ct examination of larynx tumours.ppt
TRANSCRIPT
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M. Hedesiu 1
1. “’Iuliu Hatieganu”University of Medicine and Pharmacy, Cluj Napoca, Romania
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Laryngeal tumors
squamous cell carcinoma - over 90% of laryngeal tumors
non-squamous cell tumors ○ adenocarcinoma○ adenosquamous carcinoma
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Imaging investigation Endoscopy
CT MRI
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The role of CT examination1. To establish the origin of the tumors
2. To assess the neoplastic invasion
3. To provide the useful information for surgery
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The origin of laryngeal tumors and the patterns of tumors spread
1. Supraglottic tumorsoriginating from the epiglottis
primarily invade the preepiglottic space
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The origin of laryngeal tumors and the patterns of tumors spread
1. Supraglottic tumorsoriginating from the false cord, laryngeal
ventricle, or aryepiglottic fold primarily infiltrate the paraglottic space
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The origin of laryngeal tumors and the patterns of tumors spread
1. Supraglottic tumors○ Tumors arising in the arytenoid region
typically infiltrate towards the postcricoid portion of the hypopharynx.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Supraglottic tumors○ The primary lymphatic spread is directed
toward the superior jugular lymph nodes.○ Lymph node metastases are common and
often bilateral.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Glottic carcinoma○ typically arises from the anterior half of the
vocal cordprimarily spreads into the anterior commissure.Then, easily spread into the supraglottis or
subglottis.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Glottic carcinoma Tumor spreads laterally with invasion of the the
thyroarytenoid muscle. Further spread occurs mainly in a cephalad or caudad
direction spread via the cricothyroid membrane, into the perilaryngeal
tissue. Perilaryngeal invasion is often accompanied by destruction
of the lower margin of the thyroid ala and the upper edge of the cricoid cartilage.
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P Som, 2002
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The origin of laryngeal tumors and the patterns of tumors spread
1. Glottic carcinoma Subglottic spread is relatively common and may either occur
superficial or deep to the elastic cone.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Glottic carcinoma Lymphatic metastases - uncommon as long as the tumor is
confined to the endolarynx. It the tumor spreads into the soft tissues of the neck the
frequency of lymph node metastases increases significantly.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Subglottic carcinoma are uncommon and tend to spread to the trachea or invade the thyroid
gland and the cervical esophagus.
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The origin of laryngeal tumors and the patterns of tumors spread
1. Subglottic carcinoma Lymph node metastases are much more common than in
glottic carcinoma ○ the paratracheal and pretracheal nodes. These nodes drain
to the lower jugular or upper mediastinal nodes.
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What the surgeon should know? Supraglottic carcinoma
Supra or infra-hyoidian extention Cricoid cartilage invasionBilateral arytenoid invasionPair/impair vocal cord fixation tyroid cartilage fixation Tumoral extansion into the post-cricoidian
region or into the apex of the pyriphorm sinusTumoral invasion of the tongue base more than
1 cm posterior to the cicumvalate papillaeInvasion into de anterior commissure
No supraglottic laryngectomy
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What the surgeon should know? The lower extention of the tumor Glottic carcinoma
Crico-arytenoidian space invasion Degree of extension into the tyroid
cartilageDeep invasion and vocal cord fixation
No vertical hemilaryngectomy
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Message to take home
The radiological report should describe the key region for tumoral staging and also, for surgery