Abstract
We experienced a rare case of laryngeal stenosis resulting from neck lymph node metastasis and carcinomatous lymphangiosis by a primary unknown adenocarcinoma that was positive for HER2.
A 55-year-old woman complained of bilateral cervical swelling. She had no abnormal findings on routine blood test and cervical ultrasonography. Six weeks later, she suffered from dyspnea due to laryngeal edema. She underwent a tracheotomy and intravenous steroid infusion, however, her symptoms deteriorated. For diagnostic purposes, her cervical lymph node and skin were biopsied. The pathological examination revealed metastasis of adenocarcinoma with strong HER2 expression. Furthermore, lymph ducts of the skin biopsy contained neoplastic sheets of the cells as lymphangitis carcinomatosis. The primary lesion was not indicated on various close examinations. Since axillary lymph node metastasis was found, chemotherapy including Trastuzumab was administered according to the treatment of breast cancer. Her symptoms and findings disappeared. When making a differential diagnosis of laryngeal edema, we must consider carcinomatous lymphangitis. Anti-HER2 therapy can be effective in the treatment of HER2-positive tumor, even if it is a primary unknown tumor with axillary lymph node metastasis.
