Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin's staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin's staging.
Laryngocele is a rare condition marked by an abnormal enlargement of the air-filled saccule of the laryngeal ventricle. This case report showcases a distinctive presentation of external laryngocele to assist clinicians in its diagnosis and management. A 43-year-old male, with a 20-year history of painless swelling on the right side of his neck, likened to the size of an orange, presented with a recent increment in size. He noticed a gurgling sound when pressing on the swelling but did not experience any hoarseness or difficulty swallowing. During the physical examination, it was observed that there was a swelling on the right side of the neck at level II that measured approximately 3 x 5 cm. This swelling seemed to increase when the Valsalva maneuver was performed. A computed tomography scan revealed a 5 x 3 cm air-filled lesion, indicative of an external laryngocele. Although surgical excision was advised, the patient decided not to proceed with treatment and did not attend follow-up appointments. Laryngocele mainly impacts men, especially those in their fifth and sixth decades of life and is linked to activities that raise laryngeal pressure. Diagnosis is mainly based on clinical evaluation, complemented by imaging techniques such as CT and MRI. Surgical excision remains the preferred treatment, with approaches differing, depending on the laryngocele subtype. This particular case highlights the infrequency of laryngocele, and how it may manifest as a swelling in the neck. It underscores the importance of clinicians being aware of this harmless condition, highlighting the significance of taking a detailed patient history and using suitable imaging for accurate diagnosis and effective management, especially to rule out any malignancies. This report adds to the current body of knowledge on laryngocele, offering valuable information on its clinical symptoms and treatment implications.