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.