Asphyxial death caused by a laryngeal schwannoma: a case report

Laryngeal schwannoma: A case report and literature review

Laryngeal schwannomas are rare benign neurogenic tumors of the larynx. They cannot be detected in the early stages because disease onset is asymptomatic. This case of laryngeal schwannoma provided a reference for clinical diagnosis and treatment strategy. A 24-year-old man presented with a 3-year history of hoarseness and sore throat for 6 months. Laryngoscopy and computed tomography showed submucosal bulging of the right ventricular fold in the right paraglottic space. The patient underwent tracheotomy first, followed by laryngotomy. The edema of the laryngeal mucosa was significantly alleviated, with normal movement of the bilateral vocal cords on the 10th day after surgery. The tracheal tube was removed at the time of discharge. The hoarseness had disappeared at the end of the first month after surgery. The effective treatment of laryngeal schwannoma involves complete resection with surgery while protecting the integrity of the larynx and restoring laryngeal function. The indication for surgery should be strictly controlled to avoid damage to the mucosa and structures of the larynx.

Laryngeal schwannoma masquerading as malignancy

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.

Pediatric laryngeal schwannoma: a case report

Schwannomas are benign tumors originating from Schwann cells in the peripheral nervous system. They mostly occur in the head and neck region but are rare in the larynx, and present with various symptoms. Surgical removal is the recommended treatment. This study presents a 12-year-old female with sudden onset hemoptysis, snoring, difficulty breathing, dysphagia, and voice changes. On examination, she was conscious and had muffled voice while speaking, without signs of respiratory distress. Endoscopic laryngoscopy revealed a large laryngeal mass obstructing the vocal cords. Endoscopic excision and biopsy confirmed the presence of the laryngeal schwannoma. Postoperative recovery was uneventful, with normal vocal cord function and no recurrence at follow-up.

Partial laryngectomy and reconstruction with rotation of the epiglottis in the treatment of a rare laryngeal schwannoma: a case report

Background

Neurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up.

Case presentation

A 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma.

Conclusion

The definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.

[An unusual cause of high dysphagia: schwannoma of the preepiglottic space]

Les schwannomes sont des tumeurs mésenchymateuses, bien encapsulées des nerfs périphériques, de croissance lente. La localisation laryngée est exceptionnelle, nous présentons un cas non décrit dans la littérature de shwannome localisé au niveau de la loge hyothyroépiglottique. Une patiente de 50 ans, qui présentait une sensation de corps étranger depuis 4 ans, évoluant vers une dysphagie haute associée à une voix rauque. La laryngoscopie directe en suspension objectivait une masse supraglottique sous muqueuse régulière, réduisant la lumière pharyngo-laryngée. La TDM et l'IRM concluaient à une tumeur bénigne de la loge hyo-thyro-épiglottique. Une exérèse chirurgicale par voie externe a été réalisée et une trachéotomie première était nécessaire. L'examen histologique avec une étude immunohistochimique confirmait un schwannome bénin. Les suites post opératoires étaient simples. Aucune récidive n'était objectivée après 2 ans de recul.

Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review

Objective

This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy.

Data Sources

PubMed, Google Scholar, Cochrane, and SCOPUS.

Review Methods

Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied.

Results

The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes.

Conclusions

Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

Laryngeal schwannoma as an acute airway presentation

A schwannoma is a neurogenic tumour arising from nerve sheaths. Between 25% and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare. They usually occur in women during the fourth and fifth decades of life. We present a case of a laryngeal schwannoma in a 76-year-old patient with acute stridor, hoarseness and dysphagia. Laryngeal conservation surgery was performed without the need for a tracheostomy. One year later, the patient remains symptom-free with no evidence of recurrence. Clinical presentation, diagnosis and management are discussed and the literature is reviewed.

Obstructive laryngeal schwannoma in a young female

Laryngeal schwannomas are rare, benign neurogenic tumors. They normally present as a slow-growing, encapsulated, submucosal mass in the supraglottic region. We describe a 20-year-old female presenting with a 2-year history of hoarseness and progressive worsening dyspnea. Fiberoptic laryngoscopy and computed tomography revealed a round, low-density submucosal mass at right false cord and arytenoepiglottic regions with glottic extension. Microlaryngoscopic biopsy and debulking for this solid tumor were performed without tracheostomy. Schwannoma was confirmed by histopathological study. However, rapidly worsening stridor occurred 2 weeks after the surgery. Fiberoptic laryngoscopy showed an exophytic tumor occupying the right hemilarynx with airway compromise. Definite complete excision of the tumor was performed by right vertical hemilaryngectomy. At 5-month follow-up, the laryngeal wound was clear without signs of recurrence. Rapid occurrence of airway obstruction after debulking and biopsy was demonstrated in this case. Vertical hemilaryngectomy was inevitable to cure this potentially life-threatening laryngeal schwannoma in this young female with postoperative serviceable voice.

Sudden Death Due to Asphyxia by Primary Tracheal Small Cell Carcinoma

Sudden natural asphyxial death in adults due to airway obstruction is an unusual cause of death. A variety of etiologies can cause airway obstruction, including benign or malignant tumors and soft tissue swelling from asthma, infections, or anaphylaxis.

Malignant tracheal neoplasms are exceedingly rare with a reported incidence of approximately 2/1 000 000 and the small cell carcinoma subtype accounts for <10% of these tumors.

We present a case of a 55-year-old female smoker who was found dead at home. At autopsy an obstructing lesion of the proximal trachea was identified that showed the characteristic cytomorphology of small cell carcinoma. No primary pulmonary lesions were identified. The cause of death was determined to be obstruction of the trachea by small cell carcinoma and the manner, natural.

Laryngeal schwannoma excised under direct laryngoscopy: case report

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO(2) laser, and preservation of the mucosal lining of the larynx was achieved.

Acute respiratory distress in patient with laryngeal schwannoma

Schwannoma is a neurogenic benign tumour arising from the proliferation of Schwann cells present in the peripheral nerve sheath of myelinated nerves. This proliferation can hypothetically appear in every anatomic region of the human body, but the nerve sheath tumors rarely occur within the larynx. In this paper the authors discuss the case of a 74-year-old female who presented to Emergency Unit (EU) for an important acute respiratory distress. Airway flexible endoscopy revealed a bulky mass of the aryepiglottic fold measuring 3.5 cm in diameter. The patient underwent tracheotomy and a single-step surgical excision treatment of the mass which was recognized as a schwannoma at pathological examination. Tracheotomy was closed 2 weeks postoperatively. After 18 months of followup, the patient is alive and free of disease and her voice had improved markedly.

Schwannoma of the larynx. An infrequent laryngeal tumour

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO₂ laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.

Schwannoma of the larynx

Objectives

Neurogenic tumors of the larynx are extremely rare. The goal of this report is to advert to this rare disease, to review and discuss diagnostics, differential diagnoses and treatment options. Study Design: Retrospective case report and review of the literature. Methods: Case report of a schwannoma of the supraglottic larynx and review of the English- and German-language literature regarding neurogenic tumors of the larynx. Results: Neurogenic laryngeal tumors typically involve the supraglottic larynx, rarely the glottis. They can course globus sensation, dysphagia, dysphonia and upper airway obstruction. Imaging does not yield a definite diagnosis. The only curative treatment option is complete surgical resection. Conclusions: A definite diagnosis can only be made histologically. Endoscopic (laser-) resection for smaller lesions and external approaches for larger lesions are recommended treatment options.

Sudden death by laryngeal polyp: a case report and review of the literature

Sudden unexpected death in the context of bizarre or unusual behavior usually relates to acute drug intoxication or excited delirium. We report the case of a man who died suddenly while running naked on a public street. Although the initial death investigation was indicative of excited delirium or drug intoxication, autopsy revealed glottic obstruction by an inflammatory laryngeal polyp. Toxicologic studies were negative and investigation revealed presentation at a hospital the day before death with stridor. It is believed he developed airway obstruction while dressing at home and ran out on the street to find assistance. This case illustrates the importance of a thorough death investigation and a broad differential diagnosis when approaching a forensic autopsy.

Schwannoma of larynx - a rare presentation

Neurogenous tumours of the larynx are extremely uncommon. Schwannoma of larynx is a variant of neurogenous tumour. The patient underwent microlaryngoscopic excision of that tumour. We present here the clinical findings of the case, along with direct laryngoscopic view, the photograph of the mass after removal and histological slide compatible with the diagnosis of schwannoma.

Forensic Lung Pathology

Sudden and unexpected natural deaths and nonnatural deaths may result from various pulmonary conditions. Additionally, several nonpulmonary conditions of forensic significance may be complicated by the development of respiratory lesions. Certain situations with pulmonary pathology are particularly likely to be critically scrutinized and may form the basis of allegations of medical negligence, other personal injury liability, or wrongful death.1

Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea

BACKGROUND

Schwannomas of the larynx are rare lesions in the pediatric age group.

METHODS

In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea.

RESULTS

Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically.

CONCLUSION

Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.

Schwannoma of the True Vocal Fold: A Rare Diagnosis

Schwannomas of the larynx are rare, benign, slowly growing tumors. When they do occur, they are most often isolated in the aryepiglottic folds or false vocal folds. When a tumor originates in the larynx, it typically causes hoarseness and a globus sensation. As the tumor expands, it may cause dyspnea, stridor, and possibly asphyxiation as a result of the mass effect. In this article, we report an unusual case of a schwannoma of the true vocal fold in a young woman.

Neurinoma laríngeo: a propósito de un caso

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature.

Schwannoma of the Epiglottis: First Report of a Case

Schwannomas of the larynx are rare. Most of the few such reports in the literature have described schwannomas that occurred in the aryepiglottic fold or the true vocal folds. In this article, we report what we believe is the first case of a schwannoma arising from the epiglottis.

Lateral thyrotomy for neurilemmoma of the larynx

We present a rare case of neurilemmoma of the larynx, which was excised through a lateral thyrotomy approach with resulting restoration of laryngeal function. The advantage of the lateral thyrotomy approach for submucous tumours of the larynx is discussed.