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Presented by Ashley Cimino-Mathews, M.D. and prepared by Sarah Karram, M.D.
70 year-old male with a vocal cord mass
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1. Question
Week (613): Case 2
70 year-old male with a vocal cord mass.
Correct
Answer: Vocal cord amyloidosis
Histology: The excision reveals fragments of benign respiratory and squamous mucosa with abundant extracellular proteinaceous debris characterized by acellular, pink amorphous material. A Congo red special stain is positive with apple-green birefringence, confirming a diagnosis of vocal cord amyloidosis.
Discussion: This patient actually had a decades-long history of amyloid deposition in the vocal cords. Laryngeal amyloidosis is a recognized clinical and pathologic entity, and it can either be a localized process or a manifestation of systemic amyloidosis. In one series, no patients with laryngeal amyloidosis had an associated myeloma or lymphoma. Histologically, the amyloid deposition may be confined to the blood vessels, or form an actual protuberant mass that can cause symptoms due to airway obstruction. On a small superficial biopsy, the amyloid may be overlooked or mistaken for submucosal fibrosis or scarring.
Reference:
1. Thompson LD, Derringer GA, Wenig BM. Amyloidosis of the larynx: a clinicopathologic study of 11 cases. Mod Pathol. 2000 May;13(5):528-35.Incorrect
Answer: Vocal cord amyloidosis
Histology: The excision reveals fragments of benign respiratory and squamous mucosa with abundant extracellular proteinaceous debris characterized by acellular, pink amorphous material. A Congo red special stain is positive with apple-green birefringence, confirming a diagnosis of vocal cord amyloidosis.
Discussion: This patient actually had a decades-long history of amyloid deposition in the vocal cords. Laryngeal amyloidosis is a recognized clinical and pathologic entity, and it can either be a localized process or a manifestation of systemic amyloidosis. In one series, no patients with laryngeal amyloidosis had an associated myeloma or lymphoma. Histologically, the amyloid deposition may be confined to the blood vessels, or form an actual protuberant mass that can cause symptoms due to airway obstruction. On a small superficial biopsy, the amyloid may be overlooked or mistaken for submucosal fibrosis or scarring.
Reference:
1. Thompson LD, Derringer GA, Wenig BM. Amyloidosis of the larynx: a clinicopathologic study of 11 cases. Mod Pathol. 2000 May;13(5):528-35.
