Hypopharyngeal SCC - Nodal Drainage
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Hello, everyone.
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3 00:00:02,560 --> 00:00:05,970 Dr. Sidney Levy here, continuing our discussion of the diagnosis
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and staging of hypopharyngeal squamous cell malignancy.
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We've discussed patterns of spread and general
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imaging features of piriform sinus tumors.
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I'd like to briefly touch on the patterns of nodal drainage.
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These tend to be either to levels two, three,
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or four, and can extend widely between these regions.
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They may also be ipsilateral or contralateral,
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but frequently, they are bilateral.
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There is also a tendency amongst the more
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aggressive tumors to be associated with extra
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nodal extension, so it's important to look at the
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contour of the lymph nodes as well as their size.
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Hypopharyngeal malignancies, including piriform sinus
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malignancies, have a tendency to be associated with
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other tumors within the upper aerodigestive tract.
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So it's important to look for
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synchronous or metachronous tumors.
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And in this particular case, that's important
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because if we head down into the mid-esophagus,
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there is, in fact, a synchronous tumor in this patient.
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And that would be easy to miss
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if you weren't looking for it.
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Now, that can complicate matters because the
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superior mediastinal lymph nodes, otherwise
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known as level 7 in the head and neck lymph node
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classification, are considered regional lymph
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nodes for the purposes of head and neck staging.
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So therefore, if there is a lymph node in this
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region, we need to consider it a regional lymph node.
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And there is indeed, in this patient, an abnormal
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superior mediastinal or paratracheal lymph node.
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So this can be a little bit complicated because we now
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need to make an assessment as to whether we think this
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lymph node is related to the esophageal malignancy or
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alternatively, the much larger piriform sinus malignancy.
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We will formally stage this tumor in a subsequent vignette.
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But for the purposes of the discussion now,
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it is important to remember to look for other
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tumors when assessing a piriform sinus tumor.
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And to be aware that the nodal spread is wide and not
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uncommonly involves levels 2, 3, and 4 bilaterally.
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And keep in mind that level 7, the superior
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mediastinum, must be part of your checklist
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because regional lymph nodes can spread there.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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