Primary Laryngeal Lymphoma and Voice Hoarseness: A Rare Etiology for A Common Clinical Feature

 

Abstract

Primary Laryngeal Lymphoma is rare both as a hematological and as a laryngeal malignancy. Unlike squamous cell carcinomas, lymphomas require chemo-radiotherapy as 1st-line treatment. A 67-year-old lady presented with voice hoarseness, dyspnea and dysphagia for solids. An otherwise unremarkable physical showed “hot-potato like” voice. Labs were normal, while laryngoscopy and CT revealed an epiglottic mass, which was resected. Biopsy results showed DLBCL. The patient then underwent chemotherapy with complete success. Voice hoarseness has a vast differential diagnosis depending on its character and complementary symptoms. Less than a 100 cases of Primary Laryngeal Lymphoma have been reported in the literature, proving the rarity of this clinical entity.

Keywords:Primary laryngeal lymphoma; voice hoarseness; diffuse large B-cell lymphoma; larynx; lymphoma; epiglottis; dysphagia; dyspnea; “hot-potato like” voice

Abbreviations:CT: Computed Tomography; PET-CT: Positron Emission Tomography- Computed Tomography; NHL: Non-Hodgkin Lymphoma; ECOG: Eastern Cooperative Oncology Group; WBC: White Blood Cells; NEU: Neutrophils; LYM: Lymphocytes; MONO: Monocytes; EOS: Eosinophils; BASO: Basophils; RBC: Red Blood Cells; Hgb: Hemoglobin; Hct: Hematocrit; MCV: Mean Corpuscular Volume; MCH: Mean Corpuscular Hemoglobin; PLT: Platelets; ESR: Erythrocyte Sedimentation Rate; LFTs: Liver Function Tests; AST: Aspartate Transaminase; ALT: Alanine Transaminase; γ-GT: Gamma-glutamyl transferase; Bil: Bilirubin; dBil: Direct bilirubin; iBIl: Indirect bilirubin; Cr: Creatinine; BUN: Blood Urea Nitrogen; Glu: Glucose; Alb: Albumin; TC: Total Cholesterol; TGL: Triglycerides; LDH: Lactate Dehydrogenase; CRP: C reactive protein; DLBCL: Diffuse large B-cell lymphoma; LPR: Laryngopharyngeal Reflux; NK: Natural Killer Cells; R-CHOP: Rituximab, Cyclophosphamide, Andriamycin, Oncovin, Prednisone; HD-MTX: High Dose Methotrexate; CNS: Central nervous system; SCC: Squamous Cell Carcinoma; MALT: Mucosa-Associated Lymphoid Tissue; EBV: Eibstein Barr Virus; BMI: Body Mass Index

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