Case 1: A 6-year-old boy who was previously well presented to us with a history of hoarseness of the voice over the past 1 month and breathing difficulties for the previous 2 weeks. There was no history of trauma, or any previous surgery of the head and neck region except for a tongue-tie release during the infantile period. There was no history of fever or loss of weight or appetite. On examination, the patient’s vital signs were stable. Systemic examination did not reveal any abnormality. Flexible laryngoscopy showed a polypoidal mass approximately 1 × 1 cm in size in the free border and the undersurface of the right vocal cord extending down to the subglottis (). The patient was evaluated with computed tomography (CT) of the neck, which revealed a polypoid nodule of size 1 × 1 cm in the right vocal cord projecting into the lumen with no evidence of extension into the anterior commissure or deep cartilage. An initial impression of papilloma was made. The patient underwent microlaryngeal gross total excision of the mass under general anesthesia. Histopathology of the excised mass showed polypoid fragments of the respiratory epithelium and metaplastic squamous epithelium. The subepithelium showed spindle-cell proliferation with storiform appearance and tiny microhemorrhages. There were dense infiltrates of lymphocytes, plasma cells, and eosinophils. The spindle cells did not show nuclear atypia or mitosis and possessed vesicular nuclei with conspicuous nucleoli (). Immunohistochemistry was positive for vimentin and smooth muscle actin (SMA) (), negative for cytokeratin, desmin, anaplastic lymphoma kinase (ALK), S100 and cluster of differentiation 34 (CD34). These features were thus suggestive of a spindle-cell neoplasm favoring IMT. The patient was followed up without any adjuvant therapy. After 4 months, he presented with repeat symptoms of hoarseness of voice. Laryngoscopy revealed a recurrent mass, 2 × 2 cm in size. He underwent a microlaryngeal excision using microdebrider, and also required a tracheostomy for airway protection. The post-surgery period was uneventful, and the patient was placed on regular tracheostomy care. After a 6 months of an uneventful follow-up period, a routine laryngoscopic examination showed a recurrent mass of 1 × 1 cm, and an endolaryngeal diode laser excision of the mass was performed. In view of the recurrent nature of the mass, the patient was started on adjuvant oral celecoxib at a dose of 100 mg/m2/day. The tracheostomy was decannulated successfully after 6 months. Currently, 1.5 years after the last surgery, the patient is healthy with no evidence of any recurrence, and is being continued on celecoxib therapy. Case 2: A 7-year-old male child presented with cough and respiratory distress of 15 days duration. There was no history of fever, previous history suggestive of bronchial asthma, nor any foreign body inhalation. On examination, the patient was tachypneic. On auscultation, there was mild stridor, but other systemic examination was normal. A trial of bronchodilators and antibiotics was made, but as the symptoms persisted, he was evaluated further. Bronchoscopy and high resolution CT showed a polypoidal lesion with calcification arising from the anterolateral wall of the lower trachea with significant narrowing of the lumen. The patient underwent biopsy followed by endoscopic laser excision, and histology was suggestive of IMT. Currently the patient is under follow up without any adjuvant therapy and has had no recurrence so far.