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.
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.