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Blastomycosis causing Laryngeal Leukoplakia

last modified on: Mon, 08/07/2023 - 16:15

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Return to: Laryngeal leukoplakia white plaques on vocal cords

See also: Candidiasis causing laryngeal leukoplakia and Overview of squamous dysplasia 

Blastomyces dermatitidis, a soil saprobe found endemically in regions of the Mississippi and Ohio River Valleys, may rarely cause laryngeal leukoplakia. The inflammatory infiltrate that accompanies Blastomyces is usually granulomatous with a conspicuous mix of neutrophilic inflammation. Occasionally, the negative image of the yeast can be identified on H&E stain. A well-recognized pitfall is to mistake the pseudoepitheliomatous hyperplasia overlying the inflammation for well-differentiated squamous cell carcinoma. It is important to examine the submucosa of such biopsies for granulomas and evidence of infectious etiologies. Special stains are required for diagnosis. Yeast forms for Blastomyces range in size from 8 to 20 micrometers and bud with a broad base (4 to 10 micrometers) (McBride et al. 2017).

References

Hanson JM, Spector G, El-Mofty SK. Laryngeal blastomycosis: a commonly missed diagnosis. Report of two cases and review of the literature. Ann Otol Rhinol Laryngol. 2000 Mar;109(3):281-6. doi: 10.1177/000348940010900309. PMID: 10737312.

Rucci J, Eisinger G, Miranda-Gomez G, Nguyen J. Blastomycosis of the head and neck. Am J Otolaryngol. 2014 May-Jun;35(3):390-5. doi: 10.1016/j.amjoto.2013.12.013. Epub 2014 Jan 2. PMID: 24486126.

McBride JA, Gauthier GM, Klein BS. Clinical Manifestations and Treatment of Blastomycosis. Clin Chest Med. 2017 Sep;38(3):435-449. doi: 10.1016/j.ccm.2017.04.006. Epub 2017 Jun 12. PMID: 28797487; PMCID: PMC5657236.