A patient has slowly progressive dysphonia and multifocal smooth submucosal laryngeal deposits. Biopsy shows Congo-red-positive material with apple-green birefringence. What is the next principle?
Although laryngeal amyloid is often localised, systemic disease must be excluded. Symptom-directed conservative excision is preferred because recurrence occurs and extensive resection can harm voice and airway.
A. Assume malignancy and perform total laryngectomy: Histology identifies amyloid, not carcinoma.
B. No medical assessment is required: Systemic involvement changes prognosis and management.
C. Radiotherapy as first-line treatment: Amyloid is not routinely treated with radiation.
D. Remove all deposits regardless of function: Radical clearance may create more morbidity than the disease.
E. Assess for systemic amyloidosis before treating apparently local disease: Although laryngeal amyloid is often localised, systemic disease must be excluded. Symptom-directed conservative excision is preferred because recurrence occurs and extensive resection can harm voice and airway.
If systemic plasma-cell disease were found, haematology-directed treatment would become central.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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