Pyriform sinus squamous cell carcinoma

Case contributed by Dr Smita Deb

Presentation

Fixed right vocal cord on flexible nasoendoscopy. Lifelong smoker with heavy alcohol abuse.

Patient Data

Age: 71
Gender: Male

There is an abnormal enhancing mass centred upon the right larynx/hypopharynx.

Superior extent of the lesion extends from the right aryepiglottic fold, involving the paraglottic right space (without crossing the midline) and extending into the supraglottic larynx.

Inferior extent extends to right true cord with likely subglottic spread.

Maximal transverse diameter is 2.5 x 2.1 cm. There is abnormal soft tissue extending between the right arytenoid cartilage and thyroid cartilage.

There is abnormal bony sclerosis of the right thyroid, arytenoid and superior cricoid cartilage suggesting tumour involvement.This is better assessed on the MRI. The mass is difficult to separate from the longus coli muscle at the level of the hypopharynx.

Lymphadenopathy

  • Necrotic node associated with the deep cervical chain 2.6 x 3.0 cm.
  • Further abnormal node demonstrated within level five 1 cm. There is probable extra capsular spread of disease.
  • There is a 2.5 x 2 .3 cm lymph node in the right supraclavicular region.
  • There are multiple small contralateral left sided lymph nodes.

Right pyriform sinus mass (27 x 28 x 19 mm).

Inferior extension into the right true vocal cords with subglottic spread.

Tumour also extends into the right superior aspect of the cricoid cartilage.

The right vocal cord is midline and correlates to it being fixed on examination.

Anteriorly extension into the right paraglottic fat only.

Laterally it invades into the thyroid cartilage with abnormal enhancement present in the right strap muscles. Posterior to the thyroid cartilage enhancing tissue is seen to extend into the right nodal mass.

Medially it extends into the right aryepiglottic fold.

The mass causes marked mass effect with severe narrowing of the vestibule.

Lymphadenopathy:

  • Right neck nodal mass present 30 x 31 mm. Enhancement extends outside the lymph node capsule consistent with extracapsular spread. The right internal jugular vein is compressed by the mass.
  • Right level III nodes
  • Right supraclavicular lymph node
  • Right level I lymph nodes
  • Left level II node

Case Discussion

Case submitted by Dr Smita Deb and A/Prof Pramit Phal.

Right pyriform sinus SCC (sub-site of the hypopharynx).

Staging:

T4a - extensive invasion of tumour into at least one of the following: thyroid/cricoid cartilage, hyoid bone, thyroid gland, oesophagus or central compartment soft tissue WITHOUT involvement of prevertebral fascia, carotid artery or mediastinal structures. In our case, there is invasion into the cricoid and thyroid with fixation of the larynx.

N2c - metastasis is bilateral lymph nodes <6cm. 

PlayAdd to Share

Case information

rID: 31176
Case created: 22nd Sep 2014
Last edited: 27th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.