A patient with rapid growth of superficial-type poorly differentiated hypopharyngeal squamous cell carcinoma

Abstract

An 81-year-old man was diagnosed as having cStage IVa esophageal cancer and treated by chemoradiation therapy. His treatment response to the CRT was classified as CR. Then, 34 months after the CRT, he was detected to have a small elevated lesion with abnormal blood vessels coursing over it in the rt pyriform sinus, with the lesion showing rapid increase in size to a clearly elevated lesion over the next 6 months. The surface of the lesion was covered by normal mucosa and blood vessels (Type B2) could be seen coursing over it by magnifying endoscopy with NBI. We diagnosed the lesion as a superficial hypopharyngeal cancer (Type 0-I+IIa) and performed endoscopic laryngo-pharyngeal surgery. The pathological diagnosis was poorly differentiated squamous cell carcinoma with ly1, v1, and prominent subepithelial invasion. Pharyngeal cancer is often found synchronously or metachronously in patients with esophageal cancer, presumably as a result of the shared risk factors between the two cancers, such as alcohol drinking, smoking and deficient ALDH2 activity. Endoscopic examination to detect any pharyngeal cancer must be performed in esophageal cancer patients with the aforementioned risk factors. Diagnosis of a pharyngeal elevated lesion is often difficult due to the presence of the tonsils and lymphoid follicles. Therefore, careful magnifying endoscopy with NBI should always be performed to confirm the presence/absence of blood vessels coursing over small and slightly elevated lesions.