Presentation
The patient presented with respiratory congestion, hoarseness of voice, and a persistent left-sided mass in the neck.
Patient Data
There is an enlarged left-level IIA lymph node and nodular infiltration in the left paraglottic fat at the level of the false vocal cords.
There is an interval reduction in the size of the left-sided level 2A lymph node with new small calcifications.
There is a new moderate-to-large abnormal submucosal soft tissue mass of the right supraglottic larynx without ulceration or necrosis.
There is interval development of right-sided prominent cervical lymph nodes with calcifications.
There is an avidly hypermetabolic right supraglottic laryngeal mass.
There are multiple hypermetabolic pathologic right cervical chain lymph nodes.
There is no hypermetabolic disease in the chest, abdomen, pelvis, or bones.
Case Discussion
Peripheral T-cell lymphomas (PTL) are a rare non-Hodgkin's lymphoma reported at less than 1 case per 100,000 in the United States 1. Laryngeal involvement in PTL is exceedingly rare and commonly occurs in the supraglottic region due to more follicular lymphoid tissue when compared to other parts of the larynx 2. Patients with PTL with laryngeal involvement often present with non-specific symptoms such as lymphadenopathy, dysphagia, dyspnea, and hoarseness 2.
Our patient presented with similar non-specific symptoms prior to the initial CT. The CT findings resulted in a core-needle biopsy of the enlarged left-sided lymph nodes. The biopsy revealed poorly differentiated carcinoma. One year later, follow-up biopsies and pathology reports revealed peripheral T-cell lymphoma, NOS in the new right-sided lymph nodes.
The pathology report showed that the T-cell receptor gene arrangement studies were consistent with the presence of a clonal T lymphocyte population. The tissue sample showed diffuse infiltration of small, mature lymphocytes.
In our case, direct visualization of the large right supraglottic mass showed primarily a submucosal tumor, which is typical for laryngeal lymphoma, whereas squamous cell carcinoma presents as a mucosal tumor.
Future radiologists should be aware that, on imaging, a homogeneously enhanced large soft tissue mass of the supraglottic larynx without necrosis and ulceration and primarily a submucosal component is more characteristic of lymphoma than squamous cell carcinoma.
This case was provided and edited by Ashwin Hampole, MD.
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