Cargando…

The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer

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 treatm...

Descripción completa

Detalles Bibliográficos
Autores principales: Reimer, Camilla S, Dowdall, Jayme R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547017/
https://www.ncbi.nlm.nih.gov/pubmed/37795075
http://dx.doi.org/10.7759/cureus.44606
_version_ 1785114975980748800
author Reimer, Camilla S
Dowdall, Jayme R
author_facet Reimer, Camilla S
Dowdall, Jayme R
author_sort Reimer, Camilla S
collection PubMed
description 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. 
format Online
Article
Text
id pubmed-10547017
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-105470172023-10-04 The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer Reimer, Camilla S Dowdall, Jayme R Cureus Otolaryngology 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.  Cureus 2023-09-03 /pmc/articles/PMC10547017/ /pubmed/37795075 http://dx.doi.org/10.7759/cureus.44606 Text en Copyright © 2023, Reimer et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Otolaryngology
Reimer, Camilla S
Dowdall, Jayme R
The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title_full The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title_fullStr The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title_full_unstemmed The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title_short The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer
title_sort multimodal diagnostic approach necessary in detecting elusive submucosal laryngeal cancer
topic Otolaryngology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547017/
https://www.ncbi.nlm.nih.gov/pubmed/37795075
http://dx.doi.org/10.7759/cureus.44606
work_keys_str_mv AT reimercamillas themultimodaldiagnosticapproachnecessaryindetectingelusivesubmucosallaryngealcancer
AT dowdalljaymer themultimodaldiagnosticapproachnecessaryindetectingelusivesubmucosallaryngealcancer
AT reimercamillas multimodaldiagnosticapproachnecessaryindetectingelusivesubmucosallaryngealcancer
AT dowdalljaymer multimodaldiagnosticapproachnecessaryindetectingelusivesubmucosallaryngealcancer