Archives of Otol

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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada

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Presentation: P096
Topic: Larynx/Oral Cavity
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: J R Cracchiolo, title, J S Khurana, title, J C Liu, title
Institution(s): Department of Otolaryngology Head and Neck Surgery, Temple University, Philadelphia, PA.

We present a case of a 28- year-old-male with an extremely destructive laryngeal cancer that involved all anatomic regions of the larynx. This patient presented to the emergency department with the chief complaint of a 100 pound weight loss and severe dysphagia that had progressed over 3 months. His history was significant for a 20 year tobacco history and a previous intubation for mental status changes secondary to a drug overdose 2 years previously. Physical examination was significant for extreme cachexia. Examination of the neck revealed no palpable landmarks, including lack of palpable thyroid and cricoid cartilages. Bedside flexible laryngoscopy revealed an inflamed cavity, void of any laryngeal structures with direct access into the trachea. CAT scan of the head, neck, chest, abdomen and pelvis showed significant subcutaneous emphysema and no identifiable laryngeal structures.
The patient underwent an awake tracheotomy secondary to respiratory distress soon after presentation. The procedure was complicated by bilateral pneumothoraces treated with bilateral chest tubes. After he was stabilized, a direct laryngoscopy and biopsy was performed. Examination showed no identifiable laryngeal structures and an ulcerated mucosa. Biopsy of the endolarynx revealed pathology consistent with squamous cell carcinoma. Further illustrating the extent of disease, thyroid tissue was also found within the endoscopic biopsy specimen. Percutaneous endoscopic gastrostomy tube could not be completed because the esophageal opening could not be identified. An open gastrostomy tube was performed. A PET/CT showed a large hypermetabolic mass that extended from the oropharynx down through the larynx into the hypopharynx and visceral space with direct extension into the thyroid gland. Activity was also seen in the right level 2 neck and contralateral level 5 neck lymph nodes. Final staging was T4N2cM0 squamous cell carcinoma of Larynx/Hypopharynx.
The patient was discussed at interdisciplinary head neck cancer tumor board, and underwent treatment with concurrent radiation and chemotherapy with cisplatin. The patient remains gastrostomy and tracheostomy tube dependent with no oral feeding. Future surgical plans include a laryngopharyngectomy with the goal of regaining of oral intake. He is currently with no evidence of disease on MRI and PET/CT 4 months after completion of treatment.
The extraordinary level of destruction of normal laryngeal/hypopharyngeal anatomy and young make this a very unusual case of an aggressive larynx cancer occurring decades below the median age of presentation.

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