Wk 5, Case 2 - Review

Patient History
Hoarseness.

Findings
Contrast-enhanced CT was performed from the skull base to the thoracic inlet. The study demonstrates an aggressive mass involving the true vocal cords. This mass completely involves the right true vocal cords and extends anteriorly to the anterior commissure. The tumor also involves the anterior two-thirds of the left true vocal cord. The tumor extends posteriorly to involve the posterior commissure. Superiorly, the tumor is transglottic and involves the right false vocal cord and right aryepiglottic fold. The tumor appears to involve the left false vocal cord and may involve the inferior portion of the left aryepiglottic fold. Inferiorly, the tumor extends to involve the subglottis with approximately 6-9mm of subglottic spread.

The bone algorithms demonstrate erosion of the inner and outer cortex of the thyroid cartilage with evidence of extralaryngeal spread anteriorly. These findings indicate extension along Broyles ligament. The tumor involves the posterior commissure with sclerosis and erosion of the cricoid cartilage and right arytenoid cartilage.

There is an approximately 8mm left level 3 lymph node and 10mm right level 3 lymph node. These lymph nodes are not definitely metastatic by standard size criteria. However, they are suspicious based on the extensive nature of the tumor.

Visualized portion of the brain is grossly within normal limits. However, dedicated brain imaging is necessary for complete diagnostic evaluation.

Visualized portion of the lungs is within normal limits. However, dedicated chest CT is necessary for complete diagnostic evaluation.

Conclusions
1. Aggressive mass involving the right and left true vocal cords that appears to be centered in the anterior commissure. Findings most consistent with squamous cell carcinoma. There is erosion of the cricoid cartilage and right arytenoid along with erosion of the inner and the outer cortex of the thyroid cartilage which would stage this lesion T4B.
2. Approximately 10mm right level 3 lymph node and 8mm left level 3 lymph node. These lymph nodes are not definitely metastatic by standard size criteria but are suspicious given the advanced stage of disease.