Professional Documents
Culture Documents
Briosos, Harold B.
Ruiz, Elenita Rose B.
Sy, Stephanie
Sy, Ysabella
Case Presentation
General Data
Chief Complaint
Vomitting of Blood
2 months PTA
still with above sign and symptoms,
now associated with difficulty of
breathing. Patient sought consult in
our institution where fine needle
aspiration biopsy was done on the
neck mass which revealed squamous
papilloma with chronic inflammation.
Trachestomy was also done.
1 month PTA
Family History
(+) Hypertension- maternal side
(+) Diabetes Mellitus- maternal side
(+) Pulmonary Tuberculosis- maternal
side
(-) Kidney disease
(-) Cancer
Physical Examination
(+) patent external auditory canal,
both ears
(+) patent tymphanic membrane,
both ears
Midline nasal septum
No nasal discharge
No tonsillipharyngeal congestion
6X3X2 cm multilobulated
tender movable
Movable mass
tracheostomy
3X2X2 cm non
Salient Features
30 pack years smoking history
Odynophagia
Hoarseness
Gradually enlarging neck mass
Male
Differential Diagnosis
ESOPHAGEAL CARCINOMA
(lower portion)
RULE IN
+ More common in male
+ Dysphagia/
odynophagia
+ Hoarseness of voice
+ Smoker
+ Hematemesis
+ Easy fatigability
+ Weakness
RULE OUT
Weight loss
Chest pain
Worsening indigestion
or heartburn
No history of acid
reflux
No history of alcohol
intake
Obese
LARYNGOCELE
A rare, benign dilatation of the laryngeal
saccule that may extend internally into the
airway or externally through the thyrohyoid
membrane.
It may be congenital or acquired and may
occur at any age
LARYNGOCELE
RULE IN
+ Hoarseness
+ Dyspnea
+ Dysphagia
+ Mass
+ Cough
RULE OUT
Common to middle age
Hematemesis
Easy fatigability
Weakness
PARAGANGLIOMA
Rare neuroendocrine neoplasm that may
develop at various sites of the body, and
may present as a painless mass.
Appear grossly as sharply circumscribed
polypoid masses, with firm to rubbery
consistency.
PARAGANGLIOMA
RULE IN
+ 40-70 years old
+ Mass
+ Hoarseness
+ Dysphagia/
odynophagia
+ Hypertension
RULE OUT
More
common
in
women
Aural
signs
and
symptoms
Hematemesis
Easy fatigability
EXTRAPULMONARY TB
RULE IN
+ Filipino
+ Cough
+ Smoker
+ Hoarseness
+ Easy fatigability
+ Weakness
+ Dyspnea
+ Dysphagia
+ Hematemesis
+ Cervical
lymphadenopathy
RULE OUT
Night sweats
Weight loss
Chills
Loss of appetite
Final Diagnosis
Squamous Cell Carcinoma, Larynx,
Transglottic (T4a, N2b, M0)
ANATOMY
of
L A the
RYNX
Protective
sphincter at
the inlet of
the air
passages
Voice
production
CARTILAGES OF THE
LARYNX
VOCAL
PROCES
S
MUSCULA
R
PROCESS
MEMBRANES &
LIGAMENTS OF THE
LARYNX
MUSCLES OF THE
LARYNX
ELEVATIO
EXTRINSIC MUSCLES
MUSCLES OF THE
LARYNX
DEPRESSI
EXTRINSIC MUSCLES
INTRINSIC MUSCLES
INTRINSIC MUSCLES
INTRINSIC MUSCLES
VASCULAR SUPPLY
SUPRAGLOTTIC
and GLOTTIC
Superior laryngeal
artery
SUBGLOTTIC
Inferior laryngeal
artery
Superior laryngeal
veins drain into the
superior thyroid veins,
which empty into the
internal jugular veins.
The inferior laryngeal
veins drain into the
inferior thyroid veins,
which both empty into
the left brachiocephalic
vein
LYMPHATIC DRAINAGE
NERVE SUPPLY
SUPERIOR
LARYNGEAL
NERVE
Motor innervation of the
extrinsic muscles
(external branch)
Internal sensory branch
supplies the mucosa of
the upper larynx
TUMOR SPREAD
The PRE-EPIGLOTTIC
SPACE (PES) and the
PARAGLOTTIC SPACE
(PGS) provide pathways
for spread of laryngeal
tumors.
Case Discussion
Risk Factors
Smoking
Excessive alcohol consumption
Exposure to Human Papilloma Virus 16 &18
Chronic Gastric Reflux
Occupational exposures
Prior history of head and neck irradiation
Carcinogenesis
Glottic
Supraglottic
Subglottic
Transglottic
Involves true
vocal cords
Confined to
the
supraglottic
area (free
border of the
laryngeal
epiglottis,
false vocal
cords and
laryngeal
ventricles
Extend or
arise more
than 10mm
below the free
margin of the
true vocal fold
up to the
inferior border
of the cricoid
cartilage
Cross the
ventricle from
the
supraglottic
area to
involve the
true and false
vocal folds or
involve the
glottis and
extend
subglotically
more than
10mm or both
Supraglottic
Glottic
Subglottic
- More Aggressive
- Direct extension
into pre-epiglottic
space
Lymph node
metastasis
Direct extension
into lateral
hypopharnyx,
glossoepiglottic fold,
and tongue base
- Uncommon
- Glottic spread to
the subglottic
space is a
sign of poor
prognosis
- Increases chance
of bilateral disease
and
mediastinal
extension
- Invasion of the
subglottic space
associated with
high incidence of
stomal
reoccurrence
Manifestations
Supraglottic
Chronic sore
throat
Dysphonia
Dysphagia
Neck mass
secondary to
regional
metastasis
Glottic
Hoarseness
Airway
obstruction
late symptom
Subglottic
Vocal cord
paralysis
Airway
compromise
TNM Staging
TX - Minimum requirements to assess
primary tumor cannot be met
T0 - No evidence of primary tumor
Tis - Carcinoma in situ
Staging-Supraglottis
T1
T2
T3
T4a
T4b
Staging - Glottis
T1
T1
a
T1
b
T2
T3
T4
Staging - Subglottis
T1
T2
T3
T4
a
T4
b
Staging - Nodes
N0
N1
N2a
N2b
N2c
N3
Staging - Metastasis
M0
M1
No distant metastases
Distant metastases
present
Stage Grouping
Treatment
CO2 Laser
Resection: severe
dysplasia and
carcinoma in situ
Radiotherapy
Chemotherapy
Partial/Total
Laryngectomy:
advanced tumors
T1-T2
Radiotherapy or surgery alone
85-95% cure rate
T3-T4 Lesions
Total Laryngectomy
Small T3 and lesser sized tumors can be
treated with partial laryngectomy
Post-op Radiation
Indications:
T4 primary
Bone/cartilage invasion
Vascular invasion
Multiple positive nodes
Nodal extracapsular extension
Subglottic extension of primary tumor
Chemotherapy
Advanced stage cancers
Cisplatinum and 5-flourouracil
Complications
Infection
Voice alterations
Loss of taste and smell
Tracheostomy dependence
Prognosis
5 year
survival
Stage 1
Stage 2
Stage 3
Stage 4
>95%
85-90%
70-80&
50-60%
Thank you!