A 55-year-old male presented to the ear, nose, and throat (ENT) clinic with hoarseness that had lasted several weeks. His past medical history was significant for polycythemia vera and hypertension. He had a history of smoking 40 or more packs of cigarettes a year. On laryngeal examination, he was noted to have a large right side true vocal cord tumor, with decreased mobility of the cord. A computed tomography (CT) scan of the neck was ordered, and a biopsy was recommended. The neck soft tissue with contrast in the CT scan showed a supraglottic mass involving the epiglottis, right aryepiglottic fold, right false cord, and hypopharyngeal soft tissues, suspicious for supraglottic laryngeal malignancy. In addition, multiple cavitary lesions, ranging from 1.4 cm to 5.1 cm in size, were noted in both upper lung lobes, suspicious for metastasis. The initial biopsy specimen showed squamous mucosa with marked acute inflammation, spongiosis, focal ulceration, exuberant granulation tissue, and reactive atypia. Grocott's methenamine silver (GMS) staining showed budding fungal yeast forms and no evidence of malignancy. Due to the high index of clinical suspicion, a repeat biopsy specimen was obtained. The biopsy specimen showed focally necrotizing granulomatous inflammation admixed with neutrophils, eosinophils, and plasma cells. A photomicrograph of hematoxylin and eosin (H&E)- and GMS-stained sections is shown in Fig. 1.
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