Laryngeal Blastomycosis: A Commonly Missed Diagnosis Report of Two Cases and Review of the Literature

Abstract

Blastomycosis is a relatively uncommon fungal disease that most commonly affects the lungs. Other organs may be involved, usually secondary to dissemination of the organism. Laryngeal blastomycosis may occur in isolation from active pulmonary disease. The signs, symptoms, clinical features, and pathological findings of laryngeal blastomycosis mimic those of squamous cell carcinoma. Misdiagnosis may result in inappropriate treatment with potential morbidity. Proper understanding of the clinical presentation and familiarity with the histopathologic features of this disease are therefore imperative. In this paper, we report 2 cases of laryngeal blastomycosis, 1 of which was misdiagnosed as squamous cell carcinoma, clinically and microscopically, with consequent radiotherapy and laryngectomy. In the other case, a clinical diagnosis of glottic squamous cell carcinoma was rendered. However, blastomycosis was identified in a biopsy specimen. We also review cases of isolated laryngeal blastomycosis that have been reported in the English-language literature during the last 80 years. A number of those cases were misdiagnosed clinically and microscopically as squamous cell carcinoma.

Klebsiella pneumoniae pharyngitis mimicking malignancy: a diagnostic dilemma

“…Other pharyngeal infections have been described that mimic malignancy including actinomycosis [6], syphilis [7], candidiasis [8], histoplasmosis [9], blastomycosis [10] and tuberculosis [11]. However, there are no reports of K. pneumoniae pharyngitis mimicking hypopharyngeal malignancy in the literature.…”

Primary Laryngeal Blastomycosis: Diagnostic Challenges and Advances in a Rare Cause of Laryngitis

“…Previous case series and reviews suggest that the most common otolaryngologic sites of involvement are the skin, larynx, and oral cavity . Presentation can be highly variable, and diagnosis can be challenging, particularly in the absence of identifiable pulmonary disease . Symptoms of laryngeal blastomycosis may be limited to hoarseness or may include cough, throat pain, dyspnea, and dysphagia.…”

Pathology Quiz Case 2: Diagnosis

“…1 The most common sites of dissemination to the head and neck region include the skin, larynx, oral and nasal mucosa, and thyroid. [2][3][4][5] Blastomyces dermatitidis is endemic to the Ohio River and Mississippi River basins of North America as well as to watershed areas that border the Great Lakes, including Canada. 1 Hyperendemic areas include Wisconsin, where our patient lived.…”

“…The differential diagnosis includes squamous cell carcinoma and other granulomatous diseases such as sarcoidosis and disseminated tuberculosis. 5 Oral and nasal mucosal involvement may mimic squamous cell carcinoma, with indurated tissue and leukoplakia on gross examination. 4 In the few reported cases of thyroid involvement, blastomycosis presented as a thyroid mass with evidence of nonnecrotizing granulomatous inflammation seen on a fine-needle aspirate.…”

“…When present in tissue lined by squamous cell epithelium, blastomycosis infection is known to induce pseudoepitheliomatous hyperplasia and acantholysis. 1,2,4,5 In the lungs, bronchial washings, followed by sputum samples, have the highest diagnostic yield. 8 For cutaneous lesions, it is recommended that the sample include the entire depth and that it be obtained from the diseased edge with a fine-needle biopsy or skin scrapings of exudate.…”