Hypopharynx - Postcricoid Space SCC - Local Spread
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Hello everyone. Dr.Sidney Levy.
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3 00:00:05,180 --> 00:00:09,370 I'm continuing our discussion of the general imaging
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features and patterns of spread of post-cricoid
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region hypopharyngeal squamous cell malignancies.
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We have our example case here with post-contrast T1-weighted
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imaging with fat suppression on the left, pre-contrast
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T1-weighted imaging without fat suppression in the middle, and
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pre-contrast T1-weighted imaging without fat suppression
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in a sagittal projection on the right.
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I'll just draw the tumor for you.
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So this tumor is originating in the left post-
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cricoid region and can also be appreciated
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on the sagittal projection as an abnormal
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thickening of the post-cricoid space.
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These tumors have a propensity to spread inferiorly into
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the cervical esophagus, as this one has done, remembering
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that the inferior border of the cricoid cartilage is
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the demarcation between the hypopharynx and the esophagus.
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So this tumor is going all the way down into
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the upper cervical esophagus, anterior wall.
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They also have a tendency to spread anteriorly
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into the larynx, and in particular tend to erode
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the posterior wall of the cricoid cartilage.
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So this tumor being centered here closely abuts the
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posterior wall of the cricoid cartilage, which is
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demonstrated here and here, but the tumor itself
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does not macroscopically erode that cartilage.
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So that's a very important finding to
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comment on when reporting a study like this.
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Other than that, they can spread in other
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directions, such as laterally into the apices of
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the piriform sinuses, or around and posteriorly
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to involve the posterior hypopharyngeal wall.
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Superiorly, they can also extend into the supraglottic
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larynx at the level of the laryngeal inlet.
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From a point of view of nodal drainage, these
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tumors have a tendency to spread to levels
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three and four and are often bilateral.
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In summary, post-cricoid region tumors are often
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difficult to distinguish from other tumors in the region.
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and it is helpful to look for abnormal thickening
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or bulging of the soft tissue situated between the
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cricoid cartilage and the posterior hypopharyngeal wall,
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in particular on the axial and sagittal projections.
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They have a tendency to spread to lymph
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nodes in levels three and four and are often
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associated with bilateral nodal disease.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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