Subglottic MALT lymphoma of the larynx in a patient with rheumatoid arthritis.

A 41-year-old woman was referred to our hospital presenting dysphonia, shortness of breath on moderate exertion and a one year history of stridor, with a history of RA diagnosed in 2002, and being treated with hydroxycholoroquine and NSAIDs. Nasofibrolaryngoscopy revealed a reddish growth compromising 70% of the subglottic lumen, with oedema and major hyperaemia of the supraglottic region and aryepiglottic folds. MRI (Fig. 1) showed a subglottic lesion with posterior base of 2.5 cm × 1.5 cm. The tumour was resected via laryngofissure and tracheotomy. Histopathological examination (Fig. 2) leads to a diagnosis of MALT-type lymphoma, immunophenotype CD20 (+), CD43 (+), CD10 (−) and CD3 (−). Physical examination, blood count, imaging and bone marrow biopsy did not reveal any extralaryngeal spread of disease; therefore, the patient was assessed as a stage IE (localised disease) of the Ann Arbour system. It was decided that the treatment should start with six cycles of R-CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine