Tumorile laringelui

Dr. Mugur Grasu Elena Turiac

Clasificare
I Tumori benigne
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- reprezinta ~10% din toate tumorile laringelui

papiloame (cele mai frecvente 85%, HPV) - fibroame, angiofibroame, fibromixom - adenoame (rare) - tumori miogene, lipoame, hemangioame, condroame, fibroneuroame (foarte rare) II Tumori maligne - Epiteliale (carcinomul cu celule scuamoase, carcinomul anaplastic, adenocarcinomul, carcinomul adenoid chistic, carcinomul mucoepidermoid, carcinomul cu celula acinica, melanomul malign) - Tesut conjunctiv (fibrosarcom, liposarcom, sarcom osteogenic, condrosarcom, leiomiosarcom, rabdomiosarcom, angiosarcom, limfom Hodgkin si non-Hodgkin, tumori neurogene)

 . durere. hemoptizie etc. stridor. dispnee.Simptomatologie Mici = asimptomatice  Mari = raguseala. tuse.

Investigatii Endoscopie  CT  MRI  PET CT  histopatologic  stadializare. detectarea recidivei .

Papilom   Infectie HPV Tipuri   Juvenila – se caracterizeaza prin leziuni multiple. similare unor negi. Tumori benigne . extinse uneori la trahee si eventual cu determinari pulmonare sub forma de noduli multipli Adulta – se prezinta sub forma unor leziuni unice   Excrescente nodulare la nivelul corzilor vocale adevarate si false Imagistic – nespecific (contur nodular ce proemineaza in caile respiratorii aeriene). .I.

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Tumori benigne .I. atat imagistic. cat si histologic  Intereseaza frecvent cricoidul care apare expandat.Condrom Tumori cartilaginoase rare. greu de diferentiat de condrosarcoame. cu multiple calcificari  Imagistic  – masa hipodensa spontan cu matrice condroidala  IRM – masa hipersemnal T2  CT .

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Tumori benigne – Hemangiom   Foarte rare cazuri raportate in literatura de specialitate Tipuri  Infantila   frecvent subglotic uneori se asociaza cu hemangioame cutanate mai rare ca tipul infantil poate aparea oriunde la nivelul laringelui frecvent sub forma cavernoasa  Adulta     Imagistic   CT – priza intensa de contrast IRM – hipersemnal T2.I. cu priza intensa de contrast .

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descreste intensitatea in T2. intensitate foarte joasa in T1 cu supresie de grasime) CT+IRM = diagnostic definitiv .Lipom    Frecvent la nivelul regiunii supraglotice Tumori mobile ce pot proemina in trahee sau esofag Imagistic     Edoscopic – masa sesila sau polipoida la nivelul submucoasei CT – leziune omogena.-125UH) IRM – semnal asemanator grasimii subcutanate (hiperintens T1. fara priza de contrast. Tumori benigne .I. cu densitati negative (-65 .

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bine definit.TAKE HOME POINT Leziunile benigne ale laringelui sunt rare si au un aspect neinvaziv.CT/IRM (in cazurile in care nu se poate face diferentierea intre benign vs malign)  . cu ritm scazut de crestere  Diagnosticul= endoscopie + histopatologie +/.

Tumori maligne – Carcinom cu celule scuamoase Reprezinta 75% din totalul tumorilor maligne  Clasificare     Spraglotic Glotic Subglotic .II.

 T2: Tumour extends to supraglottis and/or subglottis.  T3: Tumour limited to larynx with vocal cord fixation.  T0: No evidence of primary tumour. strap muscles. soft tissues of neck. trachea. including deep extrinsic muscle of the tongue. Regional Lymph Nodes (N)  NX: Regional lymph nodes cannot be assessed (eg. 3 cm or less in greatest dimension. thyroid.  T2: Tumour extends to vocal cord(s) with normal or impaired mobility.  T3: Tumour limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area.  T4a: Tumour invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.  T3: Tumour limited to the larynx with vocal cord fixation and/or invades paraglottic space. strap muscles.  M1 Distant metastasis.g. infrahyoid epiglottis.. suprahyoid epiglottis. Distant Metastasis (M)  MX Distant metastasis cannot be assessed. mucosa of base of tongue. or esophagus). more than 3 cm but not more than 6 cm in greatest dimension. arytenoids.  N3: Metastasis in a lymph node more than 6 cm in greatest dimension.g. including deep extrinsic muscles of the tongue.. or invades mediastinal structures Subsites include the following: ventricular bands (false cords).. . or in bilateral or contralateral lymph nodes. Previously removed).The American Joint Committee on Cancer (AJCC) has designated clinical staging using the TNM classification as documented below TNM Staging of Layngeal Cancer  • Primary Tumour (T)  TX: Primary tumour cannot be assessed. none more than 6 cm in greatest dimension. and/or invades tissues beyond the larynx (e. paraglottic space. or esophagus). inner cortex)..g. encases carotid artery. and/or minor thyroid cartilage erosion (e. inner cortex).  T2: Tumour invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e. or invades mediastinal structures. or in multiple ipsilateral lymph nodes.  T4b: Tumour invades prevertebral space.  N1: Metastasis in a single ipsilateral lymph node. pre-epiglottic tissues. thyroid.  T4a: Tumour invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.  Tis: Carcinoma in situ Supraglottis  T1: Tumour limited to one subsite of supraglottis with normal vocal cord mobility. trachea.g. none more than 6 cm in greatest dimension. strap muscles.  N0: No regional lymph node metastasis. medial wall of pyriform sinus) without fixation of the larynx.g.  M0 No distant metastasis.g.  T4b: Tumour invades prevertebral space.. thyroid. vallecula. aryepiglottic folds (laryngeal aspect).  T4b: Tumour invades prevertebral space. soft tissues of neck. encases carotid Subglottis  T1: Tumour limited to the subglottis. trachea. and/or minor thyroid cartilage erosion (e. encases carotid artery. and/or with impaired vocal cord mobility.  T4a: Tumour invades through the thyroid cartilage.. or esophagus). soft tissues of the neck including deep extrinsic muscle of the tongue. Glottis  T1: Tumour limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility.  N2: Metastasis in a single ipsilateral lymph node.

STAGE GROUPING 0 I T Tis T1 N N0 N0 M M0 M0 II III IV a IV b IV c T2 T3 T1-T3 T4a T1-T4a T4b Any T Any T N0 N0 N1 N0-1 N2 Any N N3 Any N M0 M0 M0 M0 M0 M0 M0 M1 .

Carcinom cu celule scuamoase .Supraglotic  Imagistic  Trasaturi generale   masa infiltrativa cu priza moderata de contrast la nivelul corzilor vocale false. pliu ariepiglotic si spatiile pre-epiglotic si paraglotic. ce asociaza adenopatii maligne dimensiuni variabile asimetrie tisulara supraglotica cu efect de masa scleroza cartilagiului priza moderata de contrast hipo-izosemnal T1 hipersemnal T2 T1 C+ cu priza omogena sau heterogena de contrast activitate crescuta la nivelul tumorii  CT     IRM     PET   Diagnostic diferential      laringocel artrita reumatoida laringiana sarcoidoza laringelui condrosarcom carcinomul adenoid chistic .

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Glotic  Imagistic  Trasaturi generale   masa invaziva la nivelul corzilor vocale adevarate dimensiuni variabile – deobicei mici cand sunt detectate asimetrie tisulara la nivelul corzilor vocale adevarate masa infiltrativa sau vegetanta cu priza de contrast hipo-izosemnal T1 hipersemnal T2 T1 C+ cu priza omogena de contrast activitate crescuta anormala la nivelul tumorii  CT    IRM     PET   Diagnostic diferentiat     artrita reumatoida laringiana sarcoidoza laringelui condrosarcom carcinomul adenoid chistic .Carcinom cu celule scuamoase .

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Subglotic  Imagistic  Trasaturi generale   masa invaziva cu priza de contrast centrata subglotic si deasupra marginii inferioare a cartilajului cricoid dimensiuni variabile densitate tisulara proeminenta in caile respiratorii de la nivelul cartilajului cricoid masa infiltrativa sau vegetanta cu priza de contrast hipo-izosemnal T1 hipersemnal T2 T1 C+ cu priza heterogena de contrast activitate crescuta la nivelul tumorii  CT    IRM     PET   Diagnostic diferential     artrita reumatoida laringiana modificari post-traumatice condrosarcom carcinomul adenoid chistic .Carcinom cu celule scuamoase .

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II. Tumori maligne – Condrosarcom  Imagistic  Trasaturi generale   masa expansiva cu calcificari arciforme sau inelare ce se intinde la nivelul cartilajului laringian cu suprafata mucoasei intacta dimensiuni 1 – 6 cm   CT  masa hipodensa spontan. cu priza moderata de contrast izosemnal fata de muschi in T1 hipersemnal T2 hipersemnal STIR T1 C+ cu priza heterogena de contrast IRM      Diagnosticul poate fi suspectat pe CT sau IRM. dar trebuie confirmat cu biopsie .

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stomac si ovar caracteristici imagistice nespecifice .II. prostata. Tumori maligne  Adenocarcinomul. colon. rinichi. carcinomul adenoid chistic si carcinomul mucoepidermoid    apar la nivelul glandelor salivare minore nu pot fi diferentiate imagistic de carcinomul cu celule scuamoase diagnostic = biopsie   Liposarcomul – lipom cu zone tisulare cu prize de contrast Metastazele   piele (melanom). plaman. san.

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recidiva. conduita terapeutica)  Biopsie (pentru confirmarea diagnosticului)  .TAKE HOME POINT Leziunile maligne au caracter invaziv  Fumatul + alcoolul = factori de risc  Implica cel mai frecv regiunea glotica  Endoscopia (depisteaza)  CT/IRM/PET CT (stadializare.

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