Elusive head and neck carcinomas beneath intact mucosa

This study presents 19 patients who had mucosally inapparent carcinomas of the upper aerodigestive tract demonstrated by computed tomography (CT). This group contains subpopulations that were identified both retrospectively and prospectively. During the same period 40 nasopharyngeal, 20 oropharyngeal-tongue base, and over 100 laryngeal and hypopharyngeal carcinomas were studied; all had clinically obvious mucosal components. Nine of our 19 patients had strictly submucosal tumors and a variety of clinical presentations; 5 patients had strictly submucosal recurrence of treated carcinomas and 5 had mucosal lesions which were not identified on examinations by more than one practicing head and neck surgeon. Sixteen of the 19 tumors were confirmed histologically; in 3 others confirmation was by a combination of CT and clinical course. CT can demonstrate the deep extent of aerodigestive tract carcinomas more accurately than physical examination and it can show mucosally inapparent disease. CT should be part of the staging work-up in nearly all upper aerodigestive tract carcinomas and in patients suspected of harboring an unknown primary within this region.