Obstructive Laryngeal Sarcoidosis Mimicking a Benign Cyst: Clinical, Radiologic and Surgical Insights

Abstract

Laryngeal sarcoidosis is an uncommon manifestation of systemic sarcoidosis, accounting for less than 5% of otolaryngological cases. We report the case of a 24-year-old woman, with a history of sliding hiatal hernia and gastroesophageal reflux disease, presenting with progressive dysphonia of four months duration, later complicated by exertional dyspnea and dysphagia. Flexible laryngoscopy revealed a cystic-appearing mass arising from the right aryepiglottic fold, with normal morphology and mobility of the vocal cords. Cervical CT scan demonstrated a well-defined cystic lesion partially obstructing the laryngeal lumen, extended posteriorly to the level of the esophageal inlet, and compressed it, explaining the associated dysphagia. Complete excision of the lesion was achieved with CO₂ laser surgery. Histopathological examination showed chronic inflammatory process with non-caseating epithelioid granulomas. GeneXpert testing for Mycobacterium tuberculosis was negative. The postoperative course was uneventful, with immediate resolution of dyspnea and dysphagia, and significant improvement of dysphonia. Endoscopic follow-up at two weeks and at seven months confirmed a normal laryngeal appearance with clear vocal cord mobility. Systemic evaluation for sarcoidosis involvement in other organs was negative. This case highlights a rare cystic presentation of isolated laryngeal sarcoidosis and underlines the importance of histopathology in guiding diagnosis and management.