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.
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.