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Glottic Laryngeal Squamous Cell Carcinoma


KEY FACTS

Terminology

  • Squamous cell carcinoma (SCCa) arising on mucosal surface of glottic larynx

  • Glottis = vocal cord + anterior & posterior commissures

Imaging

  • Imaging issues

    • Typically, diagnosis known at time of imaging following clinical exam

      • –

        Imaging important to assess supra- or subglottic extension, cartilage invasion, nodes

    • CECT/MR findings may be subtle if small tumor

    • CECT has fewer motion artifacts than MR

  • CECT findings

    • Enhancing infiltrative or exophytic glottic mass

    • Location: Anterior true vocal cord ± anterior commissure

    • Metastatic nodes uncommon, typically late

  • MR: Adjunctive role for cartilage invasion if CECT unsure

  • FDG avid on PET; reserved for late-stage tumors only

Top Differential Diagnoses

  • Gastroesophageal reflux disease

  • Laryngeal chondrosarcoma

  • Rheumatoid larynx

  • Laryngeal adenoid cystic carcinoma

Pathology

  • Strongly associated with tobacco & alcohol use

  • Keratinizing well- to moderately differentiated SCCa

Clinical Issues

  • Clinical presentation

    • Much more common in male patients; > 50 years

    • Often presents at low stage because of early presentation of persistent hoarseness or change in voice

  • Treatment options

    • T1: XRT or laser surgery; > 90% 5-year survival

    • T4: Laryngectomy + XRT vs. chemoradiation therapy; 30-60% 5-year survival rate

Axial CECT shows an enhancing right true vocal card (TVC) exophytic mass
. Anterior and posterior commissures are normal. The right arytenoid cartilage sclerosis
is nonspecific and may be either perichondritis from edema or tumor invasion. Diagnosis was T1a tumor.

Axial CECT reveals SCCa involving the entire left true TVC, anterior commissure
, and anterior 1/3 of right cord
. Left arytenoid
and thyroid cartilages are sclerotic but without destruction or cartilage penetration. This is T1b tumor by imaging.

Axial CECT shows bulky, ulcerated anterior SCCa involving both vocal cords and anterior commissure
. Both anterior thyroid cartilages are sclerotic with erosion of the inner cortex
, upstaging the tumor to T3.

Axial T1WI C+ FS MR in a patient previously treated for right TVC SCCa and biopsy-proven recurrence shows an enhancing tumor involving the right cricoid cartilage
, penetrating through thyroid cartilage
to the right strap muscles
. Diagnosis was T4a tumor.

TERMINOLOGY

Abbreviations

  • Glottic squamous cell carcinoma (G-SCCa)

Definitions

  • SCCa arising on mucosal surface of glottic larynx

    • Glottis = vocal cord + anterior & posterior commissures

IMAGING

General Features

  • Best diagnostic clue

    • Enhancing irregular true vocal cord (TVC)

  • Location

    • Most often anterior TVC & anterior commissure

    • Posterior commissure SCCa less common

  • Size

    • Isolated glottic SCCa usually small as present clinically early

  • Morphology

    • Invasive or exophytic TVC mass

Radiographic Findings

  • Radiography

    • May see asymmetric soft tissues on AP soft tissue neck plain films

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