Solitary Polypoid Laryngeal Xanthoma

We report the case of a 51-year-old male smoker with diabetes mellitus and hyperlipidaemia and a long history of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) infection treated with various antiretroviral regimes, who was referred to the otolaryngology department with progressive dysphonia. Fibre-optic laryngoscopy showed a solitary, yellowish-white pedunculated polyp on the anterior third of the left cord, with no other abnormality. Pathological analysis revealed a polypoid laryngeal xanthoma that was immunoreactive against CD68, perilipin, and adipophilin. This unusual laryngeal lesion in the clinical context of our patient suggests a possible role of antiretroviral treatment in the pathogenesis of these xanthomas. 1. Introduction An xanthoma is a localised collection of fat-laden histiocytes that is not considered a true tumour but rather a reactive histiocytic proliferation [1]. They are often, but not always, a consequence of hyperlipidaemia and are sometimes indicative of specific lipoprotein disorders. The clinical presentation of xanthomas is variable, often affecting the skin and subcutaneous or tendinous tissues. Mucosal xanthomas are uncommon [2] and a solitary xanthoma affecting the larynx is very rare; only two case reports have been published [3, 4]. We report a case of a solitary polypoid xanthoma of the vocal cord affecting a 51-year-old male smoker who had a long history of antiretroviral treatment for human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection, who presented with progressive dysphonia, and discuss the optical and immunohistochemical findings of this unusual lesion. 2. Case Report A 51-year-old male smoker (1 pack/day for 35 years) was referred to the otolaryngology department with progressive dysphonia of 3-week duration. The dysphonia was intermittent initially and later became almost constant. The medical history included an HIV-1 infection, diagnosed 25 years earlier and controlled with various antiretroviral drugs in the infectious diseases unit, with an acceptable current immunovirological status (CD4 529 cells/μL and serum viral load undetectable). The patient had also been diagnosed with HCV coinfection (genotype 3a) and had been treated with interferon-ribavirin. Currently the patient was a diabetic on insulin, had a serum dyslipidaemia attributed to antiretroviral treatment, and was receiving atorvastatin (40？mg/day). The lipid profile showed the following: total cholesterol: 253？mg/dL, high-density lipoprotein (HDL): 103？mg/dL, low-density lipoprotein (LDL): 135？mg/dL, very low-density