Metastatic Calcification of the True Vocal Folds in the Setting of Renal Failure

Abstract

Objectives: (1) Present a case of metastatic calcinosis of the true vocal cords. (2) Discuss the pathogenesis, diagnosis, and treatment strategies for this condition. Methods: This is a case report of a 52-year-old male with a history of end-stage renal disease and tobacco abuse who presented to clinic with complaints of dysphagia, cough, and subtle voice changes. Transnasal fiberoptic laryngoscopy revealed bilateral patches of leukoplakia on the anterior third of the vocal cords. After a 3-month period of conservative management with a proton pump inhibitor and serial scope examinations, the lesions were noted to be slowly enlarging. It was determined that an excisional biopsy should be performed to rule out malignancy. The patient underwent micro-suspension direct laryngoscopy with microflap excision of the bilateral vocal cord lesions. Results: Surgical pathology revealed benign squamous mucosa with calcinosis, parakeratosis, and submucosal hyalinization. These findings were characteristic of metastatic calcification. Review of the patient’s medical records confirmed ongoing phosphorous dysregulation. Metastatic calcinosis of the true vocal fold is a very rare finding, with only 2 other reported cases in the literature. Conclusions: In patients suffering from end-stage renal disease, dysregulation of calcium and phosphate levels may lead to deposition of calcium in many types of soft tissue, including the true vocal cords. Examination findings may mimic dysplastic lesions, and this diagnosis should be considered in patients with chronic kidney disease.