Laryngeal SCC: Local and Nodal Extension
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Hello everyone, Dr. Sidney Levy here.
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3 00:00:04,300 --> 00:00:06,219 I would like to continue our discussion of
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laryngeal squamous cell malignancy by going over
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patterns of spread, both directly of tumor and of
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nodal spread for supraglottic laryngeal tumors.
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And I will use our example of a transglottic large laryngeal
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squamous cell malignancy to help demonstrate some points.
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So as this tumor involves the supraglottis,
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as well as the subglottis and the glottis,
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it does provide an example of how laryngeal
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tumors spread at the level of the supraglottis.
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I have a pre-contrast T1 on the left, a T2 in
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the middle with fat suppression, and a post-
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contrast T1 with fat suppression on the right.
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So at the level of the supraglottic larynx, and more
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specifically at the level of the false cords,
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it is common to have either pre- or paraglottic spread.
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So preepiglottic spread occurs in the midline,
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anteriorly, by effacing the preepiglottic space,
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which would normally be in this region, just there.
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Once you have effacement of the preepiglottic
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space, a tumor can extend inferiorly
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directly to the anterior commissure.
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And in this case, it is all infiltrated by
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tumor and can access the true vocal cord.
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So that is one method by which a
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supraglottic tumor can extend to involve
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the glottis at the level of the vocal cords.
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There's also paraglottic spread.
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So that is more off to the side.
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So we have the preepiglottic space here.
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The paraglottic space here on the left,
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which is not involved, and then the right
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paraglottic space, which is involved with tumor.
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Once a tumor accesses the paraglottic space and
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there is effacement of the paraglottic fat, which
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we can see here normally on our left side,
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a tumor can then also extend inferiorly to access
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the true vocal cord, which this tumor has done.
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Or alternatively, it can extend laterally
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to invade the thyroid cartilage.
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And in this case, the tumor has done that as well.
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So this, as discussed in a previous vignette,
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this right thyroid cartilage is abnormal.
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It's destroyed.
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From a nodal perspective,
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supraglottic tumors can spread widely.
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Usually they tend to involve levels 2 and 3.
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But occasionally, they can involve level 4,
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level 1, or retropharyngeal lymph nodes.
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And they are frequently bilateral.
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In cases of supraglottic laryngeal squamous cell
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malignancy, you should always look for a second
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primary, because there is an increased incidence
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of synchronous or metachronous malignancy.
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In our next vignette, we'll discuss the
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differential diagnosis of supraglottic tumors.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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