Supraglottic laryngeal paraganglioma: A rare neuroendocrine tumor mimicking benign laryngeal masses and treated with transoral CO2 laser excision

Abstract

Laryngeal paragangliomas are rare neuroendocrine tumors, usually arising in the supraglottic region. Their nonspecific presentation and overlap with more common laryngeal lesions often delay diagnosis. We report a 55-year-old male with progressive hoarseness and exertional dyspnea for 1 year, but notably without dysphagia-a common symptom in reported cases. Flexible nasofibroscopy and contrast-enhanced imaging revealed a well-circumscribed, hyperenhancing supraglottic mass measuring 26 × 22 mm. Biochemical assays, including plasma metanephrines, urinary vanillylmandelic acid, and chromogranin A, were normal. Histopathology confirmed a paraganglioma with Zellballen architecture and immunohistochemical positivity for chromogranin and S-100. The patient underwent transoral CO₂ laser excision; intraoperative bleeding was effectively controlled with monopolar coagulation and the laser itself. Recovery was uneventful, with significant improvement in voice quality. Follow-up with quarterly laryngoscopy and annual MRI for 2 years showed no recurrence. This case illustrates the effective use of transoral CO₂ laser excision as a safe, minimally invasive, and function-preserving treatment for highly vascular laryngeal tumors. This case illustrates the unusual absence of dysphagia in a sizable supraglottic paraganglioma and demonstrates that transoral CO₂ laser excision can be a safe, minimally invasive, and function-preserving treatment for highly vascular laryngeal tumors. Multidisciplinary management and long-term surveillance are crucial for optimizing outcomes.