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Clinical Note |

More Than a Frog in the Throat A Case Series and Review of Localized Laryngeal Amyloidosis

Ryan Stevenson, MD; Ronald Witteles, MD; Edward Damrose, MD; Sally Arai, MD; Richard A. Lafayette, MD; Stanley Schrier, MD; Anosheh Afghahi, MD; Michaela Liedtke, MD
Arch Otolaryngol Head Neck Surg. 2012;138(5):509-511. doi:10.1001/archoto.2012.423.
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Amyloidosis is a disease characterized by protein deposition in tissues and organs, most commonly the kidney, heart, liver, nervous system, and gastrointestinal tract.1 Extracellular fibrils form β-pleated sheets disrupting organ function. Over 20 different proteins have been observed in amyloidosis, but all forms are identified by Congo red stain and a green birefringence pattern under polarized light.

Fibril deposits confined to a single organ system define localized amyloidosis. Respiratory, urogenital, and gastrointestinal tracts as well as the skin are the most commonly are the most commonly affected organs. Laryngeal amyloid is relatively rare, with the vocal cords and ventricles being the most affected sites.2 We present herein 3 cases of laryngeal amyloidosis, review the current literature, and provide recommendations regarding the evaluation, treatment, and follow-up of patients with laryngeal amyloidosis.

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Figure 1. Laryngeal amyloid deposits visualized by laryngoscopy. The appearance of amyloidosis of the larynx varies. A, Amyloidosis involving the right false vocal fold and ventricle. B, Amyloidosis involving the anterior subglottic larynx. C, Amyloidosis of the subglottic larynx, with extension to the level of the true vocal folds bilaterally.

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Figure 2. Diagnostic laryngeal biopsy specimen. Amorphous material underlying the epithelium is observed (hematoxylin-eosin, original magnification ×200).

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