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Laringe

Laringe

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Tumori laringe
Tumori laringe

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Published by: danielageorgiana on Jan 26, 2013
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09/14/2013

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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)

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

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

. similare unor negi.I.Papilom   Infectie HPV Tipuri   Juvenila – se caracterizeaza prin leziuni multiple. 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). Tumori benigne .

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

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cu priza intensa de contrast .I. 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.

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I.-125UH) IRM – semnal asemanator grasimii subcutanate (hiperintens T1. cu densitati negative (-65 . intensitate foarte joasa in T1 cu supresie de grasime) CT+IRM = diagnostic definitiv . descreste intensitatea in T2. Tumori benigne .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. fara priza de contrast.

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cu ritm scazut de crestere  Diagnosticul= endoscopie + histopatologie +/. 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)  .

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

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

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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dar trebuie confirmat cu biopsie .II. 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. 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.

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Tumori maligne  Adenocarcinomul. rinichi.II. prostata. colon. stomac si ovar caracteristici imagistice nespecifice . san. plaman. 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).

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conduita terapeutica)  Biopsie (pentru confirmarea diagnosticului)  . recidiva.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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