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)

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

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

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

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

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

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

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

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

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 .

Supraglotic  Imagistic  Trasaturi generale   masa infiltrativa cu priza moderata de contrast la nivelul corzilor vocale false. 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 . pliu ariepiglotic si spatiile pre-epiglotic si paraglotic.Carcinom cu celule scuamoase .

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Carcinom cu celule scuamoase .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 .

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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 . 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.II.

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

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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.