Trans-glottic squamous cell carcinoma

Case contributed by Smita Deb
Diagnosis almost certain


Two months of dysphonia, throat pain and dysphagia associated with weight loss.

Patient Data

Age: 55 years
Gender: Male

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.

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