Subglottic Carcinoma: Review of a Series and Characterization of its Patterns of Spread

Abstract

The rarity of primary subg lottic malignan cies, along with the varied definitions of the anat omi c confines of this region, have lim ited our und erstanding ofthe pa tte rns of tum or spread within the subglottis. We conducted a retrospective chart review to analyze clinical and pathologic data in pa tients with subglottic carcinoma. A patt ern of disease progressi on was ident ified, whic h is defin ed by the cartilaginous laryngealfra mework, with thefib roelastic barriers susceptible to tumor invasion. We conclude that although cartilaginous laryngeal structures are preserved until late in the disease course, the ability of tumo rs to invade the fi broe lastic membran es provides them with an insidi ous means of escape. Specifically, tumor progression occurs primarily within the paraglottic space and extralaryn geal compartments; the potential for mu cosal spre ad is limit ed. The lack of 1/1lIcosal disease in patients whose cartilagi nous laryngeal structures are inta ct may present afacad e ofnormality in patients with ad vanced disease, and perhaps delay the early diagnosis of subglott ic malignancies by ph ysical and radiologic examination.

Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma

“…The bulk of invasive carcinoma was found to penetrate through gaps between tracheal rings, respecting the boundaries of the cartilaginous framework. The majority of spread was found to be through the paraglottic space into the region bounded medially by the conus elasticus and laterally by the laryngeal cartilages …”

“…Studies have indicated that subglottic tumors frequently involve the paraglottic space, increasing likelihood of extra laryngeal spread . Brennan et.…”

Advanced larynx cancer

“…Our approach to advanced SCCA of the subglottic larynx is to initially secure the airway and to accurately stage the lesion. Staging can be difficult (our own studies demonstrate that seemingly early tumors can escape into the neck through the intercartilagenous tracheal spaces) [33]. In this setting, cartilage invasion might not be demonstrated on CT. After staging, these patients are generally offered an organ preservation approach.…”

Transcervical Conservation Laryngeal Surgery

“…Similarly, tumors were enabled to spread into the paraglottic space, in the region bounded medially by the conus elasticus and laterally by the laryngeal cartilages. 30 Furthermore, lymphatic drainage of the anterior subglottis traverses the cricothyroid membrane to reach pretracheal and prelaryngeal nodes. Posterolaterally, lymphatic drainage occurs through the cricotracheal membrane to paratracheal nodes.…”