Supraglottic Laryngeal SCCa

Patricia A. Hudgins, MD

Key Facts

Terminology

Mucosal SCCa arising in supraglottic (SG) larynx

Imaging

CECT: Moderately enhancing mass arising from mucosa of supraglottis subsite
- Epiglottis, AE fold, or false vocal cord
Look for preepiglottic & paraglottic space involvement with tumor = T3 disease
Look for cartilage erosion; describe if inner cortex (T3) or through cartilage (T4)
Cartilage sclerosis is nonspecific, may be perichondritis from adjacent tumor
Look carefully for extralaryngeal extension to surrounding soft tissues (T4)
Nodes frequent; 1st nodal station is level II
Epiglottis SCCa frequently drains bilaterally

Top Differential Diagnoses

Laryngocele
Gastro-esophageal reflux
Rheumatoid larynx
Laryngeal sarcoidosis
Laryngeal adenoid cystic carcinoma

Clinical Issues

Sore throat, dysphagia, referred ear pain
May present with metastatic nodes as neck mass
Typical patient is 50-60-year-old man with history of tobacco & alcohol abuse
5-year survival rate = 75% for all SG-SCCa

Diagnostic Checklist

Always search for 2nd primary in patient with tobacco/alcohol history

(Left) Coronal graphic shows T4 supraglottic SCCa involving left false vocal cord and AE fold

with invasion of thyroid cartilage

. Only mucosal portion

of tumor is visible on endoscopy. Submucosal extent and cartilage invasion, which are only seen on imaging, are key to staging. (Right) Axial CECT shows similar findings with invasion of bilateral paraglottic fat

and left aryepiglottic (AE) fold

. Tumor bulges through thyroid cartilage notch

. Pyriform sinus

is normal.

(Left) Axial CECT shows small epiglottic mass

, staged as T3 because of preepiglottic space invasion

. Mass is symmetric, making it difficult to appreciate; however, epiglottis should never appear this thick or enhancing. No nodes are evident, but search must be bilateral, especially with epiglottic tumors. (Right) Axial CECT shows small T1 posterior laryngeal SCCa with small mass on left aryepiglottic fold

. Left pyriform sinus is collapsed

, but no tumor is present in hypopharynx.

TERMINOLOGY

Abbreviations

Supraglottic squamous cell carcinoma (SG-SCCa)

Synonyms

SCCa of epiglottis, aryepiglottic (AE) folds, false vocal cords

Definitions

SCCa originating on mucosa of any part of supraglottic larynx
- SG subsites: Epiglottis, AE folds, & false cords
- SG deep spaces: Preepiglottic space (PES) & paraglottic space (PGS)

IMAGING

General Features

Best diagnostic clue
- Moderately enhancing, infiltrating mass of epiglottis, AE fold, or false vocal cord often with associated malignant adenopathy
Location
- Any portion of larynx from hyoid to laryngeal ventricle
Size
- Variable, larger than glottic or subglottic SCCa in most cases because detected later
Morphology
- Moderately enhancing mass invades deep tissues of larynx, including PES ± PGS
- Advanced tumors: Laryngeal cartilage destruction ± malignant nodes