Etiopathological Factor, Clinical Presentation and Management of Hypopharyngeal Malignancies.

Hypopharyngeal cancers have worst prognosis among the all head and neck cancers. The aim of this study is to study the etiopathological factors, clinical presentation, treatment outcome and prognostic factors in relation to different treatment modalities of hypopharyngeal cancer. Over the period of two years 30 hypopharyngeal malignancy cases were taken for the study and their etiology, clinical presentation, treatment modality and prognostic factors were studied and discussed. It was found that smoking and poor oral hygiene is the important causative factors. Among the patients only carcinoma of pyriform fossae were found. It was commonly seen in between 5th to 7th decade of life. Histopathologically they are squamous cell type and were moderately to poorly differentiate. Most of the patients presented at stage IV and stage III.Management was done with a combination of radiotherapy and chemotherapy. The treatment outcome was more or less the same regardless of the treatment modality chosen.

A Case of Hypopharyngeal Cancer Treated by Endoscopic Submucosal Dissection / 대한소화기학회지

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.

Celiac disease and postcricoid carcinoma.

Malignant disease of oropharynx, esophagus and small intestine occurs in patients of celiac disease frequently. The role of gluten-free diet in prevention of malignancy is unclear. We report a case of postcricoid carcinoma occurring in the patient of celiac disease.

[Usage of direct laryngoscopy in patients with laryngopharyngeal lesions]

Endoscopy of laryngopharyngeal diseases by direct laryngoscopy [DL] is still a valuable and useful endoscopic method for diagnosis, treatment and following them up. In this study, the safety of DL as an outpatient procedure is associated. This prospective study was performed on 146 patients who needed an endoscopic evaluation based on primary clinical diagnosis during two years in ENT ward of Ghaem hospital. While DL, macroscopic evaluation and biopsy was done and patient's tolerance during DL with local anesthesia, complications, age and sex, chief complaint, primary clinical findings and the results of endoscopy and pathology was written in a questionnaire and then analyzed. In 146 patients, laryngoscopy was done with local anesthesia in 84% and as an outpatient procedure in 75% and complications resulting to admission were not seen .Age average was 55 +/- 14, male to female ratio 2 to 1, the most common decade 6 and 7, and the most common complaint was dysphonia. Also, 51% of lesions were neoplastic that the squamous cell carcinoma was the most common. 21% of squamous cell carcinomas were seen in hypopharynx and 78% in the larynx. In the larynx, supraglottis was the most common site [69%] while the glottis and infraglottis were the next sites [18% and 6% respectively]. Male to female ratio of laryngeal and hypopharyngeal carcinoma was 5.3 to 1 and 3 to 4 consequtively. Much less incidence of benign neoplasm in our patients compared with other populations and older age in average, are seen in our results. Also, much more involvement of supraglottis compared with the glottis of the larynx, and male to female ratio of 3 to 4 in hypopharyngeal carcinoma of our patients are of other main differences seen in this study. Similar studies using the newer techniques and equipments such as videolaryngoscopy are needed to confirm the accuracy and safety of them compared with DL in the future

Carcinoma sarcomatoide de hipofaringe: reporte de un caso / Sarcomatoid carcinoma of hypopharynx: report of a case

El carcinoma sarcomatoide es una rara neoplasia maligna de alto grado, la cual, ha sido motivo de controversias en su diagnóstico y su tratamiento. Se observa con frecuencia en el tracto aerodigestivo superior, aunque su localización en la hipofaringe es rara, habiéndose reportado pocos casos a nivel mundial. Se presenta una paciente femenina de 42 años sin historia de consumo de tabaco ni alcohol, quien presentaba disfagia, pérdida de peso, disfonía y masa cervical bilateral, mediante laringoscopia de fibra óptica se evidenció un extenso tumor de hipofaringe a nivel del seno piriforme izquierdo que invalida la laringe supraglótica. La histología del tumor reportó un carcinoma sarcomatoide. La paciente fue intervenida quirúrgicamente realizándose una laringofaringoesofagectomía con reconstrucción con ascenso gástrico más disección cervical radical bilateral, Presentó complicaciones pulmonares y abdominales, falleciendo a los 2 meses del posoperatorio. El carcinoma sarcomatoide es una rara y agresiva neoplasia cuyo pronóstico depende de su localización, tamaño y presencia de metástasis cervicales; aunque por lo general el pronóstico es malo independientemente del tratamiento recibido

Intraoperative esophagoscopyL a diagnostic modality

A new modality, intraoperative esophagoscopy [IOE], was evaluated and compared to other diagnostic tools for the assessment of the lower margin of hypophayngeal carcinoma and the esophagus distal to the lesion. This study was carried on 25 patients with hypophayngeal carcinoma obstructing the pharyngoesophageal junction on endoscopy. Assessment of the lower tumor margin and esophageal mucosa was done by barium swallow, CT scan, intraoperative esophagoscopy [IOE] and serial sectioning of the specimen after resection. It was found that barium swallow is more accurate than CT in deciding the level of the lower extent of the tumor, but both measures failed to give any data about the extent of submucosal spread, the presence of skipped lesions and/or second primary. On the other hand, sensitivity of IOE to detect mucosal and .submucosal tumor extension inferior to the macroscopic tumor margin was 95%and 80% respectively. By this method, the upper obstructing lesion was bypassed, and also the use of different angled telescopes allowed a better and magnified view of the mucosa below the macroscopic lower tumor margin. The use of Toluidine blue 1% permitted detection of mucosal spread, which augmented the value of IOE

La desmoplasia como factor pronóstico en las metástasis ganglionares de pacientes con cáncer de laringe e hipofaringe / Patients with larynx cancer e hypopharyngeal

Se presenta la influencia de la desmoplasia (DP) en ganglios linfáticos metastatizados de pacientes con cáncer de laringe e hipofaringe. El estudio fue realizado en 122 enfermos operados de carcinomas epidermoides metástasis histológicamente comprobadas, tratados entre los años 1984 y 1992. Los resultados se evaluaron en función de la supervivencia y la recidiva cervical. Las tasas de supervivencia a los 3 años fueron las siguientes: sujetos sin DP 73,8 por ciento, y con DP 36,6 por ciento (p<0,03). Igualmente, los porcentajes de pacientes libres de recidiva cervical a los 3 años de la intervención mostraron diferencias estadísticamente significativas: pacientes sin DP 72,7 por ciento, y con DP 39,6 por ciento (p<0,03)- De acuerdo con los resultados obtenidos, la DP es un factor pronóstico ganglionar desfavorable en los enfermos con cáncer de laringe

Teratoma de hipofaringe: relato de caso e revisäo de literatura / Hipopharynx teratoma: report of a case and review of the literature

Teratomas säo neoplasias que se originam de células pluripotenciais e säo compostos de uma larga diversidade de tecidos estranhos ao órgäo ou sítio anatômico no qual eles aparecem. Ocorrem mais freqüentemente em crianças com menos de um ano de idade, principalmente neona, sendo normalmente notados ao nascimento. Os teratomas localizados na cabeça e pescoço säo raramente observados quando presentes, säo observados na nasofaringe e na regiäo cervical. Relatamos o caso de um recém-nascido portador de desconforto respiratório devido a tumor em regiäo de hipofaringe, que ocasionava uma obstruçäo das vias aéreas superiores. O paciente foi submetido à exérese do tumor por via transoral, tendo o resultado do estudo anatomopatológico demonstrado tratar-se de um teratoma maduro

Rhabdomyosarcoma of hypopharynx

Rhadbomyosarcoma is a rare tumour in the region of head and neck. A case of rhadbomyosarcoma in the hypopharynx is presented with a brief review on the subject