PDF(Pubmed)
Abstract：
Submucosal laryngeal lesions have proven themselves to be a diagnostic challenge in the field of medicine, often presenting inconsistently between endoscopic visualization, various imaging modalities, and biopsy. The conflicting clinical picture can lead to a delay in definitive diagnosis and treatment. A variety of laryngeal imaging modalities exist that give a unique perspective of the tumor being evaluated and can be used in combination to clarify discrepancies in presentation. This report describes the clinical course of an undiagnosed laryngeal squamous cell carcinoma (SCC) presenting with persistent dysphonia, dysphagia, and unilateral vocal fold immobility. A negative head and neck computerized tomography (CT) scan reduced the concern for cancer, so symptomatic treatment with vocal fold augmentation was performed. Augmentation curiously worsened the dysphonia and also may have delayed the process of definitive diagnosis. Upon presenting to the laryngology clinic, stroboscopy demonstrated no vibration of the affected vocal fold. Submucosal vascular irregularity was noted with narrow band imaging with a very subtle keratotic mucosal change raising suspicion for underlying malignancy. Despite two CT scans that failed to visualize the lesion initially, a biopsy revealed keratinizing SCC, which was subsequently staged as T3N0M0. The patient elected to receive radiation therapy alone given his medical comorbidities. This case showcases the elusive ability submucosal laryngeal cancers have in diagnostic workups. Heavy reliance on any single diagnostic modality may be misleading, resulting in delayed diagnosis and treatment. An early, thorough, and multimodal approach that analyzes the cumulative results of a variety of diagnostic tools is essential in identifying and treating these elusive cancers in a timely manner.
摘要：
喉粘膜下病变已被证明是医学领域的诊断挑战，通常在内窥镜可视化之间表现不一致，各种成像模式，还有活检.相互矛盾的临床表现可能导致最终诊断和治疗的延迟。存在多种喉部成像方式，这些方式可以提供所评估肿瘤的独特视角，并且可以组合使用以澄清表现上的差异。本报告描述了未诊断的喉鳞状细胞癌（SCC）的临床过程，表现为持续的发声障碍，吞咽困难,和单侧声带不动。阴性的头颈部计算机断层扫描（CT）扫描减少了对癌症的关注，因此进行了声带增强的对症治疗。增强功能使发音困难恶化，也可能延迟了明确诊断的过程。到喉科诊所就诊后，频闪检查显示受影响的声带没有振动。窄带成像发现粘膜下血管不规则，并伴有非常细微的角化粘膜变化，怀疑潜在的恶性肿瘤。尽管两次CT扫描最初未能可视化病变，活检显示角质化SCC,随后上演为T3N0M0。考虑到他的医疗合并症，患者选择单独接受放射治疗。此病例展示了粘膜下喉癌在诊断检查中难以捉摸的能力。严重依赖任何单一的诊断方式可能会产生误导，导致延误诊断和治疗。很早,彻底,分析各种诊断工具的累积结果的多模式方法对于及时识别和治疗这些难以捉摸的癌症至关重要。
