M. Hedesiu 1

1. “’Iuliu Hatieganu”University of Medicine and Pharmacy, Cluj Napoca, Romania

Laryngeal tumors

squamous cell carcinoma - over 90% of laryngeal tumors

non-squamous cell tumors ○ adenocarcinoma○ adenosquamous carcinoma

Imaging investigation Endoscopy

CT MRI

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

The origin of laryngeal tumors and the patterns of tumors spread

1. Supraglottic tumorsoriginating from the epiglottis

primarily invade the preepiglottic space

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

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.

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.

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.

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.

P Som, 2002

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.

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.

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.

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.

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

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

Message to take home

The radiological report should describe the key region for tumoral staging and also, for surgery