437 - Acute Hypophonia due to Metastatic Ureteral Neuroendocrine Carcinoma

Case Diagnosis: Acute Hypophonia due to Left Recurrent Laryngeal Nerve Compression Secondary to Metastatic Ureteral Neuroendocrine Carcinoma

Case Description: A 73-year-old male with a complex medical history, including neuroendocrine carcinoma with incomplete treatment, prostatectomy secondary to prostate cancer, CAD with stent, DM2, hypertension, and multiple other conditions, presented with nausea, vomiting, generalized weakness and poor oral intake. He was diagnosed with Clostridium Difficile and treated with oral vancomycin. On day 6 he was transferred to inpatient rehabilitation with the goal of addressing functional decline. On day 11, he spontaneously developed dysphonia upon waking up. CT chest revealed mediastinal masses compressing the left vocal cord. Further evaluation was performed by ENT who completed a nasopharyngoscopy which was significant for complete paralysis of the left vocal cord. These findings were suspicious for further metastasis of his neuroendocrine carcinoma whose mass effect caused compression of the Left Recurrent Laryngeal Nerve.

Discussions: Managing mediastinal masses compressing the recurrent laryngeal nerve (RLN) require a multidisciplinary approach. Clinical evaluation, vocal cord function assessment, and CT/MRI imaging to determine nerve involvement are critical. Surgical interventions may be considered along with collaboration from speech and language pathologists to preserve vocal function. In this case the patient elected to continue conservative management outpatient, which highlights the need to prioritize rehabilitation goals when formulating a plan.

Conclusions: Metastatic neuroendocrine carcinomas require careful and unique assessment to achieve patient goals of care. While surgical and palliative interventions may be considered each case requires individualized assessment and further studies are needed to assess management.