Glottic SCC: T Staging
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Hello everyone.
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Dr. Sidney Levy, continuing our discussion of the
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staging of laryngeal squamous cell malignancy.
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I'd like to now formally stage our example case of this
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large transglottic, uh, laryngeal squamous cell carcinoma.
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So we've decided in a previous vignette that
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this, uh, tumor is centered on the glottis with
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spread to the supraglottis and to the subglottis.
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Therefore we will use the staging for
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glottic laryngeal squamous cell carcinoma.
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Unlike pharyngeal squamous cell carcinoma,
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the dimensions of the tumor are less important, but should
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nevertheless be measured and quoted in the report.
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Key features which help us stage this tumor are
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the status of soft tissue planes in the supraglottis
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and the status of the thyroid cartilages.
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So in this case, at the level of the vocal cords,
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we can no longer distinguish normal arytenoid cartilages.
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So that's the first thing that I can see here.
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There should be two normal arytenoid
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cartilages here; they are not present.
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At the same level, there is invasion of both the
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inner and outer cortex of the thyroid cartilages.
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This is all abnormal soft tissue tumor,
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all abnormal laryngeal malignancy.
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And indeed, it has taken over
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the arytenoid cartilages as well.
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So based on that knowledge, we already know
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that this tumor is moderately advanced.
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And the reason we know is that it has invaded
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the outer cortex of the thyroid cartilage.
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Possibly also invaded the strap musculature
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overlying that in the anterior neck.
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The only decision that remains for T staging
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is, is it very advanced local disease?
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Does it invade the prevertebral space?
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Does it encase the carotid artery?
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Does it invade the mediastinum?
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It does none of those things,
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so therefore this tumor is a T4A tumor.
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You need to also mention that it is moderately
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to markedly narrowing the airway at this level.
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So there is the potential for an acute emergency.
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And also it is a primarily right-sided
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tumor, but well and truly crossing the
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midline with marked left-sided involvement.
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Whilst the tumor is closely abutting the cricoid cartilage
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inferiorly, it is difficult to say whether it is
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eroded, because we can actually see thyroid
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cartilage on the T2 which is intact, but there is
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some evidence of infiltration on the T1-weighted
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imaging which is likely not partial voluming.
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So, definitely involving thyroid and arytenoid
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cartilages, possibly involving cricoid cartilage as well.
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In our next vignette, we will discuss
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the N staging of this tumor.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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