sinus piriform 2012.pptx
TRANSCRIPT
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TUMORI DE SINUS PIRIFORM
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ETIOPATOGENIE 95% - carcinoame scuamoase
Factori de risc: Alcool, fumatRadioterapia
ClinicDurere: iradiaza prin n laringeu intern – n vag – n
auricular – canal auditiv extern (CAE) – otalgieAdenopatii – 75%Tu sincrone – 25%Tu metacrone – 40%Sdr. Plummer Vincent – in tumorile post-cricoidiene:
Anemie, slabire, disfagie , membrane in HP sau esofag
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Examinarea imagistica
Au origine in submucoasa si nu sunt aparente la debut clinic, endoscopic sau CT
Imagistica: are un rol f. important pentru stadializare – CT si MRI acuratete de 80% in stadializare si clinica doar in 58%
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Examinarea CT
Protocol In decubit dorsal, capul in hiperextensie, plan axial paralele cu CV, Grosimea sectiunilor: 3mm , Regiunea examinata: pana la baza
craniului pentru adenopatii RF (daca e peretele posterior prins)
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Tumorile peretelui lateral al SP
Extindere:
Partea posterioara a cartilajului tiroid
Latero-cervicalSpatiul paragloticCV
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Tu perete lateral SP drept: Extinsa in spatiul paraglotic drept , partea posterioara a cartilajului tiroid si CV dreapta
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TU SP extinsa latero-cervical
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Tumorile peretelui medial al SP
Extindere:
Invadeaza rapid laringele – CV fixate, BV, spatiul pre-epiglotic
Contralateral in 87% din cazuri
Extindere submucozala
Extindere perineurala (45%)
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Tu perete medial al SP stang
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Tu perete medial al SP stang
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Extindere contralaterala
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Extindere la Apexul SP stang
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Tu perrete medial cu invazia laringelui
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Tumorile regiunii post-cricoidiene
Extindere:
Partea posterioara a laringelui - ○ clinic: pareza CV si
ragusealaSe dezvolta postero-
lateral spre SP (100%)
Traheea si Esofagul (71%) – nu se vede endoscopic
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Tu postcricoidiana cu invazia esofagului cervical si a traheei
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Tu regiune postcricoidiana cu extindere latero-faringiana si invazia portiunii posterioare a CV
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Tumorile peretelui posterior Extindere:
Extindere craniocaudala – de la RF la Esofag
Pilieri posteriori
Fascia prevertebrala – CT se vede doar in 50% din cazuri
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TU perete posterior SP cu extindere orofaringe, baza limbii si in pilierul posterior
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Acelasi caz, extindere tu. Parafaringiana si invazia spatiului prevertebral ;
invazia anterioara a laringelui.
Invazia cartilajului cricoid
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Tumorile circumferentiale SP
perete posterior HP m cricofaringean esofagul cervical
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TUMORI SINCRONE: orofaringe stang si sinus pririform drept
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Imaging checklist
chirurgie radioterapie
Linia mediana Apexul SP Esofagul Cartilaje Spatiul paraglotic Exo-laringean M. paravertebrala
Dimensiuni Apex Cartilaj
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Stadializare – AJCC, 1997
Tis – in situ T1 - <=2cm, limitata la o regiune a HP T2 – 2-4cm, limitata la 1-2 regiuni a HP,
fara fixare de hemilaringe T3 – tu>4cm, fixare de hemilaringe T4 – invazie de : tiroid, cricoid, AC, tes.
Laterocervicale, m preveretebrali, tiroida, esofag