Involvement of the larynx by hemopoietic neoplasms. An investigation of autopsy cases and review of the literature

Metastatic sigmoid adenocarcinoma to the larynx: A case report and updated literature review

Metastatic laryngeal cancer is a rare entity, usually indicating an advanced disease once discovered. In this report, we are describing a case of a 60-year-old male patient with stage IV colorectal cancer (CRC), who presented to our clinic with dysphonia; further workups showed metastatic CRC.

Primary diffuse large B-cell lymphoma of the Larynx

The larynx is a rare site of extranodal non-Hodgkin lymphoma (NHL), accounting for less than 1% of all primary laryngeal neoplasms. We report a rare case of laryngeal diffuse large B-cell lymphoma (DLBCL) in an 85-year-old female patient, which was difficult to diagnose even after several biopsies from the primary laryngeal lesion, both under local and general anesthesia, and the diagnosis of DLBCL was obtained from the lymph node biopsy, which appeared in the proximity of the larynx 2 months after the first biopsy from the larynx. Since the diagnosis of laryngeal NHL is sometimes difficult when sufficient samples cannot be obtained, repeated biopsies may be required. Due to the small number of cases, there is no definite consensus regarding the best management of laryngeal NHL. Thus, a standard treatment option for DLBCL, such as 3 courses of R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisone) followed by Involved-field radiation therapy, or 6∼8 course of R-CHOP, are also applied for the treatment of laryngeal DLBCL. For this case, doxorubicin was not adopted and 8 courses of R-COP (rituximab + cyclophosphamide, vincristine and prednisone) at a decreased dose were chosen because of her age (85-year-old) and cardiac hypofunction.

Primary aspergillosis of the larynx causing acute airway distress

Laryngeal aspergillosis is most commonly seen as a secondary infection that spreads from the lungs and tracheobronchial tree. Primary invasive aspergillosis of the larynx is rare and most likely seen in an immunocompromised patient. We present a case of a 59-year-old woman who presented with progressive dysphonia and subsequently acute stridor. She is a non-smoker with a recent diagnosis of acute myeloid leukaemia. Fibreoptic nasendoscopy revealed a left sided vocal cord lesion ball valving into the glottic space. Histology taken during emergency debulking confirmed Aspergillus fumigatus and the patient was successfully treated with intravenous antifungals. Although there are cases of primary laryngeal aspergillosis discussed in the literature, to the best of our knowledge this is the first reported case to have caused acute airway distress requiring emergency intervention.

Primary laryngeal T-cell lymphoma: A case report and review of the literature

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Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms which consists mainly of non-Hodgkin lymphomas.

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Diagnosis requires immunohistopathological examination of the laryngeal mass.

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The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.

Introduction

Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms. It consists mainly of non-Hodgkin lymphomas (NHLs), represented particularly by diffuse large B-cell. Extranodal natural killer/T-cell lymphoma, presented in larynx is a rare condition that accounts for less than 11% of all lymphomas without distinctive clinicopathologic features, as well as challenging pathologic diagnosis.

Case report

We report here a case of a 64-years-old man who presented with primary lymphoma type T of the subglottic larynx. A histopathological examination of the biopsy confirmed non-Hodgkin T cell lymphoma. Given his age, he underwent chemotherapy and radiation therapy. The patient was disease-free after 18 months follow up.

Conclusion

The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.

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.

Hematologic malignancies of the larynx: A single institution review

BACKGROUND

Primary hematologic malignancies of the larynx are rare diagnoses, accounting for less than 1% of all laryngeal tumors. They most commonly present as submucosal masses of the supraglottis, with symptoms including hoarseness, dysphagia, dyspnea and rarely cervical lymphadenopathy.

PURPOSE

METHODS: Retrospective case series of patients in a tertiary academic laryngeal practice with hematologic malignancy of the larynx presenting over a 10 year period; charts were reviewed for diagnosis, symptoms, treatment, and outcomes.

RESULTS

12 patients were found to have primary presentation of a hematologic malignancy within the larynx between 2009 and 2019. A submucosal mass was the most common finding, and hoarseness was the most common symptom. Local control of disease was high. Airway obstruction was managed with tracheostomy. Several patients required tube feeding prior to disease control. Most patients underwent radiation therapy and chemotherapy, although surgery alone was effective in patients with isolated disease.

CONCLUSIONS

Hematologic malignancies of the larynx are rare but treatable. Biopsy is the mainstay of diagnosis, and imaging may be helpful to exclude diseases with a similar physical presentation (i.e., laryngocele). Prognosis depends on diagnosis but is generally favorable.

Role of ancillary techniques in profiling unclassified laryngeal malignancies

Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".

Epidemiology and prognostic indicators in laryngeal lymphoma: A population-based analysis

OBJECTIVES/HYPOTHESIS

To characterize the epidemiology of primary laryngeal lymphoma and to determine the prognostic factors affecting survival in patients with this disease.

STUDY DESIGN

A retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database, including cases from 1973 to 2014.

METHODS

A population-based analysis was conducted with patients from more than 15 different geographic regions across the United States. Patients were chosen based on a diagnosis of lymphoma and a primary lymphoma site within the larynx. Two hundred cases were eligible based on the inclusion criteria, and characteristic as well as clinical variables were then extracted from the database and analyzed. Characteristic and clinical variables included age, race, sex, primary site of lymphoma involvement, general histology, specific histologic subtype, tumor grade, and Ann Arbor staging. Exposure variables that were analyzed included radiation therapy and chemotherapy. Overall survival (OS) and disease-specific survival (DSS) were the main outcomes calculated using multivariate analysis.

RESULTS

A total of 200 cases of laryngeal lymphoma were identified. The mean age at diagnosis was 64.2 years. The cohort was composed of 53% males. B-cell non-Hodgkin's lymphoma (NHL) accounted for 74% of cases, whereas natural killer/T-cell NHL accounted for 10% of cases. A total of 53.1% of patients received radiation therapy, whereas 47.5% received chemotherapy. The median OS was 9.15 years and median DSS was 24.5 years. OS at 2, 5, and 10 years was 74%, 63%, and 44%, respectively. On multivariate analysis, older age, male sex, and advanced Ann Arbor staging were associated with worse OS, whereas only male sex and advanced Ann Arbor staging were associated with worse DSS (all P values < .05). Radiation and chemotherapy were not associated with improved survival.

CONCLUSIONS

Female sex and lower Ann Arbor staging are independent positive prognostic indicators for survival, whereas other clinical variables such as grade and histology do not have an effect on survival. Radiation and chemotherapy do not appear to confer a mortality benefit in patients with primary laryngeal lymphoma, which may have implications on clinical decision making as well as patient education about disease prognosis.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:2044-2049, 2018.

All That Wheezes Is Not Asthma: A Case of Diffuse Large B-Cell Lymphoma of the Larynx

Localized laryngeal lymphoma is a rare entity with an incidence of less than 1% of all laryngeal neoplasms. Diffuse large B-cell lymphoma (DLBCL) is the most common type of laryngeal neoplasms. Here, we describe a case of a young 28-year-old female with large B-cell lymphoma who remained undiagnosed for a long time owing to a myriad of nonspecific presentation including "wheezing." Although primary laryngeal lymphomas constitute a diagnostic challenge since they are rare, one should have a high index of suspicion for lymphoma of the larynx in patients presenting with unresolved wheezing as it can present catastrophically with acute airway obstruction requiring immediate surgical intervention which was observed in this case. Treatment includes radiotherapy, chemotherapy, immunotherapy, or a combination of these. We hope that the discussions ensuing from case reports regarding uncommon presentations of laryngeal lymphoma may spur the formation of regional/international databases for the description of lymphomas with unusual presentations. This effort can lead to in-depth study of cases and prompt awareness of "rare and subtle presentations" of laryngeal lymphoma.

Primary Burkitt lymphoma of the supraglottic larynx: a case report and review of the literature

Background

Burkitt lymphoma is a high-grade B cell lymphoma which accounts for less than 1% of all adult cases of non-Hodgkin lymphoma. Rare instances of Burkitt lymphoma developing secondary to prior irradiation have been described in the literature.

Case presentation

We report a case of a 90-year-old white woman with a recent history of irradiation for Hodgkin lymphoma, who presented with primary Burkitt lymphoma of the supraglottic larynx. She underwent emergency awake tracheostomy with biopsy. A histopathological examination confirmed non-Hodgkin, B cell lymphoma of Burkitt type. Given her age and poor functional status, she underwent treatment with palliative radiotherapy.

Conclusions

A literature review was performed to clarify the clinical characteristics of radiation-induced Burkitt lymphoma in the head and neck, as well as its diagnosis and management. The present case represents the second case of radiation-induced Burkitt lymphoma in the head and neck in the reported literature, and the first in the supraglottic larynx. It highlights the need to maintain a broad differential in the assessment of malignancies of the larynx, particularly in patients with a prior history of radiation treatment.

Myeloid sarcoma: An unusual and rare laryngeal presentation

INTRODUCTION

Myeloid Sarcoma (MS) or Granulocytic Sarcoma is an uncommon laryngeal malignancy. It may arise from myelodysplastic syndromes, malignancy or de novo. Presentation in the larynx is rare and some may present with Acute Myeloid Leukaemia (AML) whereby the later may be asymptomatic.

CASE PRESENTATION

A 44-year-old South East Asian lady presented with a six months history of hoarseness, shortness of breath, reduced exercise tolerance, weight loss and laryngeal irritation. Symptoms progressed to coughing with liquids two months prior. On examination, she had a resting biphasic stridor and laryngoscopy revealed right immobile vocal cord with a firm right ventricle mass extending into the right paraglottic space. She was pale and haematology investigations revealed microcytic hypochromic anaemia. Magnetic Resonance Imaging (MRI) of the neck and thorax showed thickening of the right false cord, true cord and aryepiglottic fold. A biopsy taken during endolaryngeal microsurgery (ELMS) confirmed myeloid sarcoma of the right ventricle and para glottic mass. Further investigation revealed a background of AML and she then underwent chemotherapy.

DISCUSSION

MS is a rarity with only nine reported cases between the years of 1954 until 2015. Immunohistochemistry and immunophenotyping are definite for diagnosis confirmation as MS cells often exhibit myeloperoxidase (MPO), lymphocyte common antigen (LCA) and CD117 markers. MS is treated with are chemotherapy (either systemic or intrathecal), radiotherapy, surgical excision or in combination. Systemic chemotherapy has better efficacy and prognosis as compared to localised treatment of radiotherapy or surgical excision. However, there has yet to be a definitive chemotherapy protocol. Prognosis is poor with a 5-year survival rate of 48%.

CONCLUSION

Although laryngeal MS is a rare phenomenon, early recognition is key and patients should always be investigated for an underlying myeloproliferative or dysplastic disease.

Metastatic Cancer to the Larynx: A Case Report and Update

OBJECTIVE

The aim of this study was to describe a case of colorectal carcinoma metastatic to the larynx and provide a review of the current literature.

METHODS

A case report with chart review was performed. A review of the current literature was performed by systematically searching PubMed, OVID, CINAHL Plus, and EMBASE.

RESULTS

In 1988, a comprehensive literature review identified melanoma as the most common neoplasm to exhibit laryngeal involvement. Since that study, 41 subsequent cases have been reported, and among these, colorectal adenocarcinoma was the most frequent distant primary (24%). In 25 (58%) cases, curative surgery was attempted, but only 4 patients remained disease-free at last follow up. We report the history of a 52-year-old man who presented with rectal adenocarcinoma metastatic to his larynx 4 years after definitive treatment of the primary site.

CONCLUSIONS

In patients with a laryngeal mass and a history of colorectal cancer, or those at high risk of having an occult colorectal primary, metastatic spread to the larynx must always be considered. Although secondary laryngeal metastasis portends a poor prognosis, for the select patient, surgical intervention can provide long-term disease control.

Individual participant data meta-analysis of primary laryngeal lymphoma: Focusing on the clinical characteristics and prognosis

OBJECTIVES/HYPOTHESIS

Primary lymphoma of the larynx is rare. The symptoms are ambiguous and nonspecific, and confirmation of the diagnosis is often difficult. To better understand the clinical characteristics of this distressing disease, we performed an individual participant data meta-analysis focusing on the diagnoses and treatment outcomes.

STUDY DESIGN

Systematic review article.

METHODS

A literature search of the MEDLINE, Embase, and Cochrane library databases was conducted using the following Medical Subject Headings and keywords: "primary," "lymphoma," "cancer," and "larynx." The individual data of 57 patients from 41 articles were selected based on the inclusion criteria for the analysis.

RESULTS

The mean age of the 57 patients at the time of diagnosis was 53.9 ± 18 years, and there was a preponderance of male patients (male:female = 35:22). The mean follow-up was 33.2 ± 40.5 months. The most common symptom was hoarseness (70.2%). Extension of the lymphoma was found in the supraglottic larynx (63.2%). B-symptoms were noted in only 14.0% of patients. The treatment method and disease extent were not significant factors. The significant prognostic factors were the biopsy frequency (P = .000), B-symptoms (P = .032), and cell type (P < .001).

CONCLUSIONS

From an analysis of larynx lymphoma patients, accurate biopsy, the presence of B-symptoms, and the cell type of the lymphoma are important to the prognosis. However, the treatment method was not effective in predicting the prognosis.

LEVEL OF EVIDENCE

NA.

Computed Tomography Virtual Bronchoscopy: Normal Variants, Pitfalls, and Spectrum of Common and Rare Pathology

A broad spectrum of pathologies that involve the laryngotracheobronchial airway and imaging plays a crucial role in evaluating these abnormalities. Computed tomography with virtual bronchoscopy has been found to be very helpful in defining the location, extent, and nature of these lesions, and is increasingly being used even in patients with contraindications for fiberoptic bronchoscopy and laryngoscopy. Ionizing radiation, associated with virtual bronchoscopy, can be minimized by using low-dose multidetector computed tomography and hybrid iterative reconstruction techniques. Furthermore, retrospectively generated virtual bronchoscopy from a routinely acquired computed tomography data set eliminates additional cost and radiation. In the future, virtual bronchoscopy assisted with advanced navigational techniques will broaden the diagnostic and therapeutic landscape. This article presents the characteristic features of common and rare laryngotracheobronchial pathologies seen with virtual bronchoscopy.

Computed tomography findings of a solitary extramedullary plasmacytoma of the spleen: A case report and literature review

Solitary extramedullary plasmacytoma (EMP) of the spleen is a rare condition. The present study describes the case of a 23-year-old female with an extremely rare solitary EMP of the spleen. Upon examination, the tumor demonstrated unusual and notable multiple-phase spiral computed tomography (CT) findings. The lesion was a solitary, well-defined mass, with areas of variable splenic necrosis and cystic degeneration. Contrast-enhanced CT revealed progressive enhancement of the lesion in the cystic wall, internal septa and solid portion, a finding that has not previously been described. The patient underwent a splenectomy and recovered without complications. No evidence of tumor recurrence has occurred during the past two years of follow-up. To the best of our knowledge, this is the first study to examine the CT findings of a solitary EMP of the spleen. The study aimed to investigate the imaging features of solitary EMP, in particular the multiple-phase spiral CT findings, and raise awareness of the disease to reduce misdiagnoses.

Primary granulocytic sarcoma of larynx

BACKGROUND

Granulocytic sarcoma is an extramedullary tumor of myeloblasts. The purpose of this report was to present a case of a primary laryngeal granulocytic sarcoma and review of the literature.

METHODS

A literature review was performed using Medline and PubMed databases to search for cases of all primary and secondary myelogenous tumors of the larynx.

RESULTS

A 36-year-old man presented with a mass involving the preepiglottic space that was histologically confirmed as an extramedullary acute myeloid leukemia, or granulocytic sarcoma. Our review found 18 cases of secondary involvement of the larynx by myelogenous tumors, and only 1 previously reported case of primary laryngeal granulocytic sarcoma.

CONCLUSION

The detection of granulocytic sarcoma is difficult given its rarity and nonspecific presentation. To our knowledge, this is the second reported case of primary granulocytic sarcoma of the larynx reported in the literature.

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.

Isolated laryngeal plasmacytosis

INTRODUCTION

Laryngeal plasmacytosis (LP) is a rare benign lesion of mature polyclonal plasma cells, which should be differentiated from extramedullary plasmacytoma.

CASE REPORT

Isolated laryngeal plasmacytosis was discovered in a 59-year-old woman, free of symptoms other than chronic hoarseness.

DISCUSSION

Histological presentation, treatment modalities and prognosis are discussed.

CONCLUSION

Laryngeal plasmacytosis is a rare benign lesion that must be considered in case of submucosal polyclonal plasma cell infiltrate.

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.

Solitary Extramedullary Plasmacytoma of the Apex of Arytenoid: Endoscopic, CT, and Pathologic Findings

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm that occurs mainly in the soft tissues of head and neck region, with the paranasal sinuses, nasal cavity and nasopharynx being the most common sites. Solitary EMP of the larynx is very rare but increasingly reported recently. Common sites of involvement in larynx in the order of frequency are the epiglottis, ventricles, vocal folds and ventricular folds. We report an extremely rare case of solitary EMP involving in the apex of arytenoids that was successfully treated by only surgical excision. Because solitary EMP of the apex of artytenoids is extremely rare, it should be included in the differential diagnosis for laryngeal mass. Also, solitary, small, pedunculated and localized EMP of the larynx could be completely removed by laryngeal microsurgery.

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

BACKGROUND

Extranodal lymphomas limited to the larynx are rare, accounting for less than 1% of all laryngeal neoplasms. The aim of this study was to report the experience of our department in the management of these aggressive lesions, as they require special diagnostic and therapeutic attention.

METHODS

The case records of 3 patients with the diagnosis of lymphoma involving the larynx were retrospectively reviewed.

RESULTS

The histopathological diagnosis revealed 1 case of marginal zone lymphoma mucosa-associated lymphoid tissue type, 1 case of T-lymphoblastic lymphoma, and 1 case of a rare coexistence of in situ squamous cell carcinoma with an isolated intravascular (angioimmunoblastic) lymphoma of peripheral T-cell origin. Details of the presentation, diagnostic procedures, treatment, and outcome of these patients were presented.

CONCLUSIONS

Primary laryngeal lymphoma is a rare entity. Early symptoms are subtle and nonspecific, and confirmation of the diagnosis is often difficult. Because of the rarity of this tumor type, the optimal management remains controversial and it seems that should be managed not as a distinct disease entity but as an unusual presentation of non-Hodgkin lymphoma, according to the recent treatment trends.

Imaging characteristics of primary laryngeal lymphoma

BACKGROUND AND PURPOSE

The larynx is a rare site for primary NHL. Fewer than 100 cases have been reported in the literature, with the largest imaging review involving only 4 patients. We describe the findings of laryngeal lymphoma on CT, PET, and MR imaging and identify features that may distinguish laryngeal lymphoma from the far more common laryngeal squamous cell carcinoma.

MATERIALS AND METHODS

Multi-institutional retrospective chart review revealed 20 patients with histopathologically proved laryngeal lymphoma. Pretreatment CT, PET, and MR images were reviewed by a head and neck radiologist, focusing on extent of tumor, cervical lymph node involvement, and enhancement patterns.

RESULTS

Patients ranged from 30 to 90 years of age with a mean of 63 years at the time of initial diagnosis and a 2:1 female predominance. The average tumor size was 37 +/- 19 mm. In all patients, laryngeal lymphoma involved the supraglottis but also extended into the glottis (65%) and hypopharynx (60%). The subglottis was less frequently involved (35%). Laryngeal cartilage invasion and cervical lymphadenopathy were each seen in 20% of patients. Lymphoma was consistently FDG-avid (100%) and usually enhanced uniformly with iodinated contrast (73%). Necrosis and calcification were not seen in any cases.

CONCLUSIONS

Although laryngeal lymphoma is rare, particular imaging features suggest this diagnosis. A large uniformly enhancing supraglottic tumor without central necrosis and without cervical lymphadenopathy is a characteristic finding of lymphoma. Similar to squamous cell carcinoma, lymphoma may extend into the subglottis, pharynx, and laryngeal cartilages.

Plasma cell mucositis of the oral cavity: report of a case and review of the literature

Plasma cell mucositis (PCM) is a rare plasma cell proliferative disorder of the upper aerodigestive tract with an unknown etiology. Including the present case, only 22 cases have been reported in the English-language literature. PCM affects adult patients at an average age of 56.6 years. Clinical features are an intensely erythematous mucosa with papillomatous, cobblestone, nodular, or velvety surface changes. Symptoms include oral pain of long duration, dysphagia, persistent hoarseness, and pharyngitis. The majority of cases have a history of autoimmune or immunologically mediated disease. The histopathologic features of a dense, submucosal plasma cell infiltrate are not specific and must be differentiated from other reactive and neoplastic conditions. Diagnosis of PCM depends on clinical pathologic correlations. The present case was complicated by evidence of a monoclonal plasma cell population. The significance of this case is the differentiation of a benign disease from one that is potentially life threatening.

Extranodal lymphomas of the head and neck

Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck and may involve nodal or extranodal sites. Nodal head and neck lymphomas are similar to other nodal sites and are not further reviewed here. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin's lymphomas of B-cell lineage, and overall diffuse large B-cell lymphoma is the most common type. Hodgkin's lymphoma rarely occurs in extranodal sites. Other hematologic neoplasms that commonly involve extranodal sites of the head and neck are also discussed. In this review, we begin by discussing lymphomas involving the head and neck according to anatomical site. Then we discuss specifically the pathological findings of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, plasmablastic lymphoma, extramedullary plasmacytoma, and extranodal natural killer/T-cell lymphoma of nasal type.

Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis)

Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.

[Subglottic MALT-type lymphoma: unusual location]

We report a case of a 79-year-old woman presenting subglottic tumor whose hystopathological study was MALT-type lymphoma. After excluding the possibility of systemic dissemination, local radiotherapy treatment was applied. The interest of this study lies in the rare involvement of haematopoietic neoplasms in the larynx, especially the MALT-type in subglottic location. We review the literature on this subject, exposing the clinical, therapeutical and follow up data in respect to the initial location of the lymphoma.

Solitary plasmacytosis of the larynx in a patient with non-Hodgkin's lymphoma

Solitary plasmacytosis of the larynx is a clinically unusual event. It may cause hoarseness or airway obstruction and usually needs surgical excision. Plasmacytosis is distinguished from extramedullary plasmacytoma (EMP) in that the latter primarily involves the head and neck and needs more intensive therapy such as radiotherapy. Many reports have described the histopathology and immunohistochemistry of EMP of the larynx; however, no literature in English has described solitary plasmacytosis of the larynx. We report a 44-year-old female patient with non-Hodgkin's lymphoma and systemic lupus erythromatosus with Sjögren's syndrome. She complained of 1-year period of hoarseness that became exacerbated in the most recent 3 weeks. A wide-base and smooth-surface mass at the left supraglottic area was noted by direct laryngoscope. Computed tomography scan revealed a well-defined radiopaque mass. The histopathology of a specimen excised by carbon dioxide laser-assisted laryngomicrosurgery was interpreted initially as plasmacytoma. Immunohistochemical staining for kappa and lambda light chains demonstrated polyclonal plasma cells, and the definitive diagnosis was plasmacytosis. After 6 months follow-up, the subjective quality of her voice improved. Laryngoscopic examination revealed no evidence of recurrence.

Laryngeal prostatic cancer metastases: an underestimated route of metastases?

OBJECTIVE

Despite the high rate of metastases in advanced prostatic cancer, only 12 reports with 13 cases of laryngeal metastases in prostatic cancer have been given in the literature since the first description by Schmorl in 1908. A histopathological study was undertaken to clarify the obvious controversial clinical experience of multiple metastases in prostatic cancer but rare observations of laryngeal involvement.

STUDY DESIGN

Postmortem laryngeal examination in advanced prostatic cancer.

METHODS

Six patients with prostatic cancer and tumor spread to different organs but without clinical symptoms of laryngeal involvement were available for postmortem analysis. Gross anatomical inspection of the inner and outer surfaces of the removed larynx, horizontal slices of the larynx, and subsequent histological investigations including immunohistochemical analysis were used to search for metastases.

RESULTS

Macroscopic evaluation of the whole-larynx specimens did not lead to suspicion of laryngeal metastases. Interestingly, in all six larynx specimens of patients with metastatic prostatic cancer, laryngeal tumor infiltration was detected by macroscopic inspection of horizontal slices and proven histologically. Tumor infiltration ranged from focal micrometastases in the hematopoietic tissue of the ossified laryngeal skeleton to partial destruction of the external and/or internal osseous or cartilaginous lamina of the laryngeal skeleton.

CONCLUSIONS

The larynx is more often affected in metastatic prostatic cancer disease than is suggested by clinical experience. Because prostatic cancer metastasis starts in the hematopoietic areas of the ossified laryngeal skeleton, macroscopic evaluation of the whole larynx fails to detect metastases. Detecting laryngeal involvement requires horizontal slices and histological analysis.

Impact of phenotype on treatment and prognosis of laryngeal malignancies

An overview of the impact of the phenotype on treatment and prognosis of different laryngeal malignancies is presented.

Primary non-Hodgkin's lymphoma of the larynx in an AIDS patient

A case of primary non-Hodgkin's lymphoma of the larynx in an AIDS patient is presented with a review of the literature. Non-Hodgkin's lymphomas in AIDS patients are common but the primary laryngeal presentation is very rare. The symptoms usually include dysphonia and progressive airway obstruction requiring tracheostomy. As with laryngeal non-Hodgkin's laryngeal lymphomas in non-HIV positive patients the majority are of B cell lineage and respond well to radiotherapy. Our patient had a high grade lymphoma of B cell lineage which showed a good response to radiotherapy. The role of chemotherapy and surgery is not yet established. We suggest that the diagnosis of AIDS should not influence the management of these patients unless the individual is in the terminal disease stage.

Primary laryngeal lymphoma

Primary laryngeal lymphoma is a very rare entity, with fewer than 50 cases reported in the English literature in the past 60 years. Close scrutiny of some of these case reports reveals that the larynx was not always the only site of involvement, thereby diminishing the total number of patients with primary laryngeal lymphoma to fewer than 35. The authors report a series of six patients, who were seen and evaluated at the Mayo Clinic between 1952 and 1995, with stage IAE non-Hodgkin's lymphoma of the larynx. Three patients had large-cell lymphomas according to the REAL (Revised European-American Lymphoid) classification. The other three had a small lymphocytic lymphoma, follicular small cleaved lymphoma, and follicular mixed lymphoma. All patients received radiation therapy alone as initial therapy for their disease and all patients had a complete remission to initial therapy. Four patients subsequently relapsed and the histology at relapse was the same as the initial histology in all four patients. Five patients have died, three of lymphoma, with a median survival of 67 months (range, 40 to 228 months). In view of the heterogeneity of histologies in this group of lymphomas, the variability in duration of response, and the significant number of patients who died of their disease, it is more likely that primary laryngeal lymphoma is an unusual presentation of non-Hodgkin's lymphoma than a separate disease entity. Despite the small number of patients in this study, the data would suggest that patients are best treated according to the histology of the lymphoma, rather than the limited stage and location of the disease.

Mucous membrane plasmacytosis of the upper aerodigestive tract. A case report with effective treatment

We present a case of plasmacytosis of the mucous membrane of the upper aerodigestive tract. This is a rare benign condition characterized by plasma cell infiltration of the mucosa, with only nine cases described previously (Ferreiro et al., 1994). The lesions, which have a cobblestone appearance, cause throat discomfort, dysphonia and mild dyspnoea. All the cases described previously failed to respond to antibiotics, systemic steroids, or to surgical resection. The present case has however responded favourably to intensive and prolonged treatment with beclamethasone oral spray and Corsodyl mouthwashes.

Laryngeal lymphoma derived from mucosa-associated lymphoid tissue

Extranodal lymphomas account for as many as 40% of non-Hodgkin's lymphomas, and most arise in the gastrointestinal tract, but other mucosal organs may be involved, especially the upper aerodigestive tract. Low-grade B-cell lymphomas arising in the gastrointestinal tract and other mucosae have been found to recapitulate the structure and cytologic features of mucosa-associated lymphoid tissue (MALT). Histologically low-grade MALT lymphomas are characterized by centrocyte-like B-cells with a phenotype similar to that of so-called marginal zone B-cells. Tumors evolving from MALT are generally rare among lymphomas of the upper aerodigestive tract, but a few cases of laryngeal lymphomas derived from MALT have been reported. Primary MALT lymphoma of the larynx should always be considered in tumors with histopathologic features of low-grade B-cell lymphoma, or so-called pseudolymphoma.