Respiratory Failure Due to Laryngeal Leiomyosarcoma

Abstract

Introduction: Leiomyosarcoma is a malignant smooth muscle tumor that is extremely rare in the laryngeal region. As a result of upper airway narrowing, it is able to cause dyspnea, hoarseness, dysphagia and even respiratory distress. Here we present the case of a 68-year-old man who had respiratory arrest due to leiomyosarcoma of the vocal cord treated by carbon dioxide laser cordotomy. CASE PRESENTATION: A 68-year-old man visited the emergency department of our hospital with respiratory failure. Before he admitted hospital, he had been complaining of dyspnea 3 days ago. He had a medical history of colorectal cancer, cured after surgery and a smoking history of 20 pack-years. He admitted to the intensive care unit (ICU) for mechanical ventilation with emergent endotracheal intubation. After ventilator care, he showed stability of spontaneously breathing and has been tried to extubation. However, it was unsuccessful and a tracheostomy was performed. After tracheostomy, he underwent flexible bronchoscopy showed a soft tissue tumor covered the left vocal cord extending across the midline. Chest computed tomography (CT) examination also demonstrated a mass in the left vocal cord. Biopsies were done from the mass, and the pathohistological diagnosis was laryngeal leiomyosarcoma. A positron emission tomography (PET) for stage work-up result no evidence of metastasis. Subsequently, a carbon dioxide laser cordotomy was performed. The excised tumor measured 10mm x 8mm and there was no apparent extralaryngeal invasion. The patient was discharged 9 days after surgery. There were no signs of recurrence with 1 year follow up. DISCUSSION: Initial complaints of leiomyosarcoma depend on the site and the size of the neoplasm. Dyspnea, hoarseness, and dysphagia are the most common symptoms of the laryngeal tumors because of mechanical compression. Because laryngeal tumors can be progressed to respiratory failure, the clinical suspicion will have to pay attention to the diagnosis. The scarcity of the smooth muscle in the laryngeal region is the reason why laryngeal leiomyosarcoma is very rare neoplasm. There is no established therapeutic modalities, however, generally accepted treatment of choice is curative resection of tumor. Regarding treatment, radiation therapy or chemotherapy are not effective and are associated with frequent recurrences.1 Conclusions: As a conclusion, leiomyosarcoma of the larynx is a quite rare, but potentially fatal because of the upper airway obstruction. Therefore, the most important factor for longterm survival is complete resection with clear margins.