Case of a large myofibroblastic laryngeal tumor in a patient with recurrent vocal fold leukoplakia

Abstract

The article presents an interesting case of rare inflammatory myofibroblastic tumor of the larynx, associated with long-term chronic laryngitis and recurrent leukoplakia of the vocal fold. Patient P., 74 years old, was urgently tracheotomized due to rapidly progressive tumor stenosis of larynx in ENT-hospital on duty. A week later our clinic successfully performed laser microsurgical excision of the tumor with simultaneous decanulation. Such approach was possible due to intraoperative express histological examination, which showed no signs of malignancy. Following immunohistochemical analysis made it possible to diagnose a rare inflammatory myofibroblastic tumor. Over 10 years the patient P. suffered from chronic laryngitis and recurrent leukoplakia of the vocal folds, which was operated 3 times in our clinic. Since the role of chronic inflammation is discussed in the genesis of myofibroblastic tumor and laryngeal leukoplakia of the larynx, we prescribed a prolonged 2-months course of azithromycin after the excision of the tumor. This treatment option rarely used in chronic laryngitis, resulted in substantial improvement of voice quality, stable remission of chronic laryngitis and the absence of recurrence of leukoplakia and inflammatory myofibroblastic tumor in patient P. during the next 2-year observatin. A retrospective histological examination of the histological preparation of leukoplakia removed from patient P. in 2012, showed the presence of a biofilm of coccal flora and few bacilli covering the keratosic masses. This finding, together with obvious clinic effect of prolonged antibacterial treatment, gives the reason to suggest a significant role of bacterial inflammation in the genesis of larynx leukoplakia.