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.
A 65-year-old Caucasian gentleman, with a history of ischaemic heart disease, presented to ENT with a two-month history of hoarseness. Physical examination was unremarkable, with no lymphadenopathy or organomegaly. Investigations showed a white blood count of 5.7 × 109/L, haemoglobin of 148 g/L, platelets of 213 × 109/L, and a normal serum lactate dehydrogenase level of 192 U/L.\nIndirect laryngoscopy showed vocal polyps, which were excised. Histology showed a monotonous population of lymphoid cells within the lamina propria of mucosal polyps, with slightly irregular nuclear contours and inconspicuous to clear cytoplasm. Immunohistochemistry was positive for CD45, CD20, and bcl2 and negative for CD5, CD23, bcl6, CD138, CD43, CD10, and cyclin D1 (), consistent with a diagnosis of extranodal marginal zone (low-grade) non-Hodgkin lymphoma.\nStaging with computed tomography and bone marrow aspiration and biopsy showed no evidence of disease involvement outside of the larynx.\nThe patient was managed with involved field radiotherapy to the larynx with clinical resolution of symptoms and no radiological evidence of residual disease. He remains alive and well 5 years later.