Subglottik skuamöz hücreli karsinom

Özet

Primer subglottik skuamöz hücreli karsinom nadirdir; erken yakınmalar özgül olmayabilir ve lümen daralması ortaya çıkana kadar tanı gecikebilir. Kontrastlı boyun BT, subglottik duvar kalınlaşmasının krikoid çevresi, glottis ve servikal trakea boyunca uzunlamasına yayılımını gösterir. Kontrastlı BT, subglottik lezyonun krikoid kıkırdakla ilişkisini ve hava yolu daralmasını göstermede kullanılabilir. Laringeal kanserde kesitsel görüntüleme, tümör yayılımını ve kıkırdak tutulumunu değerlendirmeye katkı sağlar.

Okuma sırası

1. Subglottik hava yolu. Koronal planda subglottik hava yolunu ve vokal kıvrımlar, krikoid ile trakeal halkaların anatomik ilişkisini incele.
2. Subglottik lümen duvarı. Kontrastlı BT'de subglottik lezyonun glottise uzanımını ve hava yolu üzerindeki etkisini değerlendir.
3. Krikoid kıkırdak. Krikoid kıkırdak invazyonu bulgusu olup olmadığını değerlendir.
4. Hava kolonu ve trakea başlangıcı. BT'de hava yolu daralmasının yerini ve belirginliğini değerlendir.
5. Servikal trakea ve paratrakeal alan. Prelarengeal (Delphian), pretrakeal ve paratrakeal nod zincirini tara.

Faz ve pencere

Venoz tanısal

Kontrastlı boyun BT'de subglottik bölgede kontrastlanan yumuşak doku lezyonu ve belirgin hava yolu daralması görülebilir.

BT bulguları

• Vokal kordların hemen altında başlayıp krikoid alt sınırına inen fokal veya eksantrik duvar kalınlaşması primer subglottik odağı düşündürür.
• Subglottik karsinom BT'de yumuşak doku lezyonu olarak izlenebilir; görüntüleme bulguları tek başına histolojik tanıyı doğrulamaz.
• Subglottik tümör krikoid kıkırdak invazyonuyla birlikte görülebilir; kontrastlı BT'de bu tutulum değerlendirilebilir.
• Subglottik tümör krikoid kıkırdağı invaze edebilir; BT'de kıkırdak ve komşu yumuşak dokuların tutulumu değerlendirilebilir.
• Glottise doğru uzanan tümörde vokal kord düzeyi ve paraglottik boşluk bağlantısı başlangıç odağını ayırt etmeye yardım eder.
• Subglottik skuamöz hücreli karsinomda hava yolu daralması görülebilir.
• Subglottik skuamöz hücreli karsinomda lenfatik drenaj prelarengeal veya pretrakeal nodlardan paratrakeal nodlara uzanabildiğinden bu nodlar değerlendirilmelidir.

Ölçütler ve sınıflamalar

AJCC 8. baskı subglottis T kategorisi

SEER kohortunda subglottik skuamöz hücreli karsinom için T1, T2, T3 ve T4 kategorileri raporlanmıştır. Laringeal tümörün yayılımını değerlendirmede BT ve endoskopi tamamlayıcı bilgiler sağlar.

Normalde

Subglottik hava yolunu çok düzlemli BT rekonstrüksiyonlarında değerlendir; darlığın yerini ve kraniokaudal uzunluğunu tarif et. Laringeal tümörün T evrelemesinde ön-arka ve transvers ölçümlerin yanı sıra tümörün yeri ve intralarengeal ya da ekstralarengeal yayılımı da değerlendirilir.

Ayırıcı tanı

Postentübasyon subglottik stenoz, özellikle uzamış endotrakeal entübasyon sonrasında gelişebilir.

Granülomatozis ile polianjiit (GPA), larengeal ve subglottik tutulum yapabileceğinden ayırıcı tanıda düşünülebilir.

Enfeksiyonlar trakeobronşiyal hava yollarını tutabilen nedenler arasındadır ve bu hava yolu patolojileri BT ile görüntülenebilir.

Trakeal kökenli lezyonlar genellikle krikoid altı trakeal halkalarda merkezlenir ve subglottis ile ayrılmış bağımsız odaklar olarak izlenebilir; nodüler lezyonlar tümöral, düzgün daralmalar ise inflamatöz süreçlerle ilişkili olabilir.

Larengeal kondrosarkomda kondroid matriks kalsifikasyonları görülebilir.

Fokal nodüler hava yolu lezyonları tümöral, fokal stenozlar ise inflamatuvar süreçlerle ilişkili olabilir; görüntüleme kesin değilse patolojik inceleme gerekebilir.

Tuzaklar

• Merkezi hava yolu patolojilerinin duvar yapısı ve lümen daralması çok boyutlu rekonstrüksiyonlarla ve sanal bronkoskopi eşliğinde detaylı değerlendirilebilir; diferansiyel tanı için lokalize nodüler versus diffüz daralma paternleri ayırt edilmelidir.
• Laringeal kıkırdak invazyonu BT'de olduğundan fazla değerlendirilebilir; kıkırdak tutulumu bulguları evreleme sırasında dikkatle yorumlanmalıdır.
• Subglottik skuamöz hücreli karsinom glottise uzanabilir; kontrastlı BT bu uzanımı gösterebilir.

Kendini dene

1. Primer subglottik skuamöz hücreli karsinom, tüm larenks karsinomlarının yaklaşık hangi oranını oluşturur?

   • %1–3
   • %10–15
   • %25–30
   • %50–60
   Cevabı göster

   %1–3. Kaynak, primer subglottik skuamöz hücreli karsinomun tüm larenks karsinomlarının %1–3'ünü oluşturduğunu bildirir.

2. Primer subglottik skuamöz hücreli karsinom tüm larenks karsinomlarının yaklaşık hangi oranını oluşturur?

   • %1–3
   • %10–15
   • %25–30
   • %50–60
   Cevabı göster

   %1–3. Primer subglottik skuamöz hücreli karsinom tüm larenks karsinomlarının yaklaşık %1–3'ünü oluşturur.

İlgili konular

• Glottik skuamöz hücreli karsinom
• Supraglottik skuamöz hücreli karsinom
• Künt larenks travması ve kıkırdak kırığı

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 27 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.