ABSTRACT
Primary solitary extramedullary plasmacytoma of the larynx involving the true vocal cords is an extremely rare entity. Extramedullary plasmacytoma has the potential to transform into multiple myeloma and mandates strict vigilance and routine follow-up. We describe such a case in a 29-year-old pregnant woman who presented with progressive hoarseness, dysphagia and intermittent respiratory difficulty. Fiberoptic laryngoscopy revealed a fleshy mass involving the posterior third of the true vocal cords, encroaching on the ventricle and false cords. Histopathology and immunohistochemistry revealed extramedullary plasmacytoma of a monoclonal nature. In spite of Bence Jones proteinuria and a rising serum ß 2-microglobulin level, a thorough search for metastasis and subsequent treatment with radiotherapy were delayed due to the patient's pregnancy. She is the youngest adult ever reported with primary solitary extramedullary plasmacytoma involving the true cords. Described for the first time in pregnancy, the relevant issues in management are highlighted.
Subject(s)
Laryngeal Neoplasms/diagnosis , Plasmacytoma/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Vocal Cords , Adult , Biomarkers, Tumor/blood , Dose Fractionation, Radiation , Female , Hoarseness/etiology , Humans , Immunoglobulin kappa-Chains/blood , Immunoglobulin lambda-Chains/blood , Laryngeal Neoplasms/complications , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/radiotherapy , Laryngoscopy , Plasmacytoma/complications , Plasmacytoma/pathology , Plasmacytoma/radiotherapy , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/radiotherapy , Pregnancy Outcome , Vocal Cords/pathology , beta 2-Microglobulin/bloodABSTRACT
Pharyngo-cutaneous fistula is a common complication after laryngectomy, which increases both the morbidity and the hospital stay. The incidence rate varies from 8.7% to 24.8% in different institutions. The continuous salivary leak is very much troublesome for the patients. There are various predisposing factors out of which preoperative radiotherapy, diabetes, malnutrition is very important. Spontaneous closure occurs in most of the cases on conservative management and only a few need surgical closures. Surgical methods used are direct surgical repair in two layers inner mucosa and outer skin, single distant flap like DP or PMMC, double distant flap like DP and PMMC one for inner mucosa and another for outer skin. Post operative swallowing was satisfactory in all the cases and there was no recurrence of fistula in one and half year follow up.
