English

Abstract

CASE REPORT: A 40 year male patient presented to us with the history of having coughed out moderate quantities of blood on two occasions during the preceding week. During one episode he had coughed out a piece of tissue as well. The hemoptysis subsided spontaneously. On further questioning he reported occasional breathing difficulty on exertion, mild intermittent change in voice and minimal discomfort in the throat during the previous one and a half month. He gave no history of evening rise of temperature, chest pain, and loss of weight or appetite. He was not habituated to smoking or alcohol consumption. General examination and systemic examination including chest and abdominal examination was unremarkable. There was no stridor. Indirect laryngoscopic examination revealed a congested and thickened right vocal cord. Both vocal cords were found to move normally. No ulcer or mass was visible in the larynx or pharynx. Neck nodes were not palpable. During one of the episodes of hemoptysis he had coughed out a piece of tissue. This had been sent for histological examination by the doctor he had consulted initially for hemoptysis and it was reported as adenoid cystic carcinoma. The chest Xray, urinalysis and routine blood tests were normal. Tomogram of the larynx showed a soft tissue shadow in the right subglottis, direct laryngoscopy and bronchoscopy revealed a pinkish, sessile mass in the right half of the subglottis with an irregular surface. There was no other lesion in the tracheobronchial tree. He underwent total laryngectomy with right hemithyroidectomy. The upper tracheal rings were resected with the larynx. No enlargement of neck nodes was noticed during surgery. The resected specimen showed a 1.5 x 1.5 cm sized pink, fleshy, sessile mass in the right subglottis extending from 1 cm below the free margin of the vocal cord to the second tracheal ring (Fig. 1). Histopathological examination of the excised specimen showed adenoid cystic carcinoma (Fig. 2). The patient had an uneventful postoperative recovery. Later on, he developed tracheostomal stenosis for which he underwent stomoplasty. Seven months after the initial surgery he underwent successful surgical voice restoration by secondary tracheo-oesophageal puncture and Blom-Singer’s voice prosthesis insertion. The patient was disease free 32 months after surgery, when last seen.