Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings

Figure 1
(A–D) 34 year-old woman with laryngeal paraganglioma. Right preepiglottic well defined enhanced mass (arrows) is seen in contrast enhanced CT (A) and contrast enhanced T1 weighted turbo spin echo spectral fat saturation inversion recovery (T1 TSE SPIR); (B) images. Axial 68Gallium-DOTA-peptide PET/CT fusion image (C); shows intense uptake by the right laryngeal paraganglioma similar with syncronous left carotid body paraganglioma (D) (figures of this case were printed in Ref. ⁵5 Dogan S, Senol S, Imamoglu H, Abdulrezzak U, Ekinci A, Yuce I, et al. An unusual case of laryngeal paraganglioma in a patient with carotid body paraganglioma: multimodality imaging findings. Case Rep Radiol. 2015;2015:342312.).

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Figure 2
(A–C) 70 year-old man with laryngeal chondroma. Contrast enhanced CT image (A) shows expansile mass arising from cricoid cartilage. Chondroid calcifications are seen within the mass. Coronal T2 weighted TSE image (B) shows high signal intensity transglottic mass. Endoscopy (C) reveals bilateral edema of the mucosa of the arytenoid cartilages and a large submucosal mass.

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Figure 3
(A–C) 52 year old woman with primary hyperparathyroidism and multiple brown tumors. Contrast enhanced CT image (A) shows expansile mass-brown tumor arising from the cricoid cartilage. Mandibular lytic expansile mass is seen on more superior level CT image (B). Parathyroid adenoma is seen at left inferior parathyroid gland location (C).

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Figure 4
(A and B) 61 year-old man with pulmonary and laryngeal tuberculosis. Contrast enhanced CT image (A) shows a mass on the left band ventricle (arrow) and left arytenoid cartilage sclerosis. Endoscopic image (B) demonstrates a mass on the left band ventricle protruding on the left vocal cord.

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Figure 5
(A–C) 23 year-old woman with posttransplant lymphoproliferative disease, monomorphic, diffuse large B-cell type. Non-enhanced CT shows mass (arrows) (A) on left aryepiglottic fold and left cervical lymphadenopathy (arrow) (B). Endoscopic image (C) reveals irregular yellowish mass involving the left band ventricle, aryepiglottic fold and tongue base.

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Table 1
Clinicopathological data of patients.

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Table 2
Diagnostic imaging characteristics of patients.

	Age (years)/Gender	Clinical presentation	Physical examination findings	Diagnosis	Approach and treatment
1	85/F	Hoarseness, stridor, dyspnea	Large subglottic mass.	Chondrosarcoma (grade 1)	Total laryngectomy
2	82/M	Hoarseness	Left sided transglottic mass	Chondrosarcoma (grade 2)	Larynx biopsy
2	82/M	Hoarseness	Left sided transglottic mass	Chondrosarcoma (grade 2)	Total laryngectomy + left neck
					Dissection
3	68/M	Hoarseness	Mass involving right aryepiglottic fold and interarytenoid mucosa.	Neuroendocrine tumor Grade 2 (atipical carcinoid tumor)	Larynx biopsy
3	68/M	Hoarseness		Neuroendocrine tumor Grade 2 (atipical carcinoid tumor)	Chemoradiotherapy
4	39/F	Hoarseness, dysphagia, right ear pain	Mass in the laryngeal side of epiglottis	Extranodal natural killer/T cell lymphoma	Larynx biopsy
4	39/F	Hoarseness, dysphagia, right ear pain	Mass in the laryngeal side of epiglottis	Extranodal natural killer/T cell lymphoma	Chemoradiotherapy
5	23/F	Hoarseness	Yellowish mass involving the left aryepiglottic fold, band ventricle and tongue base	Posttransplant lymphoproliferative disease, monomorphic, diffuse large B-cell type	Larynx and lung bx
5	23/F	Hoarseness			Systemic treatment for lymphoma
6	44/M	Dyspnea	Subglottic mass narrowing the passage.	Plasmocytoma-multiple myeloma involvement	Larynx biopsy
6	44/M	Dyspnea	Subglottic mass narrowing the passage.	Plasmocytoma-multiple myeloma involvement	Systemic treatment for multiple myeloma
7	55/M	Dyspnea, hoarseness	Transglottic mass	Plasmocytoma-multiple myeloma involvement	Spinal biopsy Systemic treatment for multiple myeloma
8	70/M	Dyspnea, dysphagia	Mass in the postcricoid region	Plasmocytoma-multiple myeloma involvement	Larynx biopsy
8	70/M	Dyspnea, dysphagia	Mass in the postcricoid region	Plasmocytoma-multiple myeloma involvement	Systemic treatment for multiple myeloma
9	74/M	Hoarseness	Right sided glottic mass	Adenocarcinoma metastasis (histopathologic features were similar with lung adenocarcinoma, operated 2 years a go).	Larynx biopsy
10	34/F	Left sided neck mass (laryngeal lesion was asymptomatic)	Normal laryngoscopic findings and palpable mobile, 1.5 cm mass anterior to the sternocleidomastoid muscle on left side.	Paraganglioma	Excision of laryngeal and carotid body paragangliomas after angiographic embolization of vascular supplies on two separate operations.
11	70/M	Hoarseness, dysphagia	Immobile left arytenoid, glottic space obstructed.	Chondroma	Urgent tracheotomy, laryngofissure surgery
12	68/F	Hoarseness	Right sided soft submucosal supraglottic and glottic mass.	Laryngeal lipoma	Excision of laryngeal lipoma
13	63/M	Hoarseness	Left sided mass involving the left vocal cord and anterior commissure.	Inflammatory myofibroblastic tumor-left vocal cord squamous cell carcinoma-anterior commissure.	Larynx biopsy
13	63/M	Hoarseness			Laser cordectomy + postoperative radiotherapy
14	52/F	Dyspnea, a mass in the jaw	Subglottic mass narrowing the passage	Brown tumor of hyperparathyroidism Parathyroid adenoma	Parathyroidectomy
15	30/M	Dyspnea, stridor	Bilateral limited vocal cord mobility, deformity of epiglottis.	Wegener's granulomatosis involvement.	Immune supressive therapy
16	61/M	Hoarseness	Left ventricle and vocal cord edema.	Granulomatous inflammation	Larynx biopsy
			Left supraglottic mass lesion	Tuberculous involvement	Antituberculous medical treatment.
			Left supraglottic mass lesion	Tuberculous involvement	Lung biopsy (Caseified granulomatous inflammation).
17	42/M	Dysphagia	An ulcerated lesion on the left arytenoid,	Chronic-active inflammation Behçet's disease involvement	Larynx biopsy
17	42/M	Dysphagia	An ulcerated lesion on the left arytenoid,	Chronic-active inflammation Behçet's disease involvement	Immune supressive therapy
18	35/M	Hoarseness and right sided neck mass	Purple colored transglottic mass right side of the larynx	Vasculary malformation (low-flow)	The patient cannot follow-up

Patient no.	Diagnosis	Maximum lesion size (mm)	Lesion location	CT	MRI	Additional imaging modalities
1	Chondrosarcoma (Grade 1)	30	Subglottic	Heterogeneous expansile mass arising from cricoid cartilage with internal chondroid matrix calcification	T1W isointense, T2W hyperintense mass, minimally heterogeneous enhancement	-
2	Chondrosarcoma (Grade 2)	60	Supraglottic + glottic + subglottic	Transglottic hypodense mass with central necrosis.	-	-
				Extralaryngeal extension.
				Thyroid and cricoid cartilage destruction.
				Level 6 metastatic lymphadenopathy.
3	Neuroendocrine tumor Grade 2 (atipical carcinoid tumor)	16	Supraglottic	Mass on right aryepiglottic fold and interarytenoid region	T1W isointense, T2W hyperintense, enhancing soft tissue	-
4	Extranodal Natural killer/T cell lymphoma	30	Supraglottic + glottic	Mass on the epiglottis, aryepiglottic fold, band ventricle, vocal Cord.	-	F-18 FDG PET/CT
				Ipsilateral level 2 metastatic lymphadenopathy.		Increased tracer uptake in right supraglottic soft tissue (SUVmax 2.1).
				Ipsilateral level 2 metastatic lymphadenopathy.		Increased tracer uptake in ipsilateral level 2 lymph nodes (SUVmax 2.6)
5	Posttransplant lymphoproliferative disease, monomorphic, diffuse large B-cell type	16	Supraglottic	Mass on left aryepiglottic fold, band ventricle,	-	F-18 FDG PET/CT
				Left level 3 metastatic lymphadenopathy		Intense tracer uptake in oropharynx and supraglottic larynx (SUVmax 11.5),
				Left level 3 metastatic lymphadenopathy		Increased tracer uptakes in lung, pleura, spleen, breast, stomach, axillary, hilar and cervical lymph nodes.
6	Plasmocytoma-multiple myeloma involvement	28	Subglottic	Lytic-expansile mass arising from cricoid cartilage	-	F-18 FDG PET/CT
				Lytic lesions at first and ninth ribs and T10 vertebra corpus.		Increased tracer uptake in subglottic larynx (SUVmax 2.9).
						Multiple skeletal increased tracer uptakes in the 1, 6, 9th ribs and T10 vertebra (SUVmax 3.6).
7	Plasmocytoma-multiple myeloma involvement	30	Supraglottic + glottic + subglottic	Transglottic mass, thyroid and cricoid cartilage destruction.	-	F-18 FDG PET/CT
7	Plasmocytoma-multiple myeloma involvement	30	Supraglottic + glottic + subglottic	Multiple lytic skeletal lesions.	-	Multiple skeletal increased tracer uptakes (SUVmax 10.9).
8	Plasmocytoma-Multiple myeloma involvement	28	Subglottic	Lytic expansile mass arising from cricoid cartilage.	-	-
8	Plasmocytoma-Multiple myeloma involvement	28	Subglottic	Multiple lytic skeletal lesions.	-	-
9	Adenocarcinoma metastasis	14	Glottic	Mass on the right vocal cord	-	-
9	Adenocarcinoma metastasis	14	Glottic	Bilateral level 2 metastatic lymphadenopathy.	-	-
10	Paraganglioma	12	Supraglottic and left carotid bifurcation	Well defined, hypervascular mass at right preepiglottic space.	T1W isointense, T2W hyperintense, homogeneously enhancing mass lesions at right preepiglottic space and left carotid bifurcation	68Ga-DOTA-peptide PET/CT
				Hypervascular mass at left carotid bifurcation.		Right preepiglottic mass; Intense tracer uptake (SUV max: 35.8)
						Left carotid body mass; Intense tracer uptake (SUV max: 37.5)
						DSA:
						Right superior thyroid artery supplied laryngeal mass
						Left ascending pharyngeal artery supplied mass at left carotid bifurcation.
11	Chondroma	50	Supraglottic + glottic + subglottic+	Transglottic expansile mass arising from cricoid cartilage	T1W hypointense, T2W hyperintense, minimally heterogeneous enhancing mass	-
12	Laryngeal lipoma	22	Supraglottic + glottic	-	Supraglottic and glottic nonenhancing mass with typical fat signal characteristics: T1W hyperintense, entirely suppressed on fat-suppressed images.	-
13	Inflammatory myofibroblastic tumor	18	Glottic	Mass on the left vocal cord	-	-
14	Brown tumor of hyperparathyroidism	20	Subglottic	Expansile mass arising from cricoid cartilage.	-	-
				Maxillary and mandibular lytic expansile mass lesions
				Parathyroid adenoma at left inferior gland location.
15	Wegener's granulomatosis involvement	-	Diffuse soft tissue involvement	Diffuse edema and increased soft tissue thickness at laryngeal soft tissue.	-	-
15	Wegener's granulomatosis involvement	-	Diffuse soft tissue involvement	Lung CT: ground glass opacities, consolidation, focal bronchiectasis, nodules, bronchial and tracheal wall thickening.	-	-
16	Tuberculous involvement	10	Supraglottic	Mass on left band ventricle, arytenoid cartilage sclerosis.	-	-
16	Tuberculous involvement	10	Supraglottic	Lung CT: right hilar lymphadenopathy, consolidations, ground glass opacities, bronchiectasis at left upper lob.	-	-
17	Behçet's disease involvement	10	Supraglottic	Increased soft tissue thickness on left aryepiglottic fold and priform sinüs.	-	-
18	Vasculary malformation (low-flow)	47	Supraglottic + glottic	-	T1W hypointense, T2W hyperintense, enhancing mass right side of the supraglottic and glottic level of larynx and oropharyngeal, lingual, nasopharyngeal extensions.	-

[1] * Corresponding author. drserapdogan@hotmail.com

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Abstract

Introduction

Objective

Methods

Results

Conclusion