Abeler et al. described the metastatic patterns of ECCC. Among 50 patients with distant metastases, uterine cancer masses were identified in the lungs in about 39% of patients [5]. It is considered that ECCC metastasis in the lung and mediastinum, which causes VCP, hasn’t been published to date. Our case thoroughly describes all symptoms, history, and consequences of this rare pathology.
Ortner’s syndrome—is a state of VCP in patients with any relation to cardiovascular diseases. It includes left atrial enlargement, pulmonary hypertension, aortic anomalies, aneurysm of the right subclavian artery, and ductus arteriosus [12]. Alexandra Mesquita (2022) presented a case of left-sided VCP as a result of the aortic arch aneurysm in a 60-year-old woman [13]. A single sign of this state was hoarseness. The patient had been treated with aortic arch replacement, subsequently, the aneurysm volume was reduced significantly. However, VCP did not disappear due to long-time stretching and compression of the RLN. The voice of our patient was slightly improved after the fourth course of chemotherapy. Presumably, it could have happened because of a relatively short period of compression and the absence of invasion into the RLN.
For instance, computed tomography with intravenous contrast can identify any lesions or tumors within the RLN pathway. This particular method is highly helpful in distinguishing an enormous metastatic mass in a mediastinum [14]. A CT scan of the neck and vocal cord can also shed light on the location of important structures of the larynx and supraglottic space. Si Wei Kheok (2021) noticed features of VCP which were as follows: the dilatation of the ipsilateral piriform sinus, medialization of the aryepiglottic fold and enlargement of the ipsilateral laryngeal ventricle, anteromedial deviation of the arytenoid cartilage [15].
Ultrasound (US) is the gold standard of a non-invasive thyroid lesion examination [16]. Our patient had signs of inflammation of the thyroid parenchyma, a lesion in the left lobe. This nodule was heteroechoic with micro- and macrocalcification, which was supposed to be suspicious. Also, the most important medial aspect of the lesion was close to the dangerous zone of the left RLN path and trachea. Therefore, the patient would have to perform a CT scan of the chest and neck to identify the signs and source of VCP in the larynx and middle mediastinum, respectively. Radiological methods should be used in difficult cases to understand the cause of the pathology.
The other cause of RLN palsy is the endovascular treatment of the aortic arch hypoplasia. Implantation of a composite stent into the lumen of the artery leads to significant enlargement of the vessel’s volume. The RLN passes directly underneath the aortic arch. Subsequent nerve stretching caused left RLN palsy, which was recovered in advance [17]. Also, the other endovascular surgery with aortic stent-graft placement can entail left VCP. An extra dilatation of the vessel is considered to be a predictor of RLN paresis [18]. These reports represented an iatrogenic injury of the RLN, which differs from our case. However, it led to a similar complication, that should be identified and treated. In the above-mentioned case, the nerve was stretched significantly because of the additional vessel’s dilatation. As opposed to that, the patient with a mediastinum tumor had nerve compression due to the permanent growth of the metastases. The treatment is different in these cases.
It seems to be found no articles in the published literature about ECCC metastasis which caused VCP. The limitations of our case were as follows: reference to the tertiary hospital without feedback, retrospective collection of data of the case history, doctors in the tertiary hospital were not focused on VCP and didn’t perform FLS to evaluate vocal ligament mobility, lack of additional data about the surgery, the volume of the lymph node dissection, initial chemo- and radiotherapies.
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