0:01

Hello, everyone.

0:02

3 00:00:02,560 --> 00:00:05,970 Dr. Sidney Levy here, continuing our discussion of the diagnosis

0:06

and staging of hypopharyngeal squamous cell malignancy.

0:10

We've discussed patterns of spread and general

0:13

imaging features of piriform sinus tumors.

0:18

I'd like to briefly touch on the patterns of nodal drainage.

0:23

These tend to be either to levels two, three,

0:27

or four, and can extend widely between these regions.

0:32

They may also be ipsilateral or contralateral,

0:38

but frequently, they are bilateral.

0:41

There is also a tendency amongst the more

0:45

aggressive tumors to be associated with extra

0:47

nodal extension, so it's important to look at the

0:51

contour of the lymph nodes as well as their size.

0:56

Hypopharyngeal malignancies, including piriform sinus

0:59

malignancies, have a tendency to be associated with

1:03

other tumors within the upper aerodigestive tract.

1:05

So it's important to look for

1:07

synchronous or metachronous tumors.

1:10

And in this particular case, that's important

1:13

because if we head down into the mid-esophagus,

1:21

there is, in fact, a synchronous tumor in this patient.

1:26

And that would be easy to miss

1:28

if you weren't looking for it.

1:30

Now, that can complicate matters because the

1:33

superior mediastinal lymph nodes, otherwise

1:37

known as level 7 in the head and neck lymph node

1:39

classification, are considered regional lymph

1:43

nodes for the purposes of head and neck staging.

1:45

So therefore, if there is a lymph node in this

1:48

region, we need to consider it a regional lymph node.

1:53

And there is indeed, in this patient, an abnormal

1:58

superior mediastinal or paratracheal lymph node.

2:02

So this can be a little bit complicated because we now

2:06

need to make an assessment as to whether we think this

2:08

lymph node is related to the esophageal malignancy or

2:15

alternatively, the much larger piriform sinus malignancy.

2:21

We will formally stage this tumor in a subsequent vignette.

2:25

But for the purposes of the discussion now,

2:29

it is important to remember to look for other

2:31

tumors when assessing a piriform sinus tumor.

2:35

And to be aware that the nodal spread is wide and not

2:40

uncommonly involves levels 2, 3, and 4 bilaterally.

2:47

And keep in mind that level 7, the superior

2:50

mediastinum, must be part of your checklist

2:52

because regional lymph nodes can spread there.

Hypopharyngeal SCC - Nodal Drainage

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0:01

Hello, everyone.

0:02

3 00:00:02,560 --> 00:00:05,970 Dr. Sidney Levy here, continuing our discussion of the diagnosis

0:06

and staging of hypopharyngeal squamous cell malignancy.

0:10

We've discussed patterns of spread and general

0:13

imaging features of piriform sinus tumors.

0:18

I'd like to briefly touch on the patterns of nodal drainage.

0:23

These tend to be either to levels two, three,

0:27

or four, and can extend widely between these regions.

0:32

They may also be ipsilateral or contralateral,

0:38

but frequently, they are bilateral.

0:41

There is also a tendency amongst the more

0:45

aggressive tumors to be associated with extra

0:47

nodal extension, so it's important to look at the

0:51

contour of the lymph nodes as well as their size.

0:56

Hypopharyngeal malignancies, including piriform sinus

0:59

malignancies, have a tendency to be associated with

1:03

other tumors within the upper aerodigestive tract.

1:05

So it's important to look for

1:07

synchronous or metachronous tumors.

1:10

And in this particular case, that's important

1:13

because if we head down into the mid-esophagus,

1:21

there is, in fact, a synchronous tumor in this patient.

1:26

And that would be easy to miss

1:28

if you weren't looking for it.

1:30

Now, that can complicate matters because the

1:33

superior mediastinal lymph nodes, otherwise

1:37

known as level 7 in the head and neck lymph node

1:39

classification, are considered regional lymph

1:43

nodes for the purposes of head and neck staging.

1:45

So therefore, if there is a lymph node in this

1:48

region, we need to consider it a regional lymph node.

1:53

And there is indeed, in this patient, an abnormal

1:58

superior mediastinal or paratracheal lymph node.

2:02

So this can be a little bit complicated because we now

2:06

need to make an assessment as to whether we think this

2:08

lymph node is related to the esophageal malignancy or

2:15

alternatively, the much larger piriform sinus malignancy.

2:21

We will formally stage this tumor in a subsequent vignette.

2:25

But for the purposes of the discussion now,

2:29

it is important to remember to look for other

2:31

tumors when assessing a piriform sinus tumor.

2:35

And to be aware that the nodal spread is wide and not

2:40

uncommonly involves levels 2, 3, and 4 bilaterally.

2:47

And keep in mind that level 7, the superior

2:50

mediastinum, must be part of your checklist

2:52

because regional lymph nodes can spread there.

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

Hypopharyngeal SCC - Nodal Drainage