Abstract
We reported previously a case of an idiopathic acquired supraglottic web in an 83-year-old man (Pegg D, Kanatas A, Makura, Z. Idiopathic acquired supraglottic web: A case report. Ear Nose Throat J 2011;90(10): 486-8). He was a retired mechanical engineer who never smoked, and his alcohol consumption was less than 5 units a week. He had no family history of head and neck malignancy. To the best of our knowledge, this was the first reported case of a truly idiopathic acquired laryngeal web.
The web was managed successfully with a combination of dilation and unilateral CO2 laser excision. The case report was published in the Ear, Nose & Throat Journal in October 2011. Since our previous report, the patient has had four additional recurrences, which were all successfully treated with the above treatment. Overall, the web recurred seven times in 6 years, and on every occasion, histology confirmed benign stratified squamous epithelium with no evidence of dysplasia. Following laser excision and dilation for all the recurrences, the patient was asymptomatic for a period of 6 to 8 months.
In this letter we report an unexpected change that necessitated aggressive management. In March 2012, the patient underwent a further dilation and CO2 laser excision. During this procedure, a left-sided transglottic web was identified, and the biopsies obtained were sent to the histopathology department. Two weeks after the last intervention, the patient presented acutely with difficulty in breathing and with a progressive, life-threatening stridor. A tracheostomy was performed. At this point, histology results were returned from the previous procedure and were found to demonstrate a well-differentiated squamous cell carcinoma.
All the previous seven specimens were reexamined and revealed no evidence of cellular atypia, dysplasia, or malignancy. After discussion in the multidisciplinary team meeting (tumor board) and taking into account the patient's wishes, a total laryngectomy was deemed appropriate. The postsurgical histologic specimen confirmed a transglottic well-differentiated squamous cell carcinoma, well clear of all surgical excision margins.
A causal link cannot be established based on our report, but a high suspicion and a long follow-up period should be considered in cases presenting with laryngeal webbing.