An 82-year-old Caucasian lady known to suffer from ischaemic heart disease, hypertension, and mild renal impairment was admitted to hospital in November 2010 complaining of a 3-month history of increasing facial pain and difficulty breathing. She had previously undergone surgery for a complicated diverticular abscess two years prior to this presentation and this had resulted in a defunctioning colostomy. Physical examination showed no lymphadenopathy or organomegaly. Indirect laryngoscopy showed a mass at the base of the tongue, involving the epiglottis and causing airway obstruction. The patient underwent an emergency tracheostomy to secure the airway. Investigations showed a white blood count of 11.3 × 109/L, haemoglobin of 104 g/L, platelets of 296 × 109/L, and a normal serum lactate dehydrogenase level of 209 U/L. Staging with computed tomography only confirmed disease in the laryngeal area () and did not show any thoracic, abdominal, or pelvic lymphadenopathy. Bone marrow aspiration and biopsy showed no evidence of bone marrow involvement.\nBiopsy of the laryngeal mass showed that the mucosa and submucosa were infiltrated by large atypical lymphoid cells with irregular nuclear outlines and multiple prominent nucleoli. The cells were positive for CD45 and CD20 and negative for CD3 and bcl2 on immunohistochemistry (). These findings were consistent with a diagnosis of diffuse large B-cell (high-grade) 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).\nThe patient was administered three cycles of R-CEOP (rituximab, cyclophosphamide, etoposide, vincristine, and prednisone) followed by involved field radiotherapy. Anthracyclines were avoided in view of a decreased left ventricular ejection fraction of 40% on echocardiography performed at diagnosis.\nThe first cycle of chemotherapy was complicated by an acute coronary syndrome, from which the patient recovered with supportive care. The tracheostomy was removed following the second cycle of cytotoxics and the patient remains alive and well 5 years later.
We report the case of a 70-year-old North African man who, two months prior to medical examination, presented with mild laryngeal respiratory distress that worsened until he ultimately required a tracheotomy. A direct laryngoscopy had been performed, revealing a subglottic, submucosal lump. A biopsy revealed a mantle cell type B NHL with the following antigen constellation: cluster of differentiation (CD)5+, CD20+, CD23-, cyclin D1+. Importantly, a physical examination and computed tomography (CT) scans showed a lack of lymph node involvement, establishing the larynx as the primary site of the neoplastic lesion.\nThe patient’s history and physical examination found no comorbidities. The patient did not present any B symptoms and had a performance status 3 as measured using the World Health Organization performance scale. During a follow-up four weeks after his initial admission, a physical examination found laterocervical lymph nodes. An investigation into possible tumoral extension by cervical, thoracoabdominal and pelvic CT scans showed a subglottic tumor (Figures and ) and cervical lymph nodes.\nA bone marrow biopsy did not show any anomalies. A blood workup showed he had normal red blood cell sedimentation rate and lactate dehydrogenase levels.\nThe patient, who has been staged IIEAa (Ann Arbor Classification), received one course of rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone but unfortunately died of unknown causes. No autopsy was performed in compliance with the family’s wish.