Abstract
BackgroundThis 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 presentationOur 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.ConclusionsThis 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.
Highlights
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
It is not uncommon for a pediatrician, a general practitioner, and a pediatric otolaryngologist to see a child presenting with hoarseness
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
Summary
Inflammatory myofibroblastic tumor is an unusual tumor that can mimic a neoplastic process. Immunohistochemical staining plays an important role in the histological diagnosis of IMT. The initial presentation of IMT in a child is most often hoarseness. It is important to exclude laryngeal lesion as a cause of persistent hoarseness in a child. This can be done with the use of a nasoendoscopy. A delay in diagnosis of a laryngeal lesion can result in a life-threatening airway issue. The endoscopic approach used in this case results in less postoperative morbidity with no increased recurrence. Good postoperative follow-up is necessary in order to detect any recurrence promptly. Abbreviations CT, computed tomography; IMT, inflammatory myofibroblastic tumor; MLB, microlaryngobronchoscopy; MRI, magnetic resonance imaging
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