Presentation
Presented with left sided throat and neck pain for 6 months radiating to the left ear, odynophagia and dysphagia.
Patient Data
Heterogeneously enhancing hypopharyngeal mass with maximum dimension of approximately 3.2 cm extending from the level of the epiglottis to the subglottic level. The cricoid bone is normal.
There is involvement of aryepiglottic folds with obliteration of bilateral pyriform sinuses (left >right). There is infiltration of the left side of the epiglottis with partial effacement of pre-epiglottic fat. Inferiorly, the tumor infiltrates the left side of the vocal cord and posterior commissure with effacement of paraglottic fat. Posteriorly, retropharyngeal space is effaced, however no infiltration of prevertebral muscles. There is minimal extension inferiorly to the left subglottic level.
There is significant airway narrowing at the level of the vocal cord.
The left arytenoid and left side of the cricoid cartilage appear sclerosed, suspicious of involvement. Thyroid cartilage is preserved. No extension into adjacent carotid space.
Cervical esophagus appears edematous.
Multiple enlarged cervical lymph nodes at stations at 1A, 1B, 2A, 2B, 3, 4, 5 (left > right), and left retropharyngeal region. Largest node at 1A measuring 1.2 cm in diameter.
Naso- and oropharynx are normal.
Histopathology report of left arytenoid shows squamous cell carcinoma. The p16 immunohistochemistry is negative.
Case Discussion
Radiological study shows heterogeneously enhancing hypopharyngeal mass with extension as described above, causing airway narrowing and regional cervical lymph nodes involvement
Flexible scope shows mass occupying the left arytenoid and left aryepiglottic fold. Unable to localize the left vocal cord. The patient also has a pooling of saliva.
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