Laryngeal Diffuse Large B-Cell Lymphoma Presenting as Laryngeal Stenosis

Abstract

Background: Laryngeal stenosis is challenging for treatment due to uncertain etiology. Primary laryngeal lymphoma as the initial clinical manifestation of laryngeal stenosis has been rarely reported. Primary diffuse large B-cell lymphoma as an underlying etiology has not been reported. Case Report: A 79-year-old male presented with dyspnea, stridor and dysphonia of 6 months' duration. Computed tomography scans and flexible laryngoscopic examination revealed vocal cord mobility with bilaterally limited abduction and a subglottic stenosis up to 50%. The laryngeal mucosa was smooth. Laryngeal biopsy showed atypical lymphoid infiltrates, predominantly large sized B-cells, in the submucosa with crush/cauterized artifacts. The tumor cells were positive for B-lymphocyte antigen CD20, paired-box 5 (PAX5), B-cell lymphoma 2 (BCL2), BCL6 and multiple myeloma oncogene 1 (MUM1). They were negative for CD10, CD30, cyclin D1 (CCND1), SRY-box 11 (SOX11), activin-receptor like kinase 1 (ALK1), CD138 and c-MYC, and negative for kappa/lambda light chain and Epstein-Barr virus-encoded small RNA by in situ hybridization. The pathologic diagnosis was diffuse large B-cell lymphoma. Fluorescent in situ hybridization (FISH) for MYC was negative. Next-generation sequencing using a 175gene panel was performed and no pathologic mutations were identified. No lymphadenopathy elsewhere was identified. The patient was treated with chemotherapy and was doing well at the 5-month follow-up. Conclusion: To the best of our knowledge, this is the first documented case of primary laryngeal diffuse large B-cell lymphoma presenting as increasing laryngeal stenosis. The rarity, diagnosis and treatment of this entity are discussed.

Primary diffuse large B‐cell lymphoma of the head and neck in a Brazilian single‐center study

“…Comparatively, our cohort exhibited a slightly lower or very similar median age (59 years) depending on the anatomical regions focused by the studies (Rayess et al, 2017; Rodrigues‐Fernandes et al, 2019; Takano et al, 2015). The number of DLBCL patients with involvement of the Waldeyer's ring was very high compared to other sites evaluated in our study, which is in agreement with literature (Epstein et al, 2001; Şalplahta et al, 2012; Tang et al, 2020; Zapater et al, 2010). Also, the most prevalent site in Waldeyer's ring was tonsil ( n = 70; 28.8%), which corroborates a recent report that demonstrated in a group of 37 patients that all tonsillar NHL cases were from DLBCL type (Das & Chatterjee, 2020).…”

“…We observed only two patients with larynx and three with mandible involvement. Therefore, lymphomas cases involving these anatomic locations are commonly described as case reports (Tang et al, 2020).…”

Imaging Characteristics of Primary Non-Hodgkin's Lymphoma of The Larynx

“…As showed in our cases of study, glottic tumors were often secondary to the spread of tumor tissues in adjacent areas. Among the seven reported cases of B-cell lymphomas causing laryngeal stenosis, ve cases were MALT-lymphoma located in the subglottic region [13][14][15][16][17][18][19]. This is consistent with the results of our study, which may indicate that most of the NHL located in the subglottic region and causing laryngeal stenosis are MALT-lymphoma.…”