Hoarseness as a presentation of mycosis fungoides infiltrating the larynx

Abstract

Laryngeal involvement is a rare manifestation of mycosis fungoides (MF), with only nine reported cases of cutaneous T cell lymphoma with laryngeal or vocal cord involvement. Herein, we report the case of a patient with a 7-year history of MF who presented to the emergency department with hoarseness, throat tightness and cough, as well as erythroderma and skin tumours. Laryngoscopy and CT imaging were concerning for lymphomatous involvement of the left false vocal cord. A biopsy was taken of the false vocal cord lesion, which revealed an aberrant immunophenotype consistent with MF. The patient was started on doxorubicin with initial rapid improvement in symptoms. Within 2 months, her respiratory status and skin involvement worsened. Subsequent studies showed bone marrow involvement. The patient expired 4 months after original presentation. This report describes the patient's presentation and clinical course, and reviews the literature on vocal cord and laryngeal involvement of MF.

Keywords: dermatology; ear, nose and throat/otolaryngology; immunology.

Figure 1

Appearance of the laryngeal lesion on CT imaging. Left supraglottic lesion with effacement of the left paraglottic fat is shown by the red arrow.

Figure 2

Patient skin findings at time of presentation. Diffuse erythroderma and tumours were found on the patient’s back (upper left), chest (upper right) and extremities (lower left and right) at time of presentation, indicating advanced mycosis fungoides.

Figure 3

Pathological evaluation of left false vocal cord lesion showing a predominance of CD4-positive lymphocytes.

Figure 4

Pathological evaluation of skin lesion showing clusters of atypical lymphocytes and a predominance of CD4-positive cells.

Figure 5

Pathological evaluation of left iliac crest bone marrow biopsy showing hypercellular bone marrow with lymphoid aggregates consistent with involvement by T cell lymphoma.