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Abstract
Recent advances in endoscopic instruments, including narrow-band imaging (NBI) and magnification endoscopy, allowed dramatic increase in the early diagnosis of hypopharyngeal cancers. In addition, endoscopic mucosal resection or endoscopic submucosal dissection has recently been used for the treatment of hypopharyngeal cancer at an early stage, especially in Japan. However, to date, there is no published report in Korea. A 68-year-old man was admitted for preoperative evaluation and treatment for known esophageal cancer initially diagnosed at a local clinic. During the evaluation, magnifying endoscopy combined with the NBI system revealed a concurrent hypopharyngeal cancer not detected by initial conventional endoscopy. In this case report, we describe for the first time in Korea a case of early stage hypopharyngeal carcinoma that was successfully treated by endoscopic submucosal dissection with a review of literature.
Figures and Tables
Fig. 1
Conventional (A) and magnifying (B) endoscopy combined with the narrow band imaging system showing a clearly demarcated brownish colored area, and increased numbers of distorted intraepithelial papillary capillary at the left pyriform sinus, respectively.
Fig. 2
Serial endoscopic images of endoscopic submucosal dissection procedure for the removal of an early hypopharyngeal cancer showing a 10×8 mm sized, slightly elevated lesion with surface irregularity and hyperemia on the left pyriform sinus (A), markings around the lesion with a needle knife (B), circumferential mucosal incision and submucosal dissection with an hook and IT knife (C), and artificial ulcer after complete en-bloc resection (D).
Fig. 3
Photomicrograph of the endoscopic submucosal dissection specimen. The tumor was moderately differentiated squamous cell carcinoma limited to the subepithelial layer showing squamous differentiation with distinct nuclear pleomorphism, mitotic activity and rare keratinization limited to the subepithelial layer (H&E, ×100).
Fig. 4
Follow-up endoscopic image. 2 months after endoscopic submucosal dissection (ESD), post ESD scar with a tiny erosion on left hypopharynx.
Table 1
Summaries of Reported 6 Case Studies of Hypopharyngeal Cancer Treated by Endoscopic Resection
Values are presented as mean±SD or mean (range).
Ca in situ, carcinoma in situ; ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; EMR-C, endoscopic mucosal resection using a transparent cap; G/A, general anesthesia; N, not mentioned.
aIntraepithelial lesions were present in 63% of the cases (17 patients) in the EMR group and 71% (30 patients) in the ESD group.
bSubepithelial invasions were present in 4 of 10 patients in the EMR group who received adjuvant radiotherapy, while none (0/12) in the ESD group.
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