A Rare Case of Subglottic Malignant Lymphoma Requiring Emergency Tracheostomy

Primary malignant lymphoma originating in the laryngeal tissue is rare. A 61-year-old woman was admitted to our hospital with hoarseness and mild dyspnea for three weeks. The fiberscopic examination revealed slight edema around the vocal cords. Despite four weeks of inhaled steroid therapy, progressive worsening of the subglottic lesion led to increasing airway obstruction, and due to diagnostic uncertainty and the risk to the airway, emergent tracheostomy was performed. Fiberscopic findings through the tracheostomy stoma revealed multiple tumors around the anterior tracheal wall and a submucosal bulge around the posterior tracheal wall in the subglottic area, so biopsies from both areas were performed. Histological examination revealed a low-grade B-cell lymphoma (probable CD5-positive mucosa-associated lymphoid tissue (MALT) lymphoma, unclassifiable). As a further biopsy would have required general anesthesia and might still have yielded insufficient tissue for definitive subclassification, treatment was initiated for an unclassifiable low-grade B-cell lymphoma, with a plan to perform a repeat biopsy at recurrence for diagnostic confirmation. The patient subsequently received chemotherapy with bendamustine and rituximab and has sustained a complete response for seven years.