Cases Of Hypopharyngeal Carcinoma Research Articles

Hypopharyngeal Reconstruction: Possibilities, Outcomes, and Updates for Improving the Human Health for Quality of Life.

Hypopharyngeal carcinoma is usually present at late stages, necessitating an aggressive line of management consisting of surgical procedures, chemotherapy, and radiation therapy, depending on the case. Practitioners tend to support total laryngectomies or total esophagostomies for most cases of hypopharyngeal carcinoma. The extensive procedures needed will most probably require, depending on the residual defect, a follow-up reconstructive procedure that might require utilizing flaps. Types of reconstructive methods and types of grafts or flaps used could be divided into a multitude of categories depending on the magnitude, shape, extension, and whether the underlying defect that is being reconstructed is circumferential or not. These reconstructive procedures are aimed at improving the quality of life, improving the aesthetic outcome, and restoring the functionality of the pharyngoesophageal segment. When it comes to hypopharyngeal cancer, the most common kind is squamous cell carcinoma (SCC), which has the worst prognosis of all the head and neck malignancies. Overall, the 5-year survival rate remains low, despite recent advancements in diagnostic imaging, radiation, and chemotherapy, as well as enhanced surgical methods and techniques. Hypopharyngeal malignancies are more probable than other tumors to present with advanced primary illness, with nodal metastasis a distinct possibility. The size and amount of local dissemination of the original carcinoma, as well as the extent of involvement of regional lymph nodes, are the most critical factors in predicting prognosis. Hypopharyngeal cancers are more likely than other head and neck cancers to manifest with distant metastases at the time of diagnosis. The appearance of second primary tumors, as well as the development of distant metastases, is a contributing factor to poor survival rate. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with contrast remain the gold standard for evaluating hypopharyngeal carcinoma in the early stages. In most cases, imaging leads to an increase in the tumor stage at the time of presentation. Objectives. The main objectives are to review the research published about flaps, outline the optimum situations that will dictate the usage of a few of the most often used flaps for the rebuilding of the hypopharyngeal segment defects, and outline some of the complications associated with reconstruction. Methods. The processing was carried out with the title-specific search of the PubMed database using the query terms “hypopharyngeal carcinoma” and “reconstruction” to identify the most relevant articles without restricting publication dates. Information about the types of defects and methods of reconstruction was extracted from the reviewed articles. Two books were also reviewed, which were Regional and Free Flaps for Head and Neck Reconstruction (second edition) and Head and Neck Reconstruction: A Defect-Oriented Approach. Conclusion. Deciding the appropriate approach to a case should be individualized and should depend on the capabilities of the center, the defect's size and status, and lastly, the surgeon's training. The use of interpretation in the diagnosis of flaps can offer the best results in restoring functionality and vascularity and might also offer improved cosmesis.

Abstract A42: Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience

Abstract Introduction: With the emergence of organ preservation protocol in head and neck cancer, management of hypopharyngeal carcinoma is generally by nonsurgical approach; however, a significant number of hypopharyngeal cancer patients present in advanced stage and exhibit poor prognosis. For such cases, thorough aggressive surgical excision of laryngopharyngoesophageal complex with appropriate reconstruction might be a viable option. Objective: To evaluate quality-of-life measures and survival outcomes in hypopharyngeal carcinoma cases undergoing above-mentioned procedure at a tertiary health care center. Methodology: A retrospective study on patients with hypopharyngeal carcinoma undergoing above-mentioned procedure was done in our tertiary care institute between September 2016 to October 2018. Results: A total of 12 patients were operated during the study period; however, 3 patients were excluded due to inadequate data. In our study, mean age of presentation was 51.3 years and majority were men (n=8). Most of the patients at the time of presentation were stage IVA or more. Postcricoid was most common subsite, followed by pyriform fossa. 4 out of 12 were operated after failed chemoradiation. Perioperative morbidity primarily in terms of complications and duration of hospital stay and quality-of-life measures consisting mainly of swallowing score were analyzed, which suggested that this procedure is tolerable and produces a reliable outcome. Conclusion: Total laryngopharyngoesophagectomy with gastric transposition is a feasible and efficacious treatment option with reasonable quality of life in carcinoma hypopharynx patients, especially after failed chemoradiation. Citation Format: Prerit Rao, K. Devaraja, Kailesh Pujary, Dipak Ranjan Nayak, R. Balakrishnan. Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A42.

A case of hypopharyngeal carcinoma that occurred in a patient with Fanconi anemia

A case of hypopharyngeal carcinoma that occurred in a patient with Fanconi anemia

Human papilloma viruses: other risk factor of head and neck carcinoma

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

Experience of applying acellular dermal matrix in the head and neck tumor surgery

To evaluate the application of acellular dermal matrix (ADM) in the reconstruction of defect after head and neck tumor resection. A total of 75 cases applied with ADM after head and neck tumor resection were reviewed. There were 47 cases of laryngeal carcinoma (glottic 41, supraglottic 3, and infraglottic 3), 5 cases of hypopharyngeal carcinoma, 11 cases of maxillary sinus carcinoma, 9 cases of oral cavity tumor, 3 cases of cervical trachea tumor. Among them 25 cases of laryngeal carcinoma, 4 cases of hypopharyngeal carcinoma, 7 cases maxillary carcinoma, 6 cases oral carcinoma, and one case of cervical trachea malignancy received postoperative adjuvant chemoradiotherapy. The patients were postoperatively followed up from 2 weeks to 3 years. Among 75 cases, 65 cases, including 40 cases of laryngeal carcinoma, 4 cases of hypopharyngeal carcinoma, 9 cases of oral cavity tumor, 9 cases of maxillary carcinoma and 3 cases trachea tumor, presented with good wound healing without any complication within 3 months; the 47 patients with tracheotomy were decannulated successfully; 2 cases of laryngeal carcinoma and 1 case of hypopharyngeal carcinoma were complicated with pharyngeal fistula, which healed with dressing change, followed by decannulation; 5 cases had laryngeal stenosis and decannulation failed in these patients; and 3 cases of maxillary carcinoma had wound infection. ADM application is a easy and feasible method for the repair of the defect after head and neck tumor resection.

Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases.

BackgroundThe aim of this study is to define an algorithm for the choice of reconstructive method for defects after laryngo-pharyngo-esophagectomy for hypopharyngeal carcinoma.MethodsOne hundred and forty two cases of hypopharyngeal carcinoma were included and operated on by either partial pharyngectomy, total pharyngectomy or esophagectomy. The reconstructive method was tailored according to the resected segment.ResultsPectoralis flap was used in 48 cases, free jejunal flap in 28 cases, augmented colon bypass in 4 cases, gastric pull up in 32 cases and gastric tube in 30 cases. Mean hospital stay was 12 days. Mortality rate was 10.6% and morbidity rate was 31.7%. Total flap failure occurred in 3 cases of free flap and one case of pectoralis flap. There were 23 cases of early fistula. Late stricture occurred in 19 cases, being highest with myocutaneous flap (early fistula 12/50 and late stricture 13/50).ConclusionFree jejunal flap was the flap of choice for reconstruction when the safety margin is still above the clavicle. In cases with added esophagectomy, we recommend gastric tube as a method of choice for reconstruction.

Partial horizontal laryngectomy and epiglottiplasty

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4% in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7% after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.

Hypopharyngeal carcinoma in Finland from 1990–1999

Data concerning the diagnosis, treatment and clinical course of patients with hypopharyngeal carcinoma (HPC) in all five university hospitals in Finland between 1 January 1990-31 December 1999 were retrospectively analysed. During the study period, 149 HPC cases were diagnosed in 111 men and 38 women (74%/26%), with a mean age of 64.5 years. At the time of diagnosis, 6 patients (4%) had stage I, 11 (7%) stage II, 32 (22%) stage III and 100 (67%) stage IV disease. In 74 (49%) cases, the primary treatment was surgery. Pre- or postoperative radiation therapy was given to 67 patients. Radiation therapy was the primary treatment in 47 (32%) patients, and 12 patients (8%) received concomitant chemoradiation. The overall 5- and 10-year disease specific survival (DSS) was 22 and 13%, respectively. The 5-year DSS was 66% for stage I, 59% for stage II, 31% for stage III and 12% for stage IV disease. In the three major treatment groups, i.e., surgery and radiation therapy, radiation therapy alone and concomitant chemoradiation, the 5-year DSS were 32% for surgery and radiation therapy, 7% for radiation therapy alone and 38% for concomitant chemoradiation. Prognosis of HPC remains poor, especially in the more advanced stages of the disease. In addition to traditional surgery and radiation therapy, concomitant chemoradiotherapy seems to give equal results in tumor control, thus making organ preservation possible in the primary treatment of HPC.

An Unusual Distant Metastatic Site from Hypopharygeal Carcinoma

The most common distant metastatic sites from hypopharyngeal carcinoma are the lung, liver and bone. Distant skin metastases are very rare in even very advanced stages, and only 5 cases have been reported in the English literature. We describe a case of hypopharyngeal carcinoma which metastasized to the forearm of a 63-year-old man. It was found coincidentally following the detection of hypopharyngeal carcinoma. The skin biopsy specimen contained poorly differentiated squamous carcinoma cells which were almost identical to those of the primary lesion. The metastatic tumor on the forearm continued to progress and the patient eventually died of the disease 32 days after diagnosis even after immediate concurrent chemoradiotherapy. Any skin tumor with rapid progression in a patient with head and neck cancer may be related to a metastatic lesion even when it is distant to the primary tumor. Skin metastasis from hypopharyngeal carcinoma appears to be refractory to radiotherapy and chemotherapy and has a poor prognosis.

A case of hypopharyngeal carcinoma in cancer pain management with high-dose intravenous morphine

A case of hypopharyngeal carcinoma in cancer pain management with high-dose intravenous morphine

Expression of Epstein-Barr virus in mesopharyngeal and hypopharyngeal carcinomas

Epstein-Barr virus (EBV) causes various tumors, including nasopharyngeal carcinoma (NPC). There have been no reports as to whether the carcinogenicity of EBV is restricted to the nasopharynx or extends into the mesopharynx and hypopharynx. We attempted to ascertain the relation between EBV and mesopharyngeal (MPC) and hypopharyngeal carcinomas (HPC). Messenger RNA in situ hybridization showed that all 29 cases of MPC and 5 of 12 HPC expressed EBV mRNA. For further analysis, we established 7 cell lines from 5 MPC and 2 HPC. All cell lines and 5 tumors formed by these cultured cells in nude mice expressed EBV transcripts. Moreover, immunofluorescence staining showed expression of EBV-related nuclear antigen-2 and latent membrane protein-1 (LMP1) in the original tumors and the cell lines, as well as in nude mouse tumors. Study by reverse transcription polymerase chain reaction (RT-PCR) also showed EBER1 and LMP1 expression. Furthermore, lytic-cycle antigens of EBV were detectable in most cell lines. Nested PCR showed the EBV genome in 3 cases of MPC and 4 cases of HPC. These results suggest that EBV plays an important role in the development of MPC and HPC as well as in NPC.

Near-total laryngopharyngectomy with pectoralis major myocutaneous flap in advanced pyriform carcinoma

Successful restoration of phonation, as well as swallowing in laryngopharyngeal surgery for patients with advanced pyriform carcinoma still remains a major challenge. In a five-year period, near-total laryngectomy operations were performed on 21 patients with laryngopharyngeal carcinoma. This report particularly emphasizes the value of near-total laryngopharyngectomy with a pectoralis major myocutaneous flap for four extensive hypopharyngeal carcinoma cases (three of which were of pyriform origin). All four patients regained intelligible shunt speech and smooth swallowing. The follow-up period ranged from 19 to 44 months. They have had no recurrence of disease since surgery. The authors suggest that an advanced pyriform carcinoma case, with a normal contralateral hemilarynx and pyriform sinus, is a candidate for a near-total excision of the laryngopharynx.

下咽頭癌の増殖指数と粘膜下進展度

Proliferation index of biopsied specimens from 11 cases of hypopharyngeal carcinoma was studied immunohistochemically using anti-BrDU monoclonal antibody. S-phase cell labelling index (SLI) was measured and compared with the extent of submucosal invasion that was evaluated histologically in each extirpated specimen by means of continuous large section technique. Conclusions were as follows: 1. The largest SLI was obtained in a moderately differentiated carcinoma, and calculated up to 56, while the smallest was encountered in a well differentiated carcinoma as 18. Mean value in these 11 cases was 35. 2. It seemed likely that moderately or poorly differentiated carcinomas show larger SLI, but its statistical significance could not be delineated in these materials. 3. Submucosal invasion was much longer in the oral direction than in the anal. The longest invasion was observed in a case that showed the largest SLI, and measured up to 22 mm. The shortest invasion, on the contrary, was seen in a case with the smallest SLI, and was only 9 mm. Mean value in these 11 cases was 14.4 mm. 4. SLI correlates well in every case to the extent of submucosal invasion toward the oropharynx. 5. SLI evaluated preoperatively in biopsied specimen may help to indicate an ample safety margin at the surgery.

Carcinoma of the hypopharynx treated with one-stage reconstruction

A case of hypopharyngeal carcinoma is presented which was treated with one-stage hypopharyngeal resection and replacement with a stainless steel funnel surrounded by split-thickness skin graft. The procedure used followed Edgerton's method with some modifications, which were discussed. The healing and results were excellent until there was local recurrence of the tumor.

Four cases of hypopharyngeal carcinoma which seem to have developed following the irradiation of cervical region for tuberculous lymphadenitis.

Four cases of hypopharyngeal carcinoma which seem to have developed following the irradiation of cervical region for tuberculous lymphadenitis.

Case of Hypopharyngeal Carcinoma; Removal; Restoration of the Wall by Turning in a Piece of Skin

Case of Hypopharyngeal Carcinoma; Removal; Restoration of the Wall by Turning in a Piece of Skin