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.
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.