Posttransplant Lymphoproliferative Disorder involving the Larynx

ABSTRACT

Aim:

Our goal is to present an unusual case of posttransplant lymphoproliferative disorder (PTLD) involving the larynx. We aim to expand the literature regarding head and neck manifestations involving PTLD and for otolaryngologists to include PTLD in their differential diagnosis of laryngeal lesions in patients who have a history of solid organ transplantation.

Background

Posttransplant lymphoproliferative disorder occurs in immunocompromised patients following solid organ transplantation. Head and neck manifestations most commonly involve Waldeyer's ring with the larynx and trachea being relatively uncommon sites of disease. However, lesions of the larynx can cause acute airway obstruction and rare fatalities have been reported in the literature.

Case report

We present the case of a 51-year-old female with a history of renal transplantation, who presented to the office after an incidental supraglottic lesion was discovered during intubation for cochlear implant placement. A mucosalized lesion arising from the right aryepiglottic fold with dynamic obstruction of the airway was noted on office endoscopic examination. Imaging revealed extension of the mass into the right posterolateral hypopharynx. The patient was taken to the operating room for microdirect laryngoscopy and CO ₂ laser excision of the mass. The lesion was excised with negative gross margins. Final pathology revealed plasmacytoma-like PTLD and the patient was referred back to her transplant team for modulation of her immunosuppressive therapy.

Conclusion

We present the case of an incidental supraglottic lesion in a posttransplant patient. Special emphasis should be given to the tissues of Waldeyer's ring and larynx.

Clinical significance

Posttransplant lymphoproliferative disorder, while rare, should be kept in the differential diagnosis of pharyngeal and airway lesions in patients with a history of solid organ transplantation. Expansile lesions can cause acute airway obstruction. Urgent evaluation and treatment of theses lesions is necessary in these circumstances.

How to cite this article

Kohli N, Wasserman JM. Posttransplant Lymphoproliferative Disorder involving the Larynx. Int J Head Neck Surg 2016;7(1):53-56.