Journal of Clinical and Diagnostic Research. 2019 Mar, Vol-13(3): XD01-XD03 1 1 DOI: 10.7860/JCDR/2019/39585.12661 Oncology Section Schwannoma of the Larynx- A Rare Case Report Case Report CASE REPORT A 30-year-old woman presented to the casualty with chief complaint of severe dyspnea, which has exacerbated over a week’s time prior to which she did have the same complaint for the past six months but of modest proportions. The patient also presented with near complete loss of speech (severe dysphonia) along with altered voice quality (hoarse, rough) with occasions of diplophonia since the past one year. She did not have a history of smoking or alcohol intake; however she does give history of tobacco and betel nut chewing for the past eight years. In casualty, the physician and the anesthetist were called in for vital stabilisation and intubation. Since vocal cords were not visualised, intubation was unsuccessful. Otorhinolaryngologist was subsequently called for and an emergency tracheostomy was carried out as SpO 2 had dropped to 60 mmHg. Once the patient’s vitals were stabilised, she was shifted to the ENT ward. On day two, Otorhinolaryngology examination was done and she was found to be severely dyspnoic with evidence of hoarseness of voice and stridor. Examination showed that the patient used the accessory muscles during phonation as well as breathing. There was no cervical lymphadenopathy and systemic examination was within normal limits. Direct laryngoscopy was carried out where the vocal cords could not be visualised however; it revealed an expansive solid well-circumscribed oval lesion arising from left aryepiglottic fold upto the level of the cricoid cartilage. The lesion was midline extending in both halves of the larynx, almost completely occluding the glottis and the subglottis. A biopsy was carried out; the histopathology report suggested an unremarkable fibrous tissue, probably from the capsule of the lesion. The report highlighted that the biopsy was not representative of the tumour tissue. Subsequently, a Contrast Enhanced Computed Tomography was carried out which showed a well defined, hypoattenuating expansile mass with heterogeneous enhancement of size 3.5 cm×2.5 cm×1.5 cm arising from epiglottis at the left aryepiglottic fold extending into the subglottis upto the level of the cricoid cartilage, with minimal destructive changes in the cricoid cartilage [Table/Fig-1]. The CT scan findings were suggestive of a benign encapsulated tumour, and differentials being Schwannoma, Neurofibroma, Neuroma and Fibroma. It is very well documented in literature that Schwannoma and Neurofibromas have similar features on NIKITA CHHABLANI 1 , HEMANI VERMA 2 , SHUBHAM BHATNAGAR 3 , SAMARTH SHUKLA 4 , SOURYA ACHARYA 5 Keywords: Mesenchymal, Neoplasm, Neurofibroma ABSTRACT Head and neck neoplasms are often referred to as areas more commonly inclusive of the upper aerodigestive tract, which includes the oral cavity, pharynx, larynx, cervical oesophagus, paranasal sinuses, thyroid, the associated bone and soft tissues, along with nodes. In the head and neck area, amongst the various mesenchymal tumours, schwannoma form a major portion, accounting for not less than 25% to 45% of tumours. Laryngeal schwannoma arising in the glottis area of the larynx is an extremely rare entity. It arises from the nerves supplying the organ and despite having a benign growth pattern; the schwannomas can pose extreme diagnostic as well as operative complexity. The strategic location of the larynx with its special functioning can both be hurdles in management of even such benign tumours like schwannoma, resulting in considerable post operative sequel. Here, we report a case of 30-year-old female with chief complaints of severe dyspnea and dysphonia. On radiological as well as histopathological examination, diagnosis of schwannoma was confirmed. [Table/Fig-1]: Computed Tomography showing well defined, hypoattenuating expansible mass with heterogeneous enhancement of size 3.5 cm×2.5 cm×1.5 cm arising from epiglottis at the left aryepiglottic fold extending into the subglottis upto the level of the cricoid cartilage (arrow). radiological scans. Considering the critical symptomatology, clinical findings and CT report, surgery was advised and a complete laryngectomy was performed thereafter. Postoperatively, the patient was extubated and tracheostomy was maintained. The resected Larynx along with the mass was sent for histopathological examination for further management and prognostic evaluation. On surgical pathological examination, grossly, the mass was arising in the left aryepiglottic fold and completely occupying the glottis and damaging the left vocal cord extending into the subglottis pushing the cricoid cartilage (arrow showing cystic area). The tumour mass was well-capsulated, oval in appearance and firm to solid in consistency. The lesion on cut section showed predominantly homogeneous white area with occasional cystic areas. There were no areas of haemorrhage and necrosis