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)

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

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

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

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

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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 . Tumori benigne .I. 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.-125UH) IRM – semnal asemanator grasimii subcutanate (hiperintens T1. 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)  .

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

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

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 . 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 .Supraglotic  Imagistic  Trasaturi generale   masa infiltrativa cu priza moderata de contrast la nivelul corzilor vocale false.

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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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Carcinom cu celule scuamoase .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 .

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dar trebuie confirmat cu biopsie . 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. 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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II. prostata. 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. rinichi. colon. san. Tumori maligne  Adenocarcinomul. stomac si ovar caracteristici imagistice nespecifice .

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

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