Presentation
2/52 of dysphagia, weight and dysphonia. Lifelong smoker. Gastroscopy revealed pharyngeal lesion.
Patient Data
Age: 80
Gender: Male
From the case:
Oro-hypo-pharyngeal squamous cell carcinoma
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- Large soft tissue heterogenous mass extends from the level of the right lingual tonsil, involves the right vallecula, the epiglottis and the right piriform sinus. Given the size and extent of lesions exact site of origin is difficult to ascertain.
- The lesion crosses the midline at the level of the oropharynx with abnormal pharyngeal mucosal soft tissue involving false cords bilaterally.
- It exerts mass effect with narrowing of the oro- and hypopharynx, with the in-situ nasogastric tube displaced towards the left. The airways at the level of the hypopharynx are markedly narrowed.
- Invasion of the pre-epiglottic fat and aryepiglottic folds/paraglottic fat bilaterally.
- The right thyroid cartilage has a permeative appearance inferiorly, with abnormal soft tissue its superficial surface. The thyroid gland is mildly enlarged and heterogeneous in appearance.
- Lympadenopathy:
- Two right level 2A nodes are necrotic measuring up to 9.7mm in diameter.
- Left level 2B node is abnormal and located immediately posterior to the left internal jugular vein, with low density centrally.
Case Discussion
Case contributed by Dr Smita Deb & A/Prof Pramit Phal
This is a right oro-hypo-pharyngeal SCC with supra-glottic involvement.
Hypopharyngeal sub-sites: pyriform sinuses, lateral and posterior hypopharyngeal walls, postcricoid region.
Staging:
- T2: invasion of >1 hypopharyngeal sub-site/adjacent site + tumor <4cm and NO fixation of the hemilarynx or invasion of thyroid/cricoid cartilage.
- N2: metastasis in bilateral lymph nodes <6cm.
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