engleski

Primary laryngeal manifestation in precursor T-cell acute lymphoblastic leukemia : case report

We report a case of a 37 year old woman with a 2-months history of a dyspnoea and the diagnosis of tracheal stenosis, before she was admitted to our ENT Department. On fiberlaryngoscopy a subglottic mass, nearly obstructing the airway, was noted. We performed tracheotomy in general anaesthesia and removed subglottic tumorous mass by carbon dioxide laser resection. Histopathology and immunohistochemistry revealed the diagnosis of laryngeal T-lymphoma. There was 30% blasts in the bone marrow and by immunophenotyping the diagnosis of precursor T-cell acute lymphoblastic leukemia (pre T- ALL) type II was finally confirmed. Postoperatively we performed staging investigation, which included computed tomography (CT) scanning of chest, abdomen and pelvis and it showed a solid anterior mediastinal mass. The patient was treated with three cycles of combination chemotherapy. After the first cycle she did not respond to chemotherapy, but the remission was achieved after second cycle of chemotherapy and she was planned for bone marrow autotransplantation because there was no compatible bone marrow donor. After the second chemotherapy cycle we performed fiberlaryngoscopy and we confirmed that larynx was completely free of subglottic mass, and no laryngeal obstruction was seen during the examination. The patient underwent the third chemotherapy cycle, unfortunately after a week she died of sepsis, but without any airway problems. Here, we describe a case of a pre T-ALL which was presented as a laryngeal obstruction due to subglottic mass. Also we showed the treatment of subglottic mass by using carbon dioxide resection which seems to be adequate because there was no recurrence of subglottioc mass and laryngeal obstruction during the whole chemotherapy treatment. In recent English literature there are articles which show isolated laryngeal T- cell lymphoma, but there is no reported case which show that laryngeal mass causing airway obstruction actually revealead acute lymphoblastic leukemia.

larynx; lymphoma; lymphoblastic leukemia

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