Atypical Vocal Fold Mass

A 53-year-old woman with a history of breast cancer presented with a gradual onset of hoarseness that was noticed when attempting to sing a new song; the patient is an avocational singer with no prior training and had undergone a bilateral mastectomy for the treatment of cancer. Metastasis to the larynx was considered unlikely. The hoarseness reportedly became worse with voice use and better with rest. There was no pain, but shortness of breath was evident upon examination. The patient was diagnosed with a left vocal fold lesion following stroboscopy (Figure 1), along with left vocal fold paresis. The lesion was suspected to be benign, and she was scheduled for surgery following a brief course of voice therapy.

Figure 1.

A, Adduction of vocal folds with protruding lesion, preoperatively. B, Abduction of vocal folds with protruding lesion, preoperatively.

At a follow-up visit 2 months later, the vocal fold mass was larger despite compliance with therapy. The lesion was excised. It was found to fill the airway except for a small area posteriorly, and it was based on the lower surface of the left vibratory margin throughout most of its length except for the 2 mm adjacent to the anterior commissure.

During follow-up 3 months later, there was a small recurrent mass on the left vocal fold (Figure 2). Despite this, the patient reported that her voice felt better, although she continued to cough daily. She was still attending voice therapy and was satisfied with her voice. Additional surgery will be considered if the mass enlarges or causes troublesome symptoms, but it has remained stable for more than a year.

Figure 2.

A, Adduction of vocal folds following excision of lesion, postoperatively. B, Abduction of vocal folds with visualization of recurrent lesion, postoperatively.