PMC4802227_01
This figure shows an image of MRI of the patient's neck in coronal view depicting thickened right false cord, true cord and aryepiglottic fold (arrowed).
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Flexible nasopharyngolaryngoscopy revealed a bulky right false cord covering part of the true cord, with limited mobility of the right vocal cord, and severe bilateral subcordal edema narrowing the airway (Fig. 1).
This figure shows an endoscopic view of the patient's larynx via flexible nasopharyngolaryngoscopy depicting a firm mass (A) on the right false cord with bilateral subcordal edema (B). The left true cord is visualised (C).
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Radiological imaging showed unremarkable chest x-ray findings whilst Magnetic Resonance Imaging (MRI) of the neck showed thickening of the right false cord, true cord and aryepiglottic fold, with edema of the subglottis, consistent with our scope findings (Fig. 2). Intra-operatively there was a firm mass arising from the right ventricle extending into the right paraglottic space (Fig. 2).
This figure shows an endoscopic view of the patient's larynx via direct laryngoscopy depicting the appearance after carbon dioxide laser biopsy of the right false cord mass (A), laser ablation of the right subcordal edema (B) and dilatation of the subcordal region (C).
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The right subcordal mass was ablated using a carbon dioxide laser and subsequently dilated up to 30 French Bougie to improve the airway (Fig. 3).
(A, B) The tissue is infiltrated by sheets of small to medium sized dyscohesive neoplastic cells. The neoplastic cells display round to oval nuclei with finely-dispersed chromatin, inconspicuous nucleoli and scanty cytoplasm. These cells are immunoreactive toward LCA (C), CD117 (D) and MPO (E). Bone marrow trephine biopsy also showed neoplastic cells infiltration that displays similar morphology (F).
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Immunohistochemically, the neoplastic cells are immunoreactive for LCA (strong and diffuse), MPO (strong and diffuse) and CD117, and they are negative for CKAE1/AE3, CD20, Cd79a, CD3, CD34 and TdT (Fig. 4).
This figure shows an endoscopic view of the patient's larynx via flexible nasopharyngolaryngoscopy depicting a clear view of the vocal cords with no subcordal edema and resolved right ventricle mass after completion of the first cycle of chemotherapy. The right(A) and left (B) true cord are visualized.
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Arabinoside (HiDAC) protocol. After a cycle of chemotherapy, the mass on the right false cord and bilateral severe subcordal edema were not visualised on a repeat flexible scope (Fig. 5).