Dysphagia following a total laryngectomy

Foreign body granulomas (FBGs) may arise from exogenous material, such as surgical sutures, several years after surgical interventions. Histopathologically they are characterized by the presence of chronic inflammation with high amount of macrophages. This type of granulomas are observed after surgeries in the abdomen, the chest etc., however there is a lack of information in the literature for such lesions after surgery in the head and neck area.

We present a case of a 61-year old man who underwent total laryngectomy (LE) and postoperative radiotherapy for advanced laryngeal carcinoma (T3N0M0). Five months after the operation, the patient presented with symptoms of dysphagia, food regurgitation and pain in the throat. Computer tomography (CT) data and endoscopic view of the neo-hypopharynx suggest local recurrence of the tumor. A biopsy of the suspected tissue did not confirmed a malignant growth. Due to the deterioration of the symptoms, the patient had 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG-PET/CT) which showed a fistula-like hypermetabolic region. In a second endoscopic intervention silk suture material was found and removed at the upper portion of the neo-hypopharynx. Again all soft surrounding tissues resected had no histological signs of malignant transformation. Seven weeks after the last surgery, the patient was symptom-free, CT scan excluded any signs for local relapse, diverticulosis, fistula formation etc.

FBGs of suture material may appear as malignancy on endoscopy and CT scan. FBG is hypermetabolic for FDG 18F-FDG and this leads to false positive PET-CT scan results.

Poster-PDF A-1288.pdf

Publication History

Article published online:
07 August 2020