most often laryngeal tumors or inflammatory edema. Lymphoma of the larynx and especially the mantle cell type is extremely rare. Case Presentation. We report a case of a 43-year-old woman with no particular pathological history. She presented with progressive dyspnea which has evolved towards an inspiratory bradypnea that worsened until she ultimately required an emergency tracheotomy. Biopsies revealed mantle cell lymphoma. The patient has been staged IVB MIPI 6, and she was treated by immunochemotherapy followed by ASCT. The therapeutic evaluation shows a complete remission, 18 months after, and the patient was always disease free.

Conclusion

The laryngeal localization of the mantle cell lymphoma is extremely rare; it may present catastrophically with acute airway obstruction. The diagnosis is mostly histological, hence the interest of deep biopsy. Given its rarity, the therapeutic strategy must be discussed case by case in a multidisciplinary consultation meeting.

Hoarseness-causes and treatments

BACKGROUND

Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords.

METHODS

This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews.

RESULTS

Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended.

CONCLUSION

Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.

An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review

Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.

Mucosa-associated lymphoid tissue lymphoma of the larynx: a case report and literature review

The clinicopathological characteristics and rational treatment of primary laryngeal mucosa-associated lymphoid tissue (MALT) lymphoma are still unclear and need to be further defined due to the paucity of this separate lymphoma.Herein, a supraglottic primary MALT lymphoma was described with detailed clinical course, intervention, and follow-up. To date, research of laryngeal MALT lymphoma has seldom been initiated. Our experience in this case will help to expand our understanding of this unique disease. A 58-year-old female presented with a history of progressive hoarseness for about 10 months. Multiple laryngoscopy examinations revealed severe hypertrophy of left ventricular band. She was admitted to our department with residual MALT lymphoma of supraglottic region after partial resection by laser. After systemic evaluation, she was staged as IEA, International Prognostic Index score 0. Irradiation of intensity modulated radiotherapy technique with a dose of 30.6 Gy/17f to the tumor and 25.5 Gy/17f to the related lymphatic drainage area achieved a complete remission. The disease-free survival has reached to 4 years. The irradiation related acute and late side effects were mild.Radiotherapy is the first option for limited-stage primary laryngeal MALT lymphoma because of excellent treatment outcome.

Primary laryngeal manifestation in precursor T-cell acute lymphoblastic leukemia

Primary involvement of the larynx in non-Hodgkin’s lymphoma (NHL) is rare. Early symptoms are non-specific and thus, it is difficult to diagnose. In the present study, the case of a 52 year-old male with hoarseness due to diffuse T-cell lymphoma as the first manifestation of precursor T-cell acute lymphoblastic leukemia is presented. Subsequent to treatment with three cycles of the etoposide and cytosine arabinoside (EA) and one cycle of the EA+L-asp chemotherapy regimens, the patient achieved complete remission. A series of consolidation therapy courses were performed subsequently. At present, the patient remains disease-free, indicating that the treatment was effective. Primary involvement of the larynx in NHL is rare. Symptoms in the early stage are subtle and non-specific and thus, diagnosis is difficult to establish. This type of tumor requires special diagnostic and therapeutic attention.

A Case of a Laryngeal MALT Lymphoma in a Patient with a History of Gastric MALT

We are reporting a case of a 62-year-old African American woman with a history of gastric MALT lymphoma successfully treated with radiation who presented with a laryngeal MALT lymphoma 4 years after her original diagnosis. She received definitive radiation with a complete response. The case presented is unique for the rare presentation of a MALT lymphoma in the larynx, especially in light of the patient's previously treated gastric MALT lymphoma years ago.

Laryngeal lymphoma: the high and low grades of rare lymphoma involvement sites

The larynx is an extremely rare site of involvement by lymphomatous disease. We present two cases of isolated laryngeal high-grade and another low-grade lymphoma, together with a literature review of laryngeal lymphoma management.

Mantle cell lymphoma of the larynx: Primary case report

INTRODUCTION

Primary laryngeal lymphomas are exceedingly rare. Only about a hundred cases have been reported. They consist mainly of non-Hodgkin lymphoma, especially of diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue. We report the first case of a primary laryngeal mantle cell lymphoma.

CASE PRESENTATION

We report a case of a primary mantle cell lymphoma of the larynx in a 70-year-old North African non-smoker male. We present a detailed report of his clinical and paraclinical data as well as treatment options.

CONCLUSIONS

Mantle cell lymphoma is a very aggressive lymphoma subset associated with poor prognosis. Laryngeal mantle cell lymphoma is exceedingly rare. To the best of our knowledge, this is the first case to ever be reported.

[Primary malignant non-Hodgkin lymphoma of the larynx: report of a case]

Le lymphome malin non hodgkinien (LMNH) primitif laryngé est une entité rare qui représente moins de 1% des cancers du larynx. Nous rapportons un nouveau cas, chez un homme de 24 ans qui avait présenté une dysphonie et une dysphagie d'installations progressives. La laryngoscopie a révélé une lésion bourgeonnante de la bande ventriculaire gauche. L'histologie a objectivé un lymphome T, CD3 positif, qui a bien évolué après traitement par quatre cures de CHOP (cyclophosphamide, doxorubicine, vincristine, et prednisone), suivies d'une radiothérapie sur le larynx et le médiastin supérieur à la dose totale de 40Gy. Malgré sa rareté relative, cette pathologie de diagnostic difficile, nécessite une vigilance particulière et devrait être gérée selon les tendances actuelles du traitement pour les LMNH ganglionnaires.

Hodgkin's disease presenting as discharging neck sinuses and a mediastinal mass

A 23-year-old Asian lady presented with a hard indurated midline neck swelling of 2 months duration without any upper aerodigestive tract or systemic symptoms of note. Her inflammatory markers were elevated and she was commenced on antibiotics. Ultrasound scan and fine needle aspiration cytology (FNAC) were inconclusive. A CT scan showed an ill-defined soft tissue mass anterior to and not well demarcated from the thyroid, and contiguous with a superior and anterior mediastinal mass. Incisional biopsy revealed necrosis and pockets of purulent material. Microbiology suggested a chronic pyogenic abscess negative for acid fast bacilli. She was treated with antituberculous therapy without resolution. She developed a discharging lateral neck mass with progressive increase of the mediastinal mass. She subsequently required a neck exploration and mediastinoscopy. Repeat mediastinal biopsies confirmed the diagnosis of Hodgkin's disease and no organisms on culture. She was commenced on chemotherapeutic treatment with a satisfactory outcome.