Larynx - Glottic SCC: Patterns of Local Spread
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Hello everyone.
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Dr. Sidney Levy here, continuing our discussion
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of laryngeal squamous cell malignancy.
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I'm at the level of the glottis, and, uh,
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I would like to use this transglottic malignancy
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to go over some of the patterns of spread
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that occur at the level of the glottis.
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It is in many ways similar to the
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supraglottis, except, uh, the site of
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origin is at the level of the vocal cords.
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You can still have anterior spread
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via the anterior commissure
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into the thyroid cartilage0.
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or indeed into strap muscles.
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So this tumor has effaced the anterior commissure,
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has invaded the anterior thyroid cartilages, and is closely
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abutting but not yet invading strap musculature.
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So I'll, I'll just draw that for you
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because it can be difficult to see.
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All of this is tumor.
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However, there is some strap musculature just in front
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here, which may or may not be involved with the tumor.
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It's definitely in close contact, and there
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is some signal abnormality in the region,
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but it's difficult to be sure whether that's involved
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with the tumor, but you certainly would want to raise it
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because of the altered signal
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intensity of the muscle in this region.
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Other patterns of spread might
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include posterior spread.
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So if the tumor is originating at the level of the
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posterior commissure, then it may spread posteriorly
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into either arytenoid cartilage or cricoid cartilage.
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This tumor is involving the arytenoid cartilage.
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And the reason we know it is that at the
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normal site of the arytenoid cartilages,
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just superior to the cricoid cartilage, we
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can't distinguish normal cartilage tissue.
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If we go down a slice or two, we start
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to come into cricoid cartilage, which is
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not clearly involved by tumor.
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We're into the subglottis by this stage.
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Other patterns of spread,
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you can have superior spread
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across the laryngeal ventricle via the mucosa, and you can have
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inferior spread directly into the subglottis.
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This tumor displays both of those features.
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Lastly, I'd like you to consider the differential
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diagnoses of, uh, tumors in this region.
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And most importantly, it is worth making an
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attempt to say where the tumor originated.
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So do we think that it's primarily a glottic
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tumor, a supraglottic tumor, or a subglottic tumor?
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In this case, most of the tumor bulk is
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within the glottis and the supraglottis.
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It is likely that it began as a supraglottic or
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glottic tumor, probably more likely a supraglottic
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tumor because of the pattern of nodal involvement.
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Other differentials in this region include
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gastroesophageal reflux disease, chondroid tumors
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such as chondrosarcoma, or autoimmune diseases
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such as rheumatoid arthritis or sarcoidosis.
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Lastly, it is worth keeping in mind that minor
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salivary gland malignancies, such as adenoid
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cystic carcinoma, can also occur in the larynx,
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although it's usually a diagnosis made by
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the pathologist rather than the radiologist.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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