Metastasis of a prostate carcinoma as a differential diagnosis in dysphonia

Introduction:

Prostate carcinoma (PC) is the most common cancer among men. Generally PCA first metastasizes to the lymph nodes and subsequently to the bones and organs. An infiltration of the larynx is rare. We report about a patient who's first symptom of a PC with metastasis was dysphonia.

Case report:

A 78-year-old patient presented himself due to hoarseness since several months. After laryngoscopic examination we had the suspicion of a chronic laryngitis with a functional component. Therefore we indicated a microlaryngoscopy (MLS) with biopsies. The histopathological report revealed squamous mucosa with no evidence of malignancy. Six months later the patient continued to complain of severe hoarseness during speech therapy. Postoperative laryngoscopy showed an increase in swelling of the vestibular folds, vocal folds and subglottic mucosa. Thus we suggested a Repitition-MLS. Deep samples of the vestibular folds revealed histopathological an epithelial cancer, most likely matching to a metastasis of a PC. Further diagnostics showed an elevated PSA of 1975 µg/l and a CT scan showed an enlarged, inhomogeneous prostate, multiple suspicious retroperitoneal and iliac lymph nodes as well as bone metastasis in the spine, pelvis and ribs. After presenting him in the tumor board of the urologists, the colleagues recommended an androgen deprivation (AT) therapy and a chemotherapy due to a PC with metastasis in the lymph nodes and bones. Already under AT there was an improvement of the laryngeal swelling and the dysphonia.

Conclusion:

In refractory dysphonia and laryngeal swollen mucosa, microlaryngoscopy should be performed with a deep biopsy for histological confirmation. The differential diagnoses should also include rare systemic diseases such as laryngeal metastasis of PC.

Publication History

Publication Date:
23 April 2019 (online)