Giant inflammatory pseudotumor of the larynx treated endoscopically by a gastroenterologist using submucosal dissection.

Submucosal pedunculated masses of the hypopharynx, larynx, and upper esophagus pose diagnostic and treatment challenges for gastrointestinal endoscopists. Because of potentially acute respiratory complications, the removal of these pedunculated masses through a transoral, transcervical, transthoracic, or endoscopic approach, depending on their location and size, is mandatory [1]. Inflammatory pseudotumors of the larynx are rare, borderline neoplasms of unknown etiology andwith uncertainmalignant potential that often show locally aggressive behavior [2]. These pedunculated submucosal masses are most commonly approached via endoscopic excision (dissection of the peduncle by ligature, electrocoagulation, or laser), high dose steroids, radiation, or surgical excision [3–5]. We report the case of an 81-year-old man, with significant cardiovascular co-morbidities, who presented with hoarseness, dysphagia, and fatigue that had progressed during the past 4 years. Upper gastrointestinal endoscopy revealed a giant submucosal mass of the right vocal fold originating from the right arytenoid cartilage; the pedicle thickness was 2cm. Computed tomography showed the mass originating from the larynx (●" Fig.1) without lymph node involvement. The pedunculated mass was removed endoscopically with submucosal dissection followed by pedicle resection, with a favorable outcome (●" Fig.2,●" Video 1). A transparent cap was attached to a gastroscope. Just below the upper esophageal sphincter, submucosal dissection was performed with an Olympus DualKnife (Olympus, Tokyo, Japan), and mucosal hemostasis was achieved with an Olympus Coagrasper. The dissection was done gradually until complete resection of the pedicle had been achieved; the total time for dissection was 112 minutes. No significant bleeding or perforation occurred. Two clips were used to close the esophageal mucosal break. Histological analysis revealed an inflammatory pseudotumor (●" Fig.3). At 6-month follow-up, the patient’s clinical status was good, without endoscopic signs of tumor recurrence. Giant pedunculated submucosal tumor masses of the larynx can be safely removed endoscopically in gastrointestinal endoscopy units with submucosal dissection and pedicle resection.