Vocal Cord Metastasis
A 49-year-old man was referred to the otorhinolaryngology clinic with a 3-month history of progressive voice changes and pain with swallowing. He had a history of hypertension and type 2 diabetes mellitus and was a current smoker. He had no recent weight loss or other systemic symptoms. Fiberoptic laryngoscopy revealed a 2-cm lesion at the level of the vocal cords (Panel A). The laryngeal lesion was excised, and findings on histologic examination were consistent with metastasis of a clear-cell carcinoma. Computed tomography of the abdomen and chest were subsequently performed and revealed a mass measuring 7.0 cm by 6.4 cm by 6.6 cm at the superior pole of the right kidney (Panel B), several pulmonary lesions, and enlarged mediastinal lymph nodes — findings consistent with metastatic disease. Laparoscopic radical nephrectomy of the right kidney was performed, and oral sunitinib was initiated for the treatment of metastatic renal-cell carcinoma. At 1 year of follow-up, the patient had stable mediastinal lesions and complete remission (disappearance) of some of the pulmonary lesions.