Laryngeal inflammatory myofibroblastic tumor (IMT): a case report and review of the literature

Abstract

Background: This case report is interesting as cases of children with laryngeal inflammatory myofibroblastic tumor are not common and previously had been presented as isolated case reports. This is the first case report in Asia describing a laryngeal inflammatory myofibroblastic tumor and its removal using an endoscopic approach.

Case presentation: Our patient is a 12-year-old Malay girl from Singapore who presented with hoarseness without respiratory distress. The initial impression was that of a granuloma or a papilloma. We did a biopsy, which confirmed the histology to be inflammatory myofibroblastic tumor, and a magnetic resonance imaging scan showed a contrast-enhanced lesion. The lesion was excised completely using an endoscopic approach. The child was discharged well on the first postoperative day and she has been on follow-up for a year in the clinic.

Conclusions: This report highlights the importance of understanding the differential diagnosis for a child with hoarseness. It is not uncommon for a pediatrician, a general practitioner, and a pediatric otolaryngologist to see a child presenting with hoarseness. In most cases, the diagnosis made would be screamer's nodules, which is commonly seen in children. In a small group, recurrent respiratory papillomatosis form the diagnosis. Over the past few years, the cases of recurrent respiratory papillomatosis have decreased significantly. Laryngeal tumors are not common in children. However, we must maintain a high index of suspicion when we have a child with hoarseness who does not improve with speech therapy and watchful waiting. In such situations, a stroboscope is usually necessary to diagnose the voice problems and to rule out pathological conditions such as laryngeal tumors. If left untreated, the lesion can grow with time and result in a life-threatening airway condition. We also demonstrate our endoscopic technique in this report, and it has proven to be safe with no increased recurrence and much lower morbidity.

Keywords: Benign; Endoscopic; Hoarseness; Laryngeal tumor; Recurrence.

Fig. 1

Pre-operatively, lesion on the right vocal cord as seen on flexible nasoendoscopy

Fig. 2

Intra-operatively, lesion seen on the anterior two thirds of the right true vocal cords and ventricle

Fig. 3

Myxoid tumour composed of ovoid to spindle shaped cells with associated plasma cells (H & E, magnification x 200)

Fig. 4

Cells demonstrating vesicular to hyperchromatic nuclei with ample eosinophilic to lightly basophilic cytoplasm (H & E, magnification x 400)

Fig. 5

Coronal T2 image showing hyperintense lesion

Fig. 6

Axial T1 image showing isointense to hypointense lesion

Fig. 7

Axial T1 image with contrast showing lesion with avid enhancement

Fig. 8

Post excision of the lesion

Fig. 9

Nodule on the right vocal cord

Fig. 10

4 months later, previously seen nodule resolved

Fig. 11

Last follow up picture showing no recurrence of the lesion