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)

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

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

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

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

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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. cu priza intensa de contrast .

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fara priza de contrast.I. 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 .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. cu densitati negative (-65 . Tumori benigne .

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

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

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

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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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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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. 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.

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

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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)  .