Presentation
Recent hoarseness of voice and odynophagia. Weight loss.
Patient Data
On PET scan. there is abnormal intense FDG avidity throughout the larynx, involving both vocal cords and crossing the anterior commissure. There is abnormal soft tissue thickening of both vocal cords on corresponding low dose CT. Avidity is more extensive in the left larynx, extending to the arytenoid cartilage posteriorly and the thyroid cartilage inferiorly, suspicous for involvement of these structures.
There is a small, but FDG avid left level 2/3 cervical lymph node - seen adjacent the greater horn of the left hyoid bone. Tracer distribution elsewhere was physiological only, with no further FDG avid nodal or distant metastatic disease identified. The lungs were clear.
Case Discussion
Primary laryngeal carcinoma was confirmed on biopsy of the larynx, with a single left cervical lymph node enfiladed on the PET scan.
PET/CT is useful for primary staging and post-treatment assessment and monitoring of primary head and neck cancers. Squamous cell carcinomas are the most common primary histological subtype of head and neck cancers, which are typically intensely FDG avid. While MRI may be more sensitive and specific for local staging, FDG PET/CT plays an important role in distant staging for detection of nodal and metastatic disease.