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Clinical Problem Solving: Pathology |

Pathology Quiz Case 2

Danielle S. Hoyne, BS; Judith C. McCaffrey, MD
Arch Otolaryngol Head Neck Surg. 2012;138(7):689. doi:10.1001/archoto.2012.898.
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A 78-year-old woman presented with a 9-year history of hoarseness, which had substantially progressed in the 12 months before presentation. Her medical history was remarkable for gastroesophageal reflux, which had been treated with Nissen fundoplication 2 years earlier. The results of a Bravo pH study performed 1 year earlier were negative. The patient had a 50 pack-year smoking history and had stopped using tobacco 9 years ago. Her vocal quality was strained and harsh, with normal frequency and significantly reduced pitch. Videostroboscopy revealed edematous, amber-colored mucosa of the false vocal cords, aryepiglottic folds, and arytenoids (Figure 1). The true vocal folds were mobile but with irregular mucosal thickening. A vibratory mucosal wave was not visualized owing to diffusely edematous false vocal cords. There were no ulcerative lesions; however, there was evidence of cobblestoning and redundancy of the interarytenoid mucosa. There also was a small amount of anterior webbing. Direct microlaryngoscopy with biopsy was recommended.

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