A 58-year-old Chinese female who was a retired doctor presented in October 2010 with a history of progressive hoarseness for about 10 months. The patient did not suffer from fever, night sweat, or weight loss. Multiple laryngoscopy examinations in other hospitals revealed severe hypertrophy of left ventricular band. As Figure showed, the left ventricular band and laryngeal ventricle bulged with smooth surface, covering most of the left vocal cord. Her past history was remarkable for rheumatoid arthritis and Sjogren syndrome for many years. Her family and psychosocial history was unremarkable. Partial resection of tumor by laser in another hospital was performed and hoarseness relieved significantly. The postoperative pathology demonstrated neoplastic cells invaded adjacent epithelial cells, forming lymphoepithelial lesion (Figure ). The immunohistochemical results showed CD3 and CD20 (focally+), κ(diffusely +), λ(−), Ki-67(5–10%). Therefore, the patient was diagnosed as non-Hodgkin MALT marginal zone B-cell lymphoma.\nOn physical examination, no enlarged superficial lymph nodes were palpated. Laboratory investigations showed a normal complete blood cell count and a generally normal serum biochemical profile. Lactate dehydrogenase was normal. β-2 Microglobulin was 2.47 mg/L (0.7–1.8 mg/L). Erythrocyte sedimentation rate was 41 mm/h (10–20 mm/h). The subsequent thoracic computed tomography (CT) and ultrasound for bilateral neck, armpit, and groin did not reveal any enlarged lymph node. Gastroscopy showed chronic nonatrophic gastritis. The bone marrow aspiration did not find neoplastic involvement. Thus, an MALT lymphoma of larynx, Ann Arbor stage IEA, International Prognostic Index score 0, was diagnosed.\nOne month after surgery, the patient was admitted to our department. Laryngoscopy demonstrated that there was a red mucosa uplift in the left ventricular band, and bilateral vocal cords were normal. The throat CT scan also revealed the front part of left ventricular band was more hypertrophy than its right counterpart (Figure ). All these findings were consistent with residual tumor. Then irradiation of 7-field 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 was carried out. The side effects were mild. The repeated laryngoscopy when she finished radiotherapy showed the tumor disappeared. Radiotherapy alone achieved a complete remission (CR) response. Until now, her condition remains stable and the DFS has reached to 4 years.
A 60-year-old Caucasian female presented with a 2-month history of progressive dysphagia, hoarseness, and globus sensation, accompanied by a 10-pound weight loss over this period. At time of presentation, she also reported exertional dyspnea. She denied nausea, vomiting, fever, hemoptysis, or hematemesis. Her only other medical comorbidity was hypertension, which was well controlled. She denied smoking, drinking, or related family history of malignancy.\nA CT neck with contrast revealed a large sessile, isointense mass on the laryngeal surface of epiglottis measuring 4.7 cm in its greatest dimension, with no submucosal extension or cervical lymphadenopathy (see ).\nThe patient was subsequently referred to the otolaryngology service for further evaluation. On examination she had a muffled voice and minimal inspiratory stridor without respiratory distress. On palpation, she had normal external laryngeal landmarks and no palpable neck masses. Using a tongue depressor, a large mass could be seen in the oropharynx behind the upper edge of epiglottis. Flexible fiberoptic examination confirmed an exophytic mass in oropharynx that was sessile to the laryngeal surface of the epiglottis and occupied most of the oropharynx. Just beyond the mass, the hypopharynx and laryngeal inlet were normal in appearance (see ).\nA transoral biopsy of the mass was conducted under local anesthesia, since it was easily visualized through her mouth and the mass was stable without glottis obstruction. The biopsy revealed an unusual B-cell lymphoma subtype (see ), based on immunostaining and in situ hybridization ().\nCT of chest, abdomen, and pelvis was negative for additional lymphadenopathy. Bone marrow aspiration and biopsy showed no evidence of bone marrow involvement. These findings were consistent with a diagnosis of diffuse large B-cell (high grade; also she has intermingled low grade areas) non-Hodgkin lymphoma of the larynx, stage IE, with an R-IPI score of 1 (age > 60, ECOG 0–2, normal LDH of 209 U/L, 0-1 extranodal sites, and stage I/II disease). The patient was subsequently treated with definitive chemotherapy and radiation.\nShe was given three cycles of R-CEOP (rituximab, cyclophosphamide, etoposide, vincristine, and prednisone) followed by involved field radiotherapy to the neck with 40 Gy radiation. The patient was seen in clinic 8 weeks later with complete resolution of dysphonia and dysphagia. Repeat fiberoptic examination demonstrated complete resolution of the epiglottic mass without evidence of recurrent or residual tumor. She was seen again four months later with normal voice and remained disease free on examination (). Her PET scan 3 months after treatment was negative.