First description of laryngeal nodular fasciitis

Introduction Nodular fasciitis (NF) are non-neoplastic, fibroblastic lesions, typically located on the trunk and the extremities. The incidence of NF in the head and neck region is 13-20 % and an occurrence in the larynx of adult patients is not described yet in literature.

Method Case-report Case Following emergency admission of a 41-year-old woman to the A&E department due to progressive dyspnea and inspiratory stridor a transnasal endoscopy revealed a left-lateral, subglottic mass. A subsequently performed CT scan of the neck, thorax and abdomen demonstrated a 2,2 x1,5cm sized lesion of the subglottic larynx with profound stenosis of the lumen, no extraluminal extension and no distant metastases. Histopathological processing of a tissue sample obtained by microlaryngoscopy and tracheoscopy revealed a spindle-cell lesion with immunohistochemical and molecular-pathogenic profile of nodular fasciitis. After tumor debulking and steroid infiltration (triamcinolone), a regrowth tendency quickly became apparent, which is why a tracheostomy had to be performed. Laryngectomy was rejected by the patient. After multiple transoral tumor reduction attempts, radiotherapy was performed according to an interdisciplinary tumor board decision to limit regrowth tendency. Subsequently, a substantial reduction of the tumor volume could be seen, although a discreet stenosis of the subglottic tracheal lumen persists in the follow up.

Conclusion This case report serves as an initial description of laryngeal nodular fasciitis. Despite its benign character, this localization is challenging in terms of function-preserving therapy.

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Publication History

Article published online:
10 June 2020