Prostate metastasis to cricoid necessitating biopsy via open approach

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Clarisse Chu and Mark Thong

Yong Loo Lin School of Medicine, Singapore
National University Hospital, Singapore

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Abstract

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Introduction: Less than 2% of laryngeal malignancies arise from distant primary sites. Prostate carcinoma metastases to the cricoid are even rarer, with four reported cases to date. We present a case of prostate metastasis to the cricoid cartilage, and describe a novel external surgical approach to obtain cricoid cartilage tissue for histological diagnosis. Case: A 58-year-old male was successfully treated for locally-advanced prostate carcinoma. Two years later, climbing PSA levels were noted on routine surveillance. As history and physical examination were unremarkable, an 18F-fluorocholine (FCH) PET/CT was performed. This revealed areas of increased focal uptake in the cricoid, rib and spine, consistent with metastases. He was empirically treated with abiraterone, LHRH agonist and prednisolone. While the rib and spine lesions responded, the cricoid lesion did not. Thus, a biopsy of the cricoid was performed to confirm that this lesion was indeed prostate metastases. This biopsy was performed, not via the typical endoscopic approach, but by a novel external approach with a skin incision, mobilization of the thyroid, and elevation of the cricopharyngeus and cricothyroid muscles. The cricoid lesion was subsequently treated with radiotherapy with good clinical response. Conclusion: Prostate carcinoma metastasis to the cricoid is rare and may require biopsy. Biopsies of cricoid lesions are usually performed endoscopically as there is frequently tumor extension into the cricoid intra-laryngeal lumen or mucosa. However, in cases where tumor tissue is relatively small and isolated within the cricoid cartilage itself, the herein described external approach may be more appropriate.

Biography

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Clarisse Chu is a final year Medical student at Yong Loo Lin School of Medicine, National University of Singapore. She has just completed Otolaryngology internship at National University Hospital, Singapore. She has a keen interest in Otolaryngology as a career because of the balance it offers between medicine and surgery, as well as the culture of collegiality. She was the first runner-up at her medical school's ENT Book Prize competition in 2017.

Email: clarissechu94@gmail.com