A Rare Case of Spontaneous Regression of Laryngeal Amyloidosis.

Abstract

Objective: To review a rare case of spontaneous regression of laryngeal amyloidosis and current management of the disease.

Introduction: While laryngeal amyloidosis is rare (<1% of benign laryngeal lesions), it is the most common site of localized head and neck amyloidosis. The most common presenting symptoms include dysphonia and dyspnea. The mainstay of treatment is surgical excision. We report a rare case of spontaneously regressing laryngeal amyloidosis, which has not been previously reported in the literature to the best of the authors' knowledge.

Methods: Single case study.

Results: We report the case of an 82-year-old male recently diagnosed with rheumatoid arthritis on methotrexate who presented with 6 months of dysphonia and significant worsening over the past month. Flexible laryngoscopy revealed an irregular mass of the right true vocal cord with hypomobility. Given concern for possible malignancy, a CT scan was obtained, which revealed a multilobulated soft tissue mass of the right true vocal cord with 15 mm caudal extension into the subglottic airway. Pathology was consistent with amyloidosis. Hematology workup revealed no systemic involvement. Subsequent laryngoscopy two months later demonstrated spontaneous regression of 85% of the lesion and return of normal vocal cord mobility. Given significant improvement, surgical intervention was deferred for surveillance monitoring. Eight months after the initial presentation, the patient's dysphonia and lesion continue to regress.

Conclusion: While laryngeal amyloidosis is rare (<1% of benign laryngeal lesions), it is the most common site of localized head and neck amyloidosis. We report a rare case of spontaneously regressing laryngeal amyloidosis, which has not been previously reported in the literature to the best of the authors' knowledge. This is a rare phenomenon as laryngeal amyloidosis typically requires surgical excision. As this case highlights, localized laryngeal amyloidosis has favorable outcomes, but diligent surveillance is required given the risk of recurrence.