Laryngo-tracheobronchial Amyloidosis: a Case Report and Review of Literature

Abstract

Amyloidosis is a spectrum of diseases characterized by abnormal extracellular accumulation of proteinaceous material; its precise etiology still remains unclear. It may affect multiple organs, of which the commonest sites are larynx, bronchus and kidney. Laryngeal amyloidosis is usually a localized phenomenon rarely associated with systemic involvement, here we report a case of laryngeal amyloidosis with tracheobronchial involved. The patient was 31-years old. He had a history of open surgical operation for laryngeal amyloidosis in the left ventricle 4-years ago. This time he was suffered by amyloid deposition in his right ventricle, the lesion was excised on staged laryngoscopy under general anesthesia. After 20-months follow-up, the post-operative recovery was wonderful. The bronchoscopy examination and computerized tomography scan for chest demonstrated he also had right main bronchus amyloidosis. Being of no dyspnea, he was unwilling to accept an operation on bronchus. Though amyloidosis is a benign lesion, up to date, there are no curable treatments for such a disease, for severe cases, it may be fatal as a result of airway obstruction or respiratory failure. Here we review the pertinent references on this subject, and discuss the main managements for amyloidosis on larynx and bronchus.

The lung in amyloidosis

“…Most cases represent localised AL amyloidosis and are restricted to this site. The pulmonary parenchyma is typically not involved, but colocalisation of laryngeal and tracheal amyloidosis has been described [74,75]. In some cases of laryngotracheal involvement, subglottic amyloidosis may result in severe dyspnoea with fixed airflow obstruction at spirometry [76].…”

Hemorrhage Due to Endotracheal Extubation in a Patient with Laryngeal Amyloidosis

“…If complete excision is proved to be with high morbidity, patients should be followed on a yearly basis. On the other hand, the patients sometime may be fatal as a result of upper airway obstruction and respiratory failure [17]. In the clinical approach of these patients, it must be proven that it is not systemic amyloidosis [10].…”

Laryngeal Primary Amyloidosis: Differential Diagnosis of Localized Granulomatosis with Polyangiitis. Report of Two Cases

“…Laryngeal amyloidosis is a type of amyloidosis in situ that is rarely associated with systemic disease [3,4]. The larynx is the main site affected by amyloidosis of the upper aerodigestive tract and lesions occur mainly in the vestibular fold (55%), presenting as a subepithelial nodule or edema [2,3].…”

“…Primary laryngeal amyloidosis (PLA) is a rare condition with an annual incidence of 5-10 cases per million [1][2][3]. PLA occurs at a gender ratio of three males to one female, typically between the fourth and sixth decades of life [1][2][3][4][5][6][7]. It accounts for 0.5-1% of all benign tumors of the larynx, and may present with isolated symptoms of dysphonia and/or dyspnea [1][2][3].…”