Adult rhabdomyoma of the larynx

Rhabdomyoma of the Larynx: A Case Report and Literature Review of a Rare Tumor in an Uncommon Location

OBJECTIVES

Laryngeal rhabdomyomas are extremely rare, benign striated muscle tumors that have been documented only ∼50 times in the literature. They can be subdivided into two types: fetal and adult types, with the adult type being more common. Common presenting symptoms include hoarseness or progressive dysphagia. Diagnosis is made via immunohistochemical and microscopic analysis. Management is typically surgical, most commonly endoscopic, or open resection.

METHODS

A comprehensive literature review was conducted with PubMed's MEDLINE index using the following search string: "rhabdomyoma" AND ("larynx" OR "laryngeal" OR "head" OR "neck"). After exclusion criteria were applied, a total of 58 cases were included. The purpose of our literature review was to elucidate information about age/gender, location, size, chief complaint and duration, treatment, and recurrence from each of the 58 cases to identify trends that could guide future diagnosis and management.

RESULTS

The average age at diagnosis of laryngeal rhabdomyoma was 52.6 years with a 2.22:1 male predominance. Hoarseness and/or dysphonia was the most common chief complaint (42/58 cases, 72%), followed by dysphagia (12/58 cases, 21%). Common treatment options included endoscopic excision (18/48 cases, 37.5%) or open surgical resection (10/48 cases, 21%). Tumor recurrence was reported in 5/40 cases (14%), most likely due to incomplete removal of the tumor.

CONCLUSIONS

Although laryngeal rhabdomyomas are rare, they should be considered in the differential diagnosis for patients with a submucosal laryngeal mass. Curative treatment is surgical via endoscopic resection. It is the preferred technique because of decreased morbidity compared to open resection. However, endoscopic resection was shown to have both higher rates of recurrence and shorter time to recurrence compared to open resection, necessitating frequent postoperative surveillance.

High 18F-fluoro-2-deoxy-D-glucose uptake in adult-type rhabdomyoma of the larynx

Rhabdomyomas are rare benign mesenchymal tumors of the skeletal muscles and uncommon in the head and neck region. Laryngeal rhabdomyomas are much rarer. We present the case of a 32-year-old woman who was admitted to our hospital for shortness of breath due to pneumothorax. As otolaryngologists, we were consulted for a soft tissue tumor over the left side of the larynx that was accidentally found on the chest computed tomography (CT). The patient underwent laryngomicrosurgery for tumor biopsy, and histological examination revealed a laryngeal rhabdomyoma. After the operation, magnetic resonance imaging of the neck was performed and the tumor was suspected as rhabdomyosarcoma. Positron emission tomography/computed tomography (PET/CT) showed an 18F-fluoro-2-deoxy-D-glucose (FDG)-avid soft tissue mass on the left side of the larynx. After complete tumor removal via transoral laser microsurgery, no recurrence was reported for 5 years.

Rhabdomyoma of the Oral Cavity Mimicking Reactive Lesions: A Case Report and Review of the Literature

Extracardiac rhabdomyoma is a tumor that rarely occurs in head and neck region. Adult and fetal types of extracardiac rhabdomyoma are diagnosed only by histopathological examination. In the oral cavity, this lesion usually affects the mouth floor and tongue. Despite the low incidence, adult rhabdomyoma should be considered in the differential diagnosis of oral cavity lesions, and histopathological evaluation might be helpful for the final diagnosis. This study aims to report a rare case of rhabdomyoma mimicking reactive lesions and review the literature. A 34-year-old male was referred to the pathology department with a yellowish sessile lesion in the labial maxillary vestibule. During an excisional biopsy, a mass of unencapsulated soft tissue beneath the vestibular mucosa was observed. The yellowish color in clinical features has led to lipoma as the initial clinical diagnosis. The histological examination exhibited an encapsulated, well-circumscribed benign neoplasm composed of multiple lobules of large polygonal cells with prominent abundant granular eosinophilic cytoplasm. No cellular atypia was observed. Diagnosis of the adult type of rhabdomyoma was made by collective agreement. Rhabdomyoma can be mistaken for other reactive lesions and may resemble their appearance.

Nonepithelial Tumors of the Larynx: Single-Institution 13-Year Review with Radiologic-Pathologic Correlation

Nonepithelial tumors of the larynx are rare and represent a minority of all laryngeal neoplasms. Imaging has an important role in the diagnosis, treatment planning, and surveillance of these entities. However, unfamiliarity with these neoplasms can cause diagnostic difficulties for radiologists, especially because many of the imaging findings are nonspecific. By using a systematic approach based on clinical history, patient age and gender, lesion location, endoscopic results, and specific imaging findings, the differential diagnosis can often be narrowed. These tumors typically affect the submucosal layer, so if a tumor has an intact mucosa at endoscopy, a nonepithelial neoplasm is the most likely diagnosis. Nonepithelial tumors of the larynx can arise from the laryngeal cartilage or muscle or from the surrounding lymphoid tissue or blood vessels. Consequently, imaging findings typically correspond to the specific cell type from which it originated. Recognizing specific features (eg, metaplastic bone formation, macroscopic fat, or enhancement pattern) can often help narrow the differential diagnosis. In addition, identification of noncircumscribed borders of the lesion and invasion of the adjacent structures is key to diagnosis of a malignant process rather than a benign neoplasm. Understanding the pathologic correlation is fundamental to understanding the radiologic manifestations and is ultimately crucial for differentiation of nonepithelial laryngeal neoplasms. Online supplemental material is available for this article. ^©RSNA, 2020.

Adult-Type Rhabdomyoma of the Larynx: Clinicopathologic Study of an Uncommon Tumor in a Rare Location

Rhabdomyoma is an uncommon benign mesenchymal tumor with skeletal muscle differentiation that may occur either in the heart or in extracardiac sites. Even though the head and neck region is the most common area of extracardiac rhabdomyoma, the larynx is rarely involved. We present the case of an 85-year-old woman who reported a 10-day history of breathing difficulties, dysphagia, and dysphonia. A computed tomography scan of the head and neck showed a contrast-enhanced, solid hypopharyngeal-laryngeal neoplasm with well-defined margins causing subtotal obliteration of the right pyriform sinus and a reduction in air lumen of the laryngeal vestibule. The patient underwent complete endoscopic removal of the lesion; histologic examination revealed an adult-type rhabdomyoma based on the histologic features and the immunoreactivity of the neoplastic cells for desmin, myoglobin, and muscle-specific actin but not for cytokeratin, S-100, CD68R, chromogranin-A, and synaptophysin. Since clinical and imaging features are not specific for rhabdomyoma, histologic examination and immunohistochemical analyses play a central role in the differential diagnosis of the adult-type rhabdomyoma from other laryngeal neoplasms. A correct diagnosis is mandatory to avoid inappropriate treatment.