CASE PRESENTATION
A 60-year-old Caucasian male patient, known to have Diabetes Mellitus (DM) type II on oral hypoglycemic agents and obstructive sleep apnea on continuous positive airway pressure CPAP, the patient was diagnosed with moderately differentiated sigmoid adenocarcinoma Stage IV (with distant metastasis to liver and lung at the time of presentation, the patient was treated with definitive chemotherapy with (FOLFOX/Panitumumab regimen, he finished 12 cycles then maintenance therapy with 5FU/ Panitumumab), the patient was referred to ENT outpatient clinic due to hoarseness of voice for 2 weeks duration, and 18 months after his primary cancer diagnosis, there was no compressive respiratory or swallowing difficulties.
Physical examination showed unremarkable oral cavity, throat, nose, and ears; neck examination revealed no palpable lymphadenopathy. Fiberoptic examination showed paralyzed right vocal cord with left vocal cord compensation; no masses or lesions were noted along the upper aerodigestive tract. The computerized tomography (CT) scan with contrast is shown in (figure I), which confirms the presence of the known distant lung and liver metastasis.
Open surgical biopsy was taken from the right cricoid cartilage, and histopathology (Figure II) confirmed the metastatic sigmoid adenocarcinoma of the right cricoid cartilage. A. Fibrous tissue infiltrated by adenocarcinoma, B. H&E x 200. Bone infiltrated by adenocarcinoma, C. Immunohistochemical stain CDX2, and D. Immunohistochemical stain with CK20.
The patient was managed from the ENT side by awake tracheostomy and continued to his course of palliative treatment; 8 months after the laryngeal metastasis diagnosis, the patient passed away due to cancer complications.
Neck CT scan with contrast demonstrating destructive right laryngeal mass destroying the cartilage and causing luminal narrowing with extra laryngeal extension (Figure I), Chest and abdomen CT with intravenous contrast showing multiple lung nodules of varying sizes (red arrows), also multiple lesions on the liver can be noted largest being marked with the yellow circle.