Leiomyosarcoma of the larynx presenting as a laryngopyocele

An 87-year-old man had an 8-month history of hoarseness, respiratory distress, and dysphagia. Physical examination, including direct laryngoscopy, revealed a mass on the right anterolateral side of the neck and a submucosal mass of the supraglottic larynx. A contrast-enhanced CT scan showed a more superior cystic mass, a laryngopyocele resulting from a more inferior, solid-appearing and obstructing mass at the level of the true vocal cord. The obstructing mass was also entirely submucosal at direct laryngoscopy; however, a biopsy specimen revealed a malignant tumor. Subsequent total laryngectomy and pathologic review showed it to be a leiomyosarcoma.