Professional Documents
Culture Documents
ABSTRACT
Metastatic tumors of the larynx are rare. The most common tumors metastasizing to the larynx are melanoma and renal
cell carcinoma. Bronchogenic carcinoma metastasizing to the larynx has been rarely described. Herein, we report the
case of a 49‑year‑old, chronic smoker, who incidentally had a laryngeal growth detected during flexible bronchoscopy
examination for evaluation of suspected lung cancer. Histopathological examination of the laryngeal nodule and the
biopsy obtained from the main bronchus growth confirmed the diagnosis of metastatic squamous cell carcinoma to the
larynx from primary lung cancer.
KEY WORDS: Carcinoma, laryngeal neoplasms, lung cancer, metastasis, squamous cell
Address for correspondence: Dr. Anant Mohan, Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi ‑ 110 029, India. E‑mail: anantmohan@yahoo.com
endobronchial growth demonstrated squamous cell as these sites have a rich lymphatic and vascular supply.
carcinoma (moderately differentiated) [Figure 2, Right In our patient, the location of the metastatic laryngeal
Panel]. An immunohistochemical examination for nodule was supraglottic. The pathway for primary
TTF‑1 (thyroid transcription factor 1) expression was pulmonary tumor metastasis to the larynx could be either
negative on both the histopathological specimens. hematogenous or via lymphatics. A hematogenous spread
may occur in an orderly fashion from the right heart to the
Keeping a diagnosis of non‑small cell (squamous) carcinoma left heart, coursing through the aorta and external carotid
of the lung (Stage IV), with asymptomatic laryngeal artery before eventually reaching the larynx through
metastasis, treatment was initiated with platinum‑based the upper thyroid artery and upper laryngeal artery.
doublet chemotherapy (Paclitaxel with Cisplatin) in view A retrograde route is also possible via the vertebral venous
of the metastatic disease. No specific intervention was plexus.[1] Retrograde lymphatic spread to the supraglottic
performed for the laryngeal nodule. However, the patient larynx from the thoracic duct can occur via the left
declined further chemotherapy following two cycles of supraclavicular and internal jugular chain nodes. There
chemotherapy and was lost to follow‑up. are lymphatic vascular interconnections of the lymphatics
of the supraglottic space, which communicate with the
DISCUSSION superior laryngeal vessels.[4]
Ferlito et al., in 1993, reported 134 cases of secondary/ Signs and symptoms of metastatic laryngeal tumors do not
metastatic laryngeal tumors.[1] The most common primary differ from primary laryngeal tumors and vary according
site in metastatic laryngeal tumors was malignant to the site and the size of involvement. Large‑sized lesions
melanoma followed by renal cell carcinoma.[2] The other can lead to significant upper airway obstruction. Our
reported sites included the breast, lung, prostate, colon, patient was asymptomatic for the laryngeal growth and
stomach, and ovary. Laryngeal metastasis from lung cancer it was incidentally detected during bronchoscopy. This
is rarely described. Till the year 1996, only 16 cases of finding highlights the importance of performing a flexible
metastatic laryngeal tumors from primary lung cancer had bronchoscopy examination in patients with lung cancer as
been reported.[2] part of the staging evaluation, as it enables identification
of radiologically normal sites of malignant involvement,
Larynx is a terminally located organ with regard to as in our patient. Metastasis from bronchogenic carcinoma
lymphatic and vascular circulation.[3] This fact likely can be clinically silent or may be the presenting
explains why it is a rare site of metastases from tumors manifestation.[5] No other site of metastasis has been
at other primary sites. The supraglottic and subglottic detected in the present case on the CECT scan of the thorax
regions are the common locations for laryngeal metastases, and abdomen. A positron emission tomography (PET)
computed tomography (CT) scan was not performed in
view of the advanced nature of the disease and no surgical
intervention was being contemplated. Patients with lung
cancer, especially the small cell variant, can have small
asymptomatic primary tumors that can be associated with
extensive symptomatic systemic metastatic involvement.[6]
Figure 2: (Left panel) Flexible bronchoscopy image showing the presence of a nodular supraglottic growth on the inferior surface of the epiglottis,
just above the normal glottic opening. Histopathological examination of the bronchoscopic biopsy obtained from the laryngeal (middle panel) and
main bronchus growth (right panel) confirms the diagnosis of squamous cell carcinoma (Hematoxylin and Eosin ×100)