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Pedunculated Laryngeal Hemangioma in a Patient With Suspected Atypical Symptoms of GERD

Published:April 15, 2017DOI:https://doi.org/10.1016/j.cgh.2017.04.019
      A 56-year-old man with a diagnosis 5 years prior of gastroesophageal reflux disease (GERD) with typical symptoms (heartburn) responsive to proton pump inhibitor (PPI) therapy was referred to our Gastroenterology Department having experienced chronic dry cough and pharyngeal foreign body sensation over a period of 2 years. He had no complaints of heartburn, dysphagia, dyspnea, choking, or hoarseness. He had history of neither smoking nor alcohol abuse. Both symptomatic specific treatments (dextromethorphan and benzocaine lozenges) and proton pump inhibitors (twice daily over a period of 3 months) had been only partially effective, as mild symptoms still persisted. Thus, a new evaluation of suspected GERD was requested.
      On esophagogastroduodenoscopy examination, a vascular pedunculated lesion with a bluish red morular surface, approximately 1.5 cm in diameter, was observed in the right aryepiglottic fold, partially occluding the entrance in the larynx (Figure 1A–C). No erosive esophagitis or other reflux suggestive mucosal injuries were observed during the examination.
      The patient was referred to the Otolaryngology Department, where the lesion was removed by laryngeal microsurgery under general anesthesia. Both cough and foreign body sensation resolved completely after resection. Histopathologic analysis showed a benign mesenchymal proliferation of vascular character in the chorion of the laryngeal mucosa (H&E, 40×) (Figure 1D). Definitive diagnosis was a laryngeal cavernous hemangioma.
      Adult laryngeal hemangiomas are rare benign tumors usually appearing as well-defined bluish-red colored lesions in the glottic or supraglottic regions.
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      The most common symptoms are hoarseness, pharyngeal foreign body sensation, cough, hemoptysis, and dysphagia. Respiratory distress is a very infrequent complication in adults.
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      • Lin Y.
      • Ho H.
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      • Jin H.
      Giant mesenteric hemangioma of cavernous and venous mixed type: a rare case report.
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      • Tsai K.
      Transoral robotic resection of an adult laryngeal haemangioma and review of the literature.
      • Lin Y.
      • Ho H.
      Adult laryngeal hemangioma.
      • Wang X.
      • Zhao X.
      • Zhu W.E.I.
      Resection of a laryngeal hemangioma in an adult using an ultrasonic scalpel: a case report.
      • Yang G.
      • Li J.
      • Jin H.
      Giant mesenteric hemangioma of cavernous and venous mixed type: a rare case report.
      Therapy election depends on patient age and complaints as well as tumor type, hemodynamic flow, size, and location.
      • Wang W.
      • Tsai K.
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      Although, conversely, compared with infant laryngeal hemangiomas adult ones do not show a tendency to spontaneous regression. However, progression or malignant transformation is very rare, and therefore for small asymptomatic laryngeal hemangiomas observation is usually sufficient.
      • Wang W.
      • Tsai K.
      Transoral robotic resection of an adult laryngeal haemangioma and review of the literature.
      • Wang X.
      • Zhao X.
      • Zhu W.E.I.
      Resection of a laryngeal hemangioma in an adult using an ultrasonic scalpel: a case report.
      • Kawakami M.
      • Hayashi I.
      • Yoshimura K.
      • et al.
      Adult giant hemangioma of the larynx: a case report.
      In the case of small symptomatic lesions, or when adjacent tissues are involved, treatment is indicated, including injection of corticosteroids, chemotherapeutic agents, cryosurgery, sclerotherapy, radiation, and excision with microlaryngoscopic laser or techniques. In the case of larger lesions, open resection and temporary tracheotomy may be required.
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      • Tsai K.
      Transoral robotic resection of an adult laryngeal haemangioma and review of the literature.
      • Lin Y.
      • Ho H.
      Adult laryngeal hemangioma.
      • Kawakami M.
      • Hayashi I.
      • Yoshimura K.
      • et al.
      Adult giant hemangioma of the larynx: a case report.
      • Bishop J.A.
      • Hillel A.T.
      • Akst L.M.
      • Best S.R.
      Non-epithelial tumors of the larynx: a single institution review.

      References

        • Wang W.
        • Tsai K.
        Transoral robotic resection of an adult laryngeal haemangioma and review of the literature.
        J Laryngol Otol. 2016; 129: 614-618
        • Lin Y.
        • Ho H.
        Adult laryngeal hemangioma.
        Tzu Chi Med J. 2010; 22: 237-240
        • Wang X.
        • Zhao X.
        • Zhu W.E.I.
        Resection of a laryngeal hemangioma in an adult using an ultrasonic scalpel: a case report.
        Oncol Lett. 2015; 9: 2477-2480
        • Yang G.
        • Li J.
        • Jin H.
        Giant mesenteric hemangioma of cavernous and venous mixed type: a rare case report.
        BMC Surg. 2013; 13: 50
        • Kawakami M.
        • Hayashi I.
        • Yoshimura K.
        • et al.
        Adult giant hemangioma of the larynx: a case report.
        Auris Nasus Larynx. 2006; 33: 479-482
        • Bishop J.A.
        • Hillel A.T.
        • Akst L.M.
        • Best S.R.
        Non-epithelial tumors of the larynx: a single institution review.
        Am J Otolaryngol Neck Med Surg. 2016; 37: 279-285