Glottic cancer - Glottic cancer - stage cT1b

Case contributed by Dr Maria Grazia Papi

Presentation

The patient complained of intermittent, unexplained hoarseness; a micro-laryngoscopy was performed which demonstrated preserved mobility and irregularity of the free edge of both vocal cords.

Patient Data

Age: 65 years
Gender: Male

Some irregularity of the free edge of the true vocal cords, thickening of the anterior commissure and focal contrast enhancement of the anterior third of the right true vocal cord, resulted. Preserved PGS (para-glottic space).

Annotated image

Some irregularity of the free edge of the true vocal cords (black arrow).

Thickening of the anterior commissure ( black arrowhead).

Focal contrast enhancement of the anterior third of the right true vocal cord (white arrow). Preserved fat hypodensity of PGS (paraglottic space) (white arrowhead).

Case Discussion

The patient had already undergone micro-laryngoscopy with biopsy and after three days a CT scan of the neck was performed: a comparison between histopathological and CT assessment was done.

According to AJCC prognostic stage grouping 2018, this primary tumor of glottic was considered T1b and stage I because the tumor invaded the vocal cords and the anterior commissure with normal mobility.

CT study confirmed the laryngoscopic results; there was a good correlation between vocal cords preserved mobility at laryngoscopy and paraglottic space (PGS) sparing on the CT study; moreover good correlation of the neoplastic extension in the axial plane with both the modalities resulted.

If there had been vocal cord impaired mobility and PGS invasion at CT scan more advanced disease with T2 extension and stage II would result.

Histopathological diagnosis

Incisional biopsy  specimens from within the
1. Righ true vocal cord
2. Left true vocal cord
Results of 1 and 2 specimens: invasive epidermoid carcinoma of the Malpighian epithelium.

Radiotherapy planning was considered.

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