Professional Documents
Culture Documents
Sanjay Munireddy
Sinai Hospital of Baltimore
June 24, 2008
Case Presentation
Pt is a 64 yo female, smoker, presented with
c/o difficulty in swallowing for 6 weeks; felt
something in the right side of throat when she
swallowed; also, c/o rt. ear pain, sore throat
and dysphagia for meat; no wt. loss or voice
change
PMH: Hypothyroidism, COPD, anxiety
PSH: CS x 3, TAH/BSO
MEDS: Synthroid, xanax
Case Presentation
Social Hx: 45 pack-years smoking, Alcohol in
the past
PE: level III group of LNs enlarged with the
largest LN about 3 cm
Work-up:
Laryngoscopy: showed supraglottic tumor,
ulcerated, friable; biopsy showed squamous cell
carcinoma
CT/PET: showed lesion in rt. vocal cord and rt
neck lymphadenopathy
Case Presentation
A/P:
Supraglottic squamous cell carcinoma with
LN metastases (T3N2Mx)
MRND followed by chemotherapy and
radiation therapy
Case Presentation
Operative Procedure
Direct pharyngolaryngoscopy
Rt. MRND
PEG placement
Mediport placement
Signs
Mass or ulceration in oral cavity or oropharynx, neck
mass, vocal cord paralysis, swallowing dysfunction
TNM Staging of
SCCHNN
Neck Metastases
Powerful adverse prognostic feature
Reduces survival by 50% in pts with
neck nodal metastases