Solitary Fibrous Tumor of the Larynx and Anterior Neck
Whether benign or malignant, laryngeal and neck masses may involve the upper airway and obstruct breathing. While surgically-resectable malignancies are generally extirpated with adequate margins of normal tissue, benign lesions are usually excised conservatively. However, even benign masses may behave malignantly, necessitating more aggressive surgical resection. We present one such case.
A 35-year-old man from Cotabato City consulted due to difficulty of breathing. He had a six-year history of progressively enlarging anterior neck mass with intermittent dyspnea, foreign body sensation, progressive dysphagia and hoarseness over the last three months. Physical examination revealed a well-defined, 5 x 6 cm smooth, firm, non-tender anterior neck mass that moved with deglutition. Rigid endoscopy showed a right supraglottic mass with bulging of the right glottic and subglottic area, with a less than 10% airway opening. (Figure 1A) Both arytenoids were visibly mobile, but glottic closure was impaired. (Figure 1B) Tracheostomy and suspension laryngoscopy with biopsy yielded inconclusive results (fibromuscular tissue) and fine needle aspiration cytology (FNAC) of the anterior neck mass only revealed blood and colloid. Contrast computed tomography of the neck showed a well-marginated, hypodense, thick-walled, heterogeneously enhancing mass in the right laryngeal fossa measuring 2.86 x 1.78 cm with a larger extension anteriorly measuring 4.66 x 2.52 cm. Effacement of the epiglottis and aryepiglottic fold was noted. The hyoid and thyroid cartilage were intact, and the thyroid gland was normal. (Figure 2A, B)
Because of inconclusive histopathological and cytological results, an incision biopsy of the anterior neck mass was performed. Histopathological evaluation revealed spindle cell mesenchymal proliferation, and immunohistochemical stains showed positive immunoreactivity for CD34, with a weakly positive S-100 and negative SMA, favoring a solitary fibrous tumor.
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