Rare case of Vocal Cord Metastasis: A report

Dr Pablo Garrido-Abad and Dr Luis García-Martín at Hospital Universitario del Henares, Coslada, Spain have reported a rare case of vocal Cord Metastasis. The case has appeared in the New England Journal of Medicine.

The larynx, or voice box, is an area in the throat that contains both cartilage and muscles. It is responsible for producing our voice, and also performs other complex functions such as protecting our airway during swallowing. Metastatic tumors of the larynx are rare. The most common tumors metastasizing to the larynx are melanoma and renal cell carcinoma. Bronchogenic carcinoma metastasizing to the larynx has been rarely described.

These tumors may remain clinically silent even in the presence of disseminated primary malignancy or uncommonly may be the primary clinical manifestation. Laryngeal infiltration from tumors arising in the nearby head and neck structures is well known and has been described. However, metastatic tumors to the larynx from other primary sites (secondary laryngeal tumors) are uncommon and account for less than 1% of all laryngeal tumors.

A 49-year-old man was referred to the otorhinolaryngology clinic with a 3-month history of progressive voice changes and pain with swallowing. He had a history of hypertension and type 2 diabetes mellitus and was a current smoker. He had no recent weight loss or other systemic symptoms. Fiberoptic laryngoscopy revealed a 2-cm lesion at the level of the vocal cords.

The laryngeal lesion was excised, and findings on histologic examination were consistent with metastasis of a clear-cell carcinoma. Computed tomography of the abdomen and chest were subsequently performed and revealed a mass measuring 7.0 cm by 6.4 cm by 6.6 cm at the superior pole of the right kidney, several pulmonary lesions, and enlarged mediastinal lymph nodes — findings consistent with metastatic disease.

Laparoscopic radical nephrectomy of the right kidney was performed, and oral sunitinib was initiated for the treatment of metastatic renal-cell carcinoma. At 1 year of follow-up, the patient had stable mediastinal lesions and complete remission (disappearance) of some of the pulmonary lesions.