Laser Resection of Subglottic Pleomorphic Adenoma

Abstract

A 48 years old male was referred to our center, a specialized tertiary comprehensive cancer center with a history of progressively worsening dyspnea since 6 months. The patient was admitted in a general hospital for stridor and treated with steroids following which his stridor subsided. Further investigations with rigid laryngoscopy under general anesthesia revealed a subglottic mass. The biopsy was reported as pleomorphic adenoma and he was referred to us for further management.On presentation, the patient had no stridor or hoarseness. On flexible laryngoscopy, a pedunculated mass with a broad base was seen arising 1 cm below the level of the vocal cords, extending inferiorly for about 1 cm and occluding 30% of the subglottic lumen. Both the vocal cords were normal in appearance and mobility (Fig. 1). The rest of the tracheobronchial tree was normal. A computed tomography (CT) scan of the larynx revealed a lobulated mass in the subglottis arising from the posterior wall measuring 1.2 × 1.2 × 1.4 cm, extending anterior and abutting the right lateral wall of subglottis with no erosion of the underlying cartilage (Figs 2 and 3). The patient underwent endolaryngeal endoscopic CO 2 laser (Lumenis TM Israel, 3.5 W, superpulse mode) resection of the mass under general anesthesia using apnea technique. The base of the mass was completely resected with wide margins. The cricoid cartilage was not exposed. Postoperative recovery was uneventful.The histopathology report demonstrated a biphasic tumor in submucosa consisting of epithelial nests, trabeculae and tubules embedded in a fibromyxoid stroma (Fig. 4A). The epithelial component composed of 2 cell types: epithelial cells arranged in duct like structures or cords and myoepithelial cells situated at around the ducts and in solid Fig. 1: Flexible laryngoscopy picture showing presence of pedunculated mass arising from posterior wall of subglottis, compromising laryngeal lumen AbstractTumors arising from the minor salivary glands in the larynx are rare. The most common tumors occurring here are adenoid cystic carcinomas. 1 Among the benign tumors, pleomorphic adenoma is the most common. 1 We present a case of subglottic pleomorphic adenoma which was managed by endolaryngeal endoscopic CO 2 laser surgery. Laser as a primary treatment modality for the treatment of subglottic pleomorphic adenomas has not been well-described, as only one case has been reported in literature using this modality.