case_images: PMC11789541_01
case_images: A: Spirometry measurements show a reduced FEV1/FVC ratio with no improvement with bronchodilator administration. B: Flow volume loops demonstrating a 'coved' pattern of expiratory limb (red arrow), seen in peripheral or lower airway obstruction.. FEV1: Forced Expiratory Volume in 1 sec; FVC: Forced Vital Capacity
case_images: cureus-0017-00000076903-i01.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i01.jpg
case_images: FIG1
case_images: A spirometry and flow volume loop indicated a mild fixed obstructive ventilatory defect (Figure 1).
case_images: A: CT scan of the neck with a blue arrow indicating the polypoid lesion of the left vocal cord. B: PET-CT scan of laryngeal cancer with a red arrow showing FDG uptake at the left vocal cord and yellow arrows showing two normal-sized FDG-avid lymph nodes. C: PET-CT scan of neck with a yellow arrow showing a right upper anterior cervical FDG-avid lymph node, measuring 1.3 cm. PET-CT: Positron Emission Tomography-Computed Tomography; FDG: Fludeoxyglucose
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case_images: PMC11789541_01_cureus-0017-00000076903-i02.jpg
case_images: FIG2
case_images: Diagnostic evaluation began with a CT (computed tomography) scan of the neck, which revealed a small polypoid lesion originating from the left vocal fold (Figure 2). Additional imaging, including a CT scan of the neck and PET-CT (positron emission tomography-computed tomography), established stage IV subglottic cancer, classified as cT3N2cM0 (Figure 2).
case_images: Upper Panel: Biopsy from vocal cord tumor. A: Low-power image shows proliferation of atypical squamous cells and keratin pearl formation. B: High-power image demonstrates keratin pearl formation, intercellular bridges, and pleomorphic nuclei, characteristic of invasive keratinizing squamous cell carcinoma. Lower Panel: Biopsy from the endotracheal lesion: C: Low-power image shows nests of malignant squamous cells with keratin pearl formation. D: High-power image demonstrates infiltrating groups of tumor cells, surrounded by desmoplastic stroma, characteristic of invasive keratinizing squamous cell carcinoma.
case_images: cureus-0017-00000076903-i03.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i03.jpg
case_images: FIG3
case_images: Biopsy results confirmed invasive moderately differentiated keratinizing squamous cell carcinoma (Figure 3). A CT scan of the neck, performed at the same interval, showed a reduction in the size of the primary tumor involving the glottis, as well as a decrease in the size of the cervical lymph nodes (Figure 3). Histopathological analysis of the biopsied specimens demonstrated invasive moderately differentiated keratinizing squamous cell carcinoma (Figure 3).
case_images: A: Post-treatment CT scan of laryngeal cancer with a blue arrow indicating a decrease in size of the left vocal cord lesion. B: Post-treatment PET-CT scan with a red arrow indicating improvement and resolution of FDG uptake in the laryngeal region. C: Post-treatment PET-CT scan with a yellow arrow indicating a decrease in size and resolution of FDG uptake in the right cervical node. PET-CT: Positron Emission Tomography-Computed Tomography; FDG: Fludeoxyglucose
case_images: cureus-0017-00000076903-i04.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i04.jpg
case_images: FIG4
case_images: A PET-CT scan conducted six months after the initial diagnosis showed resolution of the laryngeal tumor and cervical lymphadenopathy (Figure 4).
case_images: PET-CT scan with a red arrow showing a small focus of FDG uptake in the upper part of the posterior wall of the trachea, along with evidence of endotracheal irregularity. PET-CT: Positron Emission Tomography-Computed Tomography; FDG: Fludeoxyglucose
case_images: cureus-0017-00000076903-i05.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i05.jpg
case_images: FIG5
case_images: However, a small focus of FDG uptake was observed in the upper part of the posterior wall of the trachea, at the site of a tracheoesophageal lymph node (Figure 5).
case_images: Bronchoscopic findings of two endotracheal lesions. A: One lesion located in the left posterolateral aspect of the upper part of the trachea. B: Another in the left posterolateral aspect of the lower part of the trachea.
case_images: cureus-0017-00000076903-i06.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i06.jpg
case_images: FIG6
case_images: The patient underwent a bronchoscopy, which revealed two small endotracheal lesions: one in the left posterolateral aspect of the upper part and another in the left posterolateral aspect of the lower part of the trachea (Figure 6).
case_images: Follow-up PET-CT scan with a red arrow showing a decreased size and FDG uptake at the upper endotracheal lesion. PET-CT: Positron Emission Tomography-Computed Tomography; FDG: Fludeoxyglucose
case_images: cureus-0017-00000076903-i07.jpg
case_images: PMC11789541_01_cureus-0017-00000076903-i07.jpg
case_images: FIG7
case_images: A PET-CT obtained two months later, demonstrated a reduction in the size of the endotracheal lesion with decreased FDG uptake (Figure 7).