PMC5738199_01
Thickened mucosa throughout oropharynx, supraglottic larynx including the epiglottis, aryepiglottic folds, piriform sinuses, and false vocal cords. Narrowing of the airway including effacement of the piriform sinuses and vallecula. Mild thickening of the true vocal cords. Prominent soft tissue with erosive change in the maxilla in the midline.
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Computed tomography of the neck was performed and revealed diffuse thickening of the mucosal oropharynx, supraglottic larynx, aryepiglottic folds, piriform sinuses, and true/false vocal cords (Fig. 1, Fig. 2).
Hematoxylin and eosin stained section demonstrating multiple multinucleate giant cells containing numerous organisms consistent with Histoplasma spp. (40x).
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Histologic examination of the biopsy revealed granulomatous mucositis with multinucleated giant cells containing multiple budding yeast forms (Fig. 3) that stained with Grocott's methenamine silver (Fig. 4) and were consistent with histoplasma species.