Nasal Polyps, Multifocal Laryngeal Masses, and Subglottic Stenosis in a Middle-aged Man

Abstract

A 52-year-old man who had recently emigrated from Guatemala and had a history of asthma presentedtotheemergencydepartmentwithexacerbationoflong-standingdyspneaalongwith progressivelyworseningnasalcongestionanddysphoniaoverthepast2years.Hewasdiagnosed with asthma 2 years earlier when he first started experiencing shortness of breath and had partial relief with inhaled albuterol treatments only. He had no history of fevers, dysphagia, odynophagia, cough, or allergies.Onphysicalexamination,moderatelyseveredysphoniacharacterizedprimarilybyroughness with mild breathiness as well as mild inspiratory stridor were noted. Anterior rhinoscopy demonstrated large, bilateral obstructive nasal polyps. Flexible laryngoscopy revealed smooth, lobulated masses involving the epiglottis and right aryepiglottic fold. The epiglottic component extended inferiorly along the petiole, involving and obstructing the anterior glottis. The vocal fold mucosawasthickened,butbilateralmobilitywasintactwithanadequateposteriorglotticairway.Computed tomography demonstrated homogenous, isodense, laryngeal lesions that correlated with the previously mentioned laryngoscopy findings, but also showed subglottic stenosis approximately 2 cm in length secondary to the thickened intraluminal soft tissue (Figure , A). The cartilaginous laryngotracheal framework was preserved. The chest radiograph was unremarkable. The patient was taken to the operating room for direct laryngoscopy with endoscopic airway dilation and laryngeal mass biopsy (Figure , B, C, and D). Sagittal computed tomography scan A Laryngoscopic view B Endoscopic view C Original magnification ×80 D Figure. A, Subglottic stenosis was noted on computed tomography (yellow arrowhead). Multifocal laryngeal masses were also observed, with the largest mass involving the epiglottic petiole and extending to obstruct the anterior glottis (black arrowhead). B, The arrowhead points to a smooth, lobulated mass involving the epiglottis and anterior glottis. C, Cotton-Meyer grade II subglottic stenosis was noted. D, Laryngeal mass biopsy results showed vacuolated macrophages with bacilli (yellow arrowhead) and eosinophilic inclusions within plasma cells (black arrowhead) (hematoxylin-eosin).