High-technologic methods of laryngeal cancer diagnostics: a clinical case

Summary. The article observes the possibilities of high-technologic radiologic methods for diagnostics of laryngeal malignancy. Despite of large amount of publications, dedicated to the question of different radiologic imaging modalities application for laryngeal tumors the aspects of complex radiological examination and highly differentiated laryngeal tumors detection are not well described.

Materials and methods. In our article there is the case of diagnostic process in 56-years old male patient complained on voice changes with the right vocal fold neoplasm detected in laryngeal videoendoscopy, which had ambiguous pattern in autofluorescence. The results of laryngeal videoendoscopy included differently colored zones from white ones, which corresponded to benign tissue, to blue and violet ones, which corresponded to malignancy. The patient was examined with contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging with diffusion-weighted protocol and combined positron-emission and computed tomography with ¹⁸F-fluorodeoxyglucose.

Results. Computed tomography data showed the right vocal fold thickening without contrast agent uptake, on magnetic resonance images there was detected the irregular thickening of the same fold, also without contrast medium agent uptake. In positron-emission and computed tomography with ¹⁸F-fluorodeoxyglucose a focal radiotracer hypermetabolism with highly increased standard uptake value was detected, which indicated malignancy. In addition distant metastases in thoracic lymph nodes were found. Pathomorphologic diagnosis of high-differentiated laryngeal cancer was established.

Discussion. Highly differentiated laryngeal malignant tumors can imitate benign process on computed tomography and magnetic resonance imaging because of peculiar cell composition, but they are characterized with ¹⁸F-fluorodeoxyglucose hyperfixation conditioned by glycolytical activity of malignant cells. Negative computed tomography and magnetic resonance imaging data in combination with positive positron-emission and computed tomography results may correspond to highly differentiated laryngeal tumor.

1. Malignant tumors in Russia, еds. A.D. Kaprin, V.V. Srarinsky, G.V. Petrova Moscow: Publishing house MNIOI of P.A. Gertsen, 2018, 250 p. (In Russ.).

2. Remacle M., Eckel H.E. Surgery of larynx and trachea. Transl. into Russ. Moscow: Publishing house Binom, 2014, 368 p. (In Russ.).

3. Paches A.I. Tumors of head and neck. Moscow: Publishing house Medicina, 2000. 480 p. (In Russ.).

4. Rostovtsev M.V., Karmazanovsky G.G., Litvinenko I.V. Imaging of laryngeal cancer (tactics, difficulties, pitfalls). Moscow: Publishing house Vidar, 2013, рр. 47-70 (In Russ.).

5. Speranskaya A.A., Cheremisin V.M. Computed tomography of throat, maxillofacial and laryngeal tumors. Saint Petersburg: Publishing house ELBI-SPb, 2005, рр. 10-40 (In Russ.).

6. Berkiten G. et al. Comarison of magnetic resonance imaging findings with postoperative histopathologic results in laryngeal cancers // Kulak. burun. bogaz. ihtis. derg. 2002. Vol. 9, No. 3. P. 203-207.

7. Hafidh M.A. et al. Evaluation of the impact of addition of PET to CT and MR scanning in the staging of patients with head and neck carcinomas // Eur. arch. otorhinolaryngol. 2006. Vol. 263. P. 853-859. DOI: 10.1007/s00405-006-0067-1.

8. Muylle K., Castaigne C., Flamen P. 18F-fluoro-2-deoxy-D-glucose positron emission tomographic imaging: recent developments in head and neck cancer // Curr. opin. oncol. 2005. Vol. 17, No. 3. P. 249-253. DOI: 10.1097/01.cco.0000160276.78762.17.

9. Porceddu S.V. et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after chemo-radiotherapy in head and neck cancer // Head neck. 2005. Vol. 27. P. 175-181. DOI: 10.1002/hed.20130.

10. Roh J.L. et al. 2-[18F]-Fluoro-2-deoxy-Dglucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx // Eur. surg. oncol. 2007. Vol. 33, No. 6. P. 790-795. DOI: 10.1016/j.ejso.2007.01.002.

11. Wong R.J. et al. Diagnostic and prognostic value of [(18)F] fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma // J. clin. oncol. 2002. Vol. 20. P. 4199-4208. DOI: 10.1200/JC0.2002.02.590.