Pathology Quiz Case

Abstract

A 67-YEAR-OLDWOMANWITHAHISTORYOFLEFT true vocal fold paralysis presented with a 6-dayhistoryofworseningdysphonia,dyspnea,andnoisybreathing.Shecomplained ofdysphagia tosolidsbutnot to liquids.She did not have any fevers, chills, otalgia, or weight loss. Examinationofher larynxrevealeda left vocal cordmasswith extension into the subglottis and a fixed left vocal fold. Her airway was significantly narrowed. The findings of the rest of the examination were significant only for biphasic stridor and a 2 2-cm mass in the anterior aspect of the neck. The patient was brought to the operating room, where an awake tracheostomy, laryngoscopy with biopsy of the subglottic mass, and a core biopsy of the neck mass were performed. The biopsy specimens showed similar findings, with the subglottic mass revealing fragments of fibrous tissue containing birefringent transparent spherical material with a foreign body giant cell reaction (Figure 1 and Figure 2). Birefringent foreign material was identified in a sample of the specimen under polarized light (Figure 3). What is your diagnosis?