Solitary Laryngeal Neurofibroma: An Unusual Case of Shortness of Breath

Abstract

INTRODUCTION: Neurogenic tumors arising from the larynx are extremely rare. Sucharek reported the first case of laryngeal neurofibroma in 1925. We describe an adult patient with laryngeal neurofibroma who presented with shortness of breath and cough CASE PRESENTATION: A 35-year-old Caucasian male presented to pulmonary clinic for evaluation of intermittent shortness of breath and cough, which he had for 8 months. Prior to his presentation he was treated with multiple doses of antibiotics at least two different times, bronchodilators and antihistamines without resolution of symptoms. His past medical history was significant for bronchitis as a child. Family history was noncontributory. He denied tobacco, alcohol or recreational drug use. He was a police officer and a hockey referee. His examination was unremarkable. Methacholine challenge test, CT chest, CPET and sleep studies were unremarkable. Albuterol inhaler occasionally relieved his symptoms. On further questioning about his symptoms he stated that when he tilts his head to one side was more short of breath. Following this information we proceeded with CT neck, which showed a right aryepiglottic fold mass. ENT evaluation was done which showed a 2 cm mass in the posterior pharynx. Microlaryngoscopy was performed the entire mass was isolated histology showed neurofibroma. Then the entire mass was removed. DISCUSSION: Neurofibromas are not encapsulated and are often associated with NF-1. Due to its slow growth laryngeal neurofibroma can remain symptom free for years. The symptoms vary from slight hoarseness and discomfort in the throat to disturbances in breathing, cough and dyspnea according to the size and the location of the tumor. They occur more commonly in supraglottic area due to abundance of sensory nerve. Surgery is the treatment of choice. No malignant transformation has been documented. CONCLUSIONS: The patient's shortness of breath and cough was attributed to the laryngeal neurofibroma and removal of the mass relieved his symptoms. Among the huge differential diagnosis of shortness of breath the mechanism of our patient's symptom is unusual. Thorough history taking and high index of suspicion is rewarding. Multidisciplinary team approach is necessary for the proper diagnosis and treatment of laryngeal neurofibroma.