Presentation
Two months of dysphonia, throat pain and dysphagia associated with weight loss.
Patient Data
Note: images are sub-optimal due to patient movement.
• T2 hyper-intense enhancing mass involves the right aryepiglottic fold, vocal cord and paraglottic fat
• Likely involvement of right thyroid cartilage. There is no abnormal signal/enhancement in the tissue overlying the thyroid lamina to suggest cartilage invasion.
• Abnormal enhancement at anterior commissure and left cord suggests contra-lateral involvement. There is evidence of subglottic extension to the level of the inferior border of cricoid.
• No post cricoid or hypopharynx posterior wall involvement.
• Jugular chain lymph nodes are increased in number but not enlarged.
Case Discussion
Case submitted by Dr Smita Deb and A/Prof Pramit Phal.
Right trans-glottic SCC.
Staging on imaging using the classification for tumors of the glottis.
T3 = in this case the tumor involves the true cords as well as the aryepiglottic folds (a site of the supra-glottis), plus the para-glottic space with a question of minor thyroid cartilage involvement. To give a staging of T4a involvement of structures outside the larynx would need to be demonstrated: thyroid cartilage, trachea, esophagus, neck soft tissue, tongue or strap muscles, soft tissues of the neck.
N0 = no lymph node involvement.
The patient went on to have extensive head & neck surgery; laryngectomy, pharyngectomy and bilateral neck dissections. Histology revealed a poorly differentiated SCC with NO skeletal muscle or cartilage invasion and a normal thyroid gland.