Obstructive laryngeal schwannoma in a young female

Abstract

Laryngeal schwannomas are rare, benign neurogenic tumors. They normally present as a slow-growing, encapsulated, submucosal mass in the supraglottic region. We describe a 20-year-old female presenting with a 2-year history of hoarseness and progressive worsening dyspnea. Fiberoptic laryngoscopy and computed tomography revealed a round, low-density submucosal mass at right false cord and arytenoepiglottic regions with glottic extension. Microlaryngoscopic biopsy and debulking for this solid tumor were performed without tracheostomy. Schwannoma was confirmed by histopathological study. However, rapidly worsening stridor occurred 2 weeks after the surgery. Fiberoptic laryngoscopy showed an exophytic tumor occupying the right hemilarynx with airway compromise. Definite complete excision of the tumor was performed by right vertical hemilaryngectomy. At 5-month follow-up, the laryngeal wound was clear without signs of recurrence. Rapid occurrence of airway obstruction after debulking and biopsy was demonstrated in this case. Vertical hemilaryngectomy was inevitable to cure this potentially life-threatening laryngeal schwannoma in this young female with postoperative serviceable voice.

Figure 1

Preoperative findings. (A) Preoperative fiberoptic laryngoscopy revealed a submucosal bulging in the right false and true vocal folds. Preoperative contrast-enhanced computed tomography in (B) axial and (C) coronal view showed a round, slightly heterogenously enhanced mass in the supraglottic area with glottic extension.

Figure 2

Intraoperative findings of transoral CO ₂ laser microsurgery. (A) A submucosal mass obstructing the view of right vocal fold was found via direct laryngoscopy. (B) The mucosa overlying the tumor was elevated, revealing a well-encapsulated tumor. The tumor was adhered to the underlying cartilage. (C) With CO₂ laser, the tumor was removed as much as possible.

Figure 3

Histopathological findings of transoral CO ₂ laser microsurgery and vertical hemilaryngectomy. (A,B) Transoral CO₂ laser microsurgery: (A) the histopathological specimen shows biphasic pattern of compact hypercellular Antoni A and myxoid hypocellular Antoni B areas (hematoxylin-eosin stain, magnification × 200); (B) the schwannoma cells showed strong immunoreactivity for S-100 protein. (C,D) Vertical hemilaryngectomy: microscopically, the specimen of vertical laryngectomy showed characteristic findings of schwannoma without surrounding tissue or vascular invasion (black arrow in (C): capsule) (hematoxylin-eosin stain, (C) magnification × 40, (D) magnification × 100).

Figure 4

Pre- and intraoperative findings of vertical hemilaryngectomy. (A) Fiberoptic laryngoscopy revealed space-occupying tumor in the right hemilarynx with partial airway obstruction 2 weeks after transoral CO₂ laser debulking. (B) Intraoperative findings of vertical hemilaryngectomy: an exophytic tumor extending from supraglottis to subglottic region was found. Black arrow: cutting edge of laryngofissure. (C) Resected tumor showing glottic and subglottic extension. (D) Laryngoscopic view 5 months after vertical hemilaryngectomy.