C78-27 Airway Emergency: A Case of Isolated Laryngeal B-cell Lymphoma

Introduction Primary extranodal B-cell lymphoma is exceptionally rare, and isolated primary laryngeal B-cell lymphoma is even more so. Lymphoma of the larynx or hypopharynx only accounts for 1% of all laryngeal tumors. Clinical presentation involves dyspnea, dysphagia, dysphonia, throat swelling, and airway compromise. Here, we present a patient with progressive respiratory distress who was found to have an invasive laryngeal mass. Initially suspected to be a primary thyroid malignancy, the mass was ultimately diagnosed as an isolated B-cell lymphoma with no evidence of distant metastasis. Following airway stabilization, appropriate treatment was initiated. Case Report A 56-year-old male with a remote history of 10 pack years of tobacco use (quit 30 years ago) presented to the emergency department for evaluation of progressively worsening vocal hoarseness, wheezing, dysphagia, and dyspnea with an enlarging right-sided neck mass, which was palpable, nonmobile, and nontender. He was hemodynamically stable and on room air; however, he was noted to have severe dysphonia and orthopnea with intermittent stridor. A CT neck demonstrated a 2.5 x 4 cm, ill-defined, lobulated soft tissue mass involving the right piriformis sinus, true and false vocal folds, paraglottic fat, and right lateral thyroid lamina with infiltration of the arytenoid and cricoid cartilages and extension into the posterior hypopharyngeal wall, resulting in severe airway narrowing (Fig 1). He received IV steroids and underwent percutaneous, image guided biopsy. Histopathology showed aggressive high-grade B-cell lymphoma, and the patient was initiated on chemotherapy. Staging imaging showed no evidence of distant metastasis. Discussion This case highlights the importance of considering laryngeal B-cell lymphoma in the differential diagnosis of patients presenting with a variety of upper airway symptoms, including dyspnea, dysphagia, vocal hoarseness, stridor, facial pain, throat swelling/globus sensation, as well as more typical symptoms of malignancy such as B symptoms. Prompt airway assessment is critical for guiding decision-making for urgent airway intervention. In cases with impending airway compromise, high-dose IV steroids may be used to reduce airway edema; however, intubation may still be required. Once the airway is secured, biopsy confirms the diagnosis and enables timely treatment. High-grade B-cell lymphoma has a 5-year survival rate of 60-70% with standard therapy. The National Comprehensive Cancer Network recommends systemic immunochemotherapy and/or localized radiation based on patient and disease characteristics. Timely recognition, airway stabilization, and prompt histopathologic diagnosis are critical in managing isolated laryngeal B-cell lymphoma, particularly in cases with airway compromise.