Mallick J A, Ali S A, Aziz A.
Squamous Cell Carcinoma of True Vocal Cords (T1) Lesion Metastasis to Lung - a Case Report.
J Pak Med Assoc Jan ;52(6):258-62.

In December 1999, a 38 year old male was referred to us as a diagnosed case of Squamous cell carcinoma of True vocal cords (Glottic) region. After initial work-up including CT Scan, X-ray chest, U/S whole abdomen; the stage of disease was labeled as T1 N0 M0 / Stage I. The plan of treatment was decided by radical radiotherapy (cobalt). Total dose of 6600 cGy in 33 fractions, 5 days in a week was given as initial treatment. After the completion of radiotherapy he remained well for 6-8 months. In October 2000 he developed cough which was initially dry and then became productive. For this complaint he went to the chest physician who advised him an X-ray chest; which showed multiple well-defined opacities with cavitation in upper lobe of right lung. On the basis of the X-ray findings alone a diagnosis of Pulmonary Tuberculous was established and anti Tuberculosis treatment started. Despite 2 months of treatment he did not show a satisfactory response. In January 2001, he came to oncology clinic for the above mentioned complaints. On the basis of history, clinical examination, X-ray findings and failure to treatment, an urgent CT Scan chest was performed which showed multiple well-marginated soft tissue densities in the right lung measuring 3.8 x 3.8cms in anterior segment of right upper lobe. The other two densities were lying in the posterior basal segment of right lung. No evidence of lymphoadenopathy was noted. In view of CT findings; the U/S Abdomen was performed to evaluate the distant metastasis. Biopsy of primary site and lung mass was performed. U/S abdomen and biopsy of primary site revealed no evidence of disease but biopsy from lung mass showed atypical cell highly suggestive of Squamous cell carcinoma. On the basis all investigations the stage of disease had been changed from Stage I to Stage IV. Therefore plan of palliative systemic combination chemotherapy comprising of Cisplatinum 75mg/m2 on day 1 and 5- 5-Flurouracil 750mg/m2 from day 2-6, with each cycle to be repeated after every 3-4 weeks was decided. After at least 2 courses of chemotherapy the response of treatment would be assessed clinically and radiologically to decide the further plan of management.

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