Abstract
A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery; there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.
Highlights
Multiple primary malignant cancers in the same patient frequently have been found because of the advancing age of patients and improvements in the diagnostic tool in identifying early stage mucosal cancer of the head and neck
Trans-nasal endoscopy with narrow band imaging (NBI) was performed
We previously reported that the utility of trans-nasal endoscopy using the trumpet maneuver for precise inspection before treatment [7] [8]
Summary
Multiple primary malignant cancers in the same patient frequently have been found because of the advancing age of patients and improvements in the diagnostic tool in identifying early stage mucosal cancer of the head and neck. Most cases of hypopharyngeal cancer are detected at an advanced stage, and require extensive treatment and are usually associated with a loss of function of swallowing or speaking. Several reports [4] [5] [6] have indicated the use fullness of narrow band imaging (NBI) improving the detection of superficial hypopharyngeal cancer. We here in report a case of simultaneous triple primary cancers of the hypopharynx, esophagus, and stomach which were dissected by Endoscopic laryngo-pharyngeal surgery (ELPS) combined with Endoscopic submucosal dissection (ESD)
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