A Clinicopathological Evaluation of Neck Secondaries in Hypopharyngeal Malignancy

Selvarajan, N (2021) A Clinicopathological Evaluation of Neck Secondaries in Hypopharyngeal Malignancy. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Cervical lymphadenopathy, a common clinical problem, often presents as a diagnostic dilemma. It is essential to establish an early definite diagnosis in the course of evaluation in order to institute a meaningful treatment. In view of rich lymphatic drainage, majority of patients with malignancies of hypopharynx presents with regional dissemination of disease to cervical lymph nodes. In the absence of detectable metastasis, cervical metastasis is currently regarded as the single most significant independent adverse prognostic factor which influences disease free and over all survival. Hence this study is done to estimate the prevalence of cervical node metastasis in all subsites of hypopharyngeal malignancy and to study the presentation of stages of neck node at the time of first visit in hypopharyngeal malignancy. MATERIAL AND METHODS: This prospective study was performed from January 2020 to November 2020 in the Department of Otorhinolaryngology, Thanjavur Medical College, Thanjavur, Tamilnadu and included 40 patients with Hypopharyngeal primary with or without Neck secondaries. A predesigned proforma was used to record relevant information like patient data, history, clinical findings and investigation report from individual cases. A detailed history regarding primary lesion and occurrence of swelling in the neck was assessed. A detailed local examination of neck for metastatic neck node was done for its site, size, number and its apparent relation in surrounding structure. A detailed examination of Hypopharynx was done by videolaryngoscopic examination, computerized Tomogram of Neck to detect primary tumor and staging the disease. FNAC for neck node and biopsy of primary lesion was done for histopathological confirmation were studied. RESULTS: In this study, the majority of patients were in 40-89 year age group. Males accounted for 50% of the sample and females for 50%, with a Male : Female ratio of 1 : 1. Postcricoid tumors have female preponderance while Pyriform sinus and Posterior Pharyngeal wall tumours have male preponderance. The peak incidence of hypopharyngeal malignancy in this study is 6th decade (40%). Pyriform sinus is the most common primary subsite (55%) followed by Postcricoid region(37.5%), Posterior Pharyngeal wall (7.5%) tumours. Cervical nodal metastasis is 72%, 40%, 33% in Pyriform sinus, Postcricoid region and Posterior Pharyngeal wall respectively. Lymphnode metastasis highest in Pyriform fossa tumours. Majority of patients with primary squamous cell carcinoma of the hypopharynx, Metastasize to level Ⅱ, Ⅲ, Ⅳ. Most common lymphnode involved are level III (34%) followed by level IV (24%), level II (20%). In this study, there were 22.5%with N1 stage while 35% presented in N2 stage and about present 42.5% presented in N0 stage. CONCLUSION: All cases of cervical lymphadenopathy especially in elderly persons must have high suspicion of hypopharyngeal tumours. And all hypopharyngeal tumours need early screening by Otolaryngologist for evaluation of hypopharynx by clinical, videolaryngoscopic examination and diagnostic evaluation by CT Neck and proper referral by health care provider will decrease patient with advance tumour and reduce the mortality and morbidity.

Item Type: Thesis (Masters)
Additional Information: 221914205
Uncontrolled Keywords: Hypoharyngeal tumours, Cervical Node, Videolaryngoscopic Examination, FNAC.
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 12 May 2021 16:24
Last Modified: 08 Jan 2022 14:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/16517

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