Abstract
A previously healthy 54-year-old man complained of progressive voice changes. A firm subglottic polypoid mass was located at the right posterior site, as seen on fiberoptic laryngoscopy, with a distinctly narrowed subglottic space being seen on neck computed tomography, and there were multiple opacities from the cricoid cartilage to the tracheal rings. Resection was done under general anesthesia. The mass-like elevated lesion showed enchondral ossification of the laryngeal cartilage just beneath the squamous metaplastic surface epithelium. The vocal cord mobility was normal. Compared with the computed tomography and the laryngoscopic examination, the polypoid mass-like elevation corresponded to a ossified vocal process of the right arytenoid cartilage. To date, clinically symptomatic ossification of the laryngeal cartilages has presented with foreign body–like impaction. The present case is a rare case of ossification of the laryngeal cartilage that masqueraded as a subglottic polypoid mass. The ossification of laryngeal cartilage is part of the normal aging process, but a tumor-like mass at the airway related with voice changes, like was seen in the present case, is rare. Albeit rare, clinicians and radiologists should be aware that this heterotopic ossification may mimic a polypoid mass–like presentation as well as the accompanying symptoms.
1
Introduction
Osseous changes in the laryngeal cartilages are often described as being a degenerative process in hyaline cartilage that is associated with advancing age, although there exist wide variations in the timing of ossification between different individuals and races . Ossification of the thyroid cartilage begins first, and the cricoid cartilage begins first in the curvilinear superior border of the lamina . This ossification of the airway cartilages can be detected on plain X-ray, and it may be misinterpreted as a foreign body .
Here, we report on a rare case of a subglottic polypoid tumor–like presentation of ossified laryngeal cartilage around the cricoarytenoid joint.
2
Case report
A 54-year-old man presented with a voice changes for the previous 3 years. Fiberoptic laryngoscopic examination revealed a bulging mass of bony consistency that arose from the posterior portion just beneath the right true vocal cord, and the mass was firmly fixed to the posterolateral wall of the cricoid cartilage ( Fig. 1 A ). There were small multiple whitish mucosal nodules at the tracheal wall. Neck computed tomography (CT) showed a protruding calcific lesion around the subglottic level ( Fig. 1 B). These calcific densities were multifocal eccentrical wall thickenings throughout the larynx and trachea. No lymph node enlargement was noted. He showed normal vocal cord mobility. With the patient under general anesthesia, 5.5-mm endotracheal intubation was done. At the Boice position, fiberoptic laryngoscopy exposed a vocal cord, and we confirmed the right subglottic polypoid mass, which was an elevated lesion lined by normal-appearing surface mucosa, and it had a bony firm consistency. With wet gauze covering the tracheal mucosa, a 5-W laser was used to resect the subglottic mass. Pathologically, the surface was lined by pseudostratified respiratory epithelium with squamous metaplasia ( Fig. 2 A ). The stromal connective tissue showed chronic inflammation with markedly infiltrating lymphocytes and focal dystrophic calcification that was seen at the stroma as well as around the capillaries ( Fig. 2 B). The hyaline cartilage and enchondral ossified lamellar bone containing Haversian canals were found just beneath the surface epithelium. The marrow was composed of the true erythropoietic cells and mature fat. Compared with the CT and the laryngoscopic examination, the polypoid mass–like elevation corresponded to the ossified vocal process of the right arytenoid cartilage. During the 6 months of follow-up, his voice was slightly hoarse.
2
Case report
A 54-year-old man presented with a voice changes for the previous 3 years. Fiberoptic laryngoscopic examination revealed a bulging mass of bony consistency that arose from the posterior portion just beneath the right true vocal cord, and the mass was firmly fixed to the posterolateral wall of the cricoid cartilage ( Fig. 1 A ). There were small multiple whitish mucosal nodules at the tracheal wall. Neck computed tomography (CT) showed a protruding calcific lesion around the subglottic level ( Fig. 1 B). These calcific densities were multifocal eccentrical wall thickenings throughout the larynx and trachea. No lymph node enlargement was noted. He showed normal vocal cord mobility. With the patient under general anesthesia, 5.5-mm endotracheal intubation was done. At the Boice position, fiberoptic laryngoscopy exposed a vocal cord, and we confirmed the right subglottic polypoid mass, which was an elevated lesion lined by normal-appearing surface mucosa, and it had a bony firm consistency. With wet gauze covering the tracheal mucosa, a 5-W laser was used to resect the subglottic mass. Pathologically, the surface was lined by pseudostratified respiratory epithelium with squamous metaplasia ( Fig. 2 A ). The stromal connective tissue showed chronic inflammation with markedly infiltrating lymphocytes and focal dystrophic calcification that was seen at the stroma as well as around the capillaries ( Fig. 2 B). The hyaline cartilage and enchondral ossified lamellar bone containing Haversian canals were found just beneath the surface epithelium. The marrow was composed of the true erythropoietic cells and mature fat. Compared with the CT and the laryngoscopic examination, the polypoid mass–like elevation corresponded to the ossified vocal process of the right arytenoid cartilage. During the 6 months of follow-up, his voice was slightly hoarse.
