0:01

Hello everyone.

0:03

Dr. Sidney Levy here.

0:05

Today, I'd like to discuss diagnosis

0:08

and staging of, uh, postcricoid region

0:12

hypopharyngeal squamous cell malignancy.

0:16

I have a sample case here, and I'd like to

0:18

use it to demonstrate some of the general

0:20

principles of these tumors, as well as their

0:23

uh, patterns of spread and nodal drainage.

0:27

These tumors, like other hypopharyngeal

0:30

tumors, tend to be T1 iso-intense to muscle.

0:33

This is a pre-contrast, non-fat

0:36

suppressed T1 weighted sequence.

0:39

In this case, the tumor is difficult to distinguish

0:41

from adjacent mucosa on T1 weighted imaging.

0:46

And if anything, it's a little bit hyperintense

0:49

with respect to normal strap musculature in front.

0:53

On T2 weighted imaging, these tumors tend to be

0:56

moderately hyperintense, and, uh, on post-contrast

1:00

imaging, which we have on the left-hand side,

1:03

they demonstrate mild to moderate enhancement.

1:06

They are always situated posterior

1:09

to the glottis or subglottis.

1:12

And the sagittal projection can be quite

1:14

helpful in distinguishing the postcricoid

1:17

space here from the larynx anteriorly and the

1:23

posterior hypopharyngeal wall posteriorly.

1:26

So let me draw that for you because that

1:28

can be a difficult concept to embrace.

1:31

On this diagram, I have drawn the postcricoid

1:35

space to try and distinguish it from the

1:37

adjacent posterior hypopharyngeal wall,

1:40

posteriorly, and the larynx, anteriorly.

1:44

The, uh, key landmarks are the inferior border

1:48

of the cricoid cartilage, because once we go

1:51

below this level, we are into the cervical esophagus.

1:55

So, this tumor is abnormally thickening the post

2:00

cricoid space at this level, but it is also extending

2:06

inferiorly into the cervical esophagus, anterior wall,

2:10

beyond the inferior border of the cricoid cartilage.

2:14

It, however, has not extended directly

2:17

into laryngeal cartilages, specifically

2:20

the cricoid cartilage anteriorly.

2:24

Now, these tumors can present with laryngeal invasion

2:28

and do have a propensity to involve the cricoid

2:31

cartilage because of the close proximity of it.

2:35

So it's important when you're looking

2:37

at these tumors to

2:39

go carefully up and down the laryngeal cartilages,

2:43

especially the cricoid cartilage, and look for erosion

2:46

of the posterior margin of the cricoid cartilage.

2:50

Best appreciated on the axial projection.

2:53

In our next vignette, we will discuss

2:55

patterns of spread, both directly and

2:59

through lymph nodes for these tumors.

Hypopharynx - Postcricoid Space SCC

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0:01

Hello everyone.

0:03

Dr. Sidney Levy here.

0:05

Today, I'd like to discuss diagnosis

0:08

and staging of, uh, postcricoid region

0:12

hypopharyngeal squamous cell malignancy.

0:16

I have a sample case here, and I'd like to

0:18

use it to demonstrate some of the general

0:20

principles of these tumors, as well as their

0:23

uh, patterns of spread and nodal drainage.

0:27

These tumors, like other hypopharyngeal

0:30

tumors, tend to be T1 iso-intense to muscle.

0:33

This is a pre-contrast, non-fat

0:36

suppressed T1 weighted sequence.

0:39

In this case, the tumor is difficult to distinguish

0:41

from adjacent mucosa on T1 weighted imaging.

0:46

And if anything, it's a little bit hyperintense

0:49

with respect to normal strap musculature in front.

0:53

On T2 weighted imaging, these tumors tend to be

0:56

moderately hyperintense, and, uh, on post-contrast

1:00

imaging, which we have on the left-hand side,

1:03

they demonstrate mild to moderate enhancement.

1:06

They are always situated posterior

1:09

to the glottis or subglottis.

1:12

And the sagittal projection can be quite

1:14

helpful in distinguishing the postcricoid

1:17

space here from the larynx anteriorly and the

1:23

posterior hypopharyngeal wall posteriorly.

1:26

So let me draw that for you because that

1:28

can be a difficult concept to embrace.

1:31

On this diagram, I have drawn the postcricoid

1:35

space to try and distinguish it from the

1:37

adjacent posterior hypopharyngeal wall,

1:40

posteriorly, and the larynx, anteriorly.

1:44

The, uh, key landmarks are the inferior border

1:48

of the cricoid cartilage, because once we go

1:51

below this level, we are into the cervical esophagus.

1:55

So, this tumor is abnormally thickening the post

2:00

cricoid space at this level, but it is also extending

2:06

inferiorly into the cervical esophagus, anterior wall,

2:10

beyond the inferior border of the cricoid cartilage.

2:14

It, however, has not extended directly

2:17

into laryngeal cartilages, specifically

2:20

the cricoid cartilage anteriorly.

2:24

Now, these tumors can present with laryngeal invasion

2:28

and do have a propensity to involve the cricoid

2:31

cartilage because of the close proximity of it.

2:35

So it's important when you're looking

2:37

at these tumors to

2:39

go carefully up and down the laryngeal cartilages,

2:43

especially the cricoid cartilage, and look for erosion

2:46

of the posterior margin of the cricoid cartilage.

2:50

Best appreciated on the axial projection.

2:53

In our next vignette, we will discuss

2:55

patterns of spread, both directly and

2:59

through lymph nodes for these tumors.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Lesson

Oral Cavity Anatomy

Lesson

Oral Cavity Staging of Squamous Cell Malignancy

Lesson

Lymph Node Levels of the Neck

Lesson

Oropharynx

Lesson

Hypopharynx

Lesson

Larynx

Lesson

Sinonasal

Lesson

Perineural Tumor Spread

Hypopharynx - Postcricoid Space SCC