History Of Squamous Cell Carcinoma Research Articles

A New Self-expanding, Large-caliber Ureteral Stent Applied for Bilateral Long-segment Ureteral Strictures — A Case Report

Abstract Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.

Expression of mast cell tryptase and immunoglobulin E is increased in cutaneous photodamage: implications for carcinogenesis

Purpose: Mast cells, their serine proteinase tryptase, and immunoglobulin E (IgE) can be involved in cutaneous carcinogenesis. Materials and methods: To study the association of tryptase+ and IgE+ cells with photodamage and skin cancers 385 adult patients (201 males, 184 females, 75 with immunosuppression) at risk of any type of skin cancer were examined. Skin biopsies were taken from the sun-protected medial arm and from the photodamaged dorsal forearm skin followed by immunohistochemical staining for tryptase and IgE. Results: The results show that tryptase+ and IgE+ cells are significantly higher in number in the photodamaged than sun-protected skin, both in immunocompetent and -compromised subjects, and there is a strong correlation between tryptase+ and IgE+ cells. The numbers of forearm tryptase+ and especially IgE+ cells associated significantly with the forearm photodamage severity. In the logistic regression analysis, the forearm to upper arm ratio of IgE+ cells produced a univariate odds ratio of 1.521 (p = .010) and a multivariate one of 3.875 (p = .047) for the history of squamous cell carcinoma. The serum level of total IgE correlated significantly to the IgE to tryptase ratio in both skin sites. Conclusions: Therefore, IgE+ mast cells participate in photodamage and carcinogenesis, though it is unclear whether they are tumor-protective or -causative.

Deep vein thrombosis and bilateral submassive pulmonary emboli post‐routine sinus lift: A case report and review of the literature

AbstractVenous thromboembolism (VTE) arising after major oral surgery under general anaesthesia is an exceedingly rare occurrence, and under local anaesthesia even more so. We report a case of a 55‐year‐old male with a remote history of squamous cell carcinoma of the left tonsil, in remission, who developed deep vein thrombosis and bilateral pulmonary emboli after routine sinus lift under local anaesthetic. We discuss the diagnosis, risk factors, and the role of sinus lift in contributing to the onset of VTE in this report. We also discuss a role of potential thromboembolic prophylaxis in high‐risk patients undergoing dentoalveolar procedures under local anaesthetic.

Risk factors influencing chemotherapy compliance and survival of elderly patients with non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) has high degree of malignance and proneness to recurrence and metastasis. The aim of this study was to analyse the risk factors influencing the chemotherapy compliance and survival status of elderly NSCLC patients. The clinical data of 110 patients admitted from January 2014 to March 2018 were retrospectively analysed. They were assigned to non-chemotherapy (n=25), partial chemotherapy (n=30) and complete chemotherapy (n=55) groups according to chemotherapy compliance, and followed up until March 2021. Their clinicopathological characteristics were investigated by univariate analysis and then multivariate Cox regression analysis. The survival rates were compared by Kaplan-Meier survival curve and log-rank test. Among the 110 NSCLC patients, 25 did not receive chemotherapy, 30 underwent partial chemotherapy and 55 received complete chemotherapy. Educational level, pathological tumor-node-metastasis (TNM) stage, pathological type, surgical approach, place of residence, payment mode and chemotherapy stage were independent risk factors influencing the chemotherapy compliance (P<0.05). Particular attention should be paid to improving the chemotherapy compliance of patients with low educational level, late TNM stage, medical history of squamous cell carcinoma, history of thoracotomy, living in rural areas and no medical insurance, and those in the recurrence period or consolidation period of chemotherapy.

Occipital Cavernous Malformation. Case Report and Literature Review

We present a 47-year-old female patient with a personal pathological history of squamous cell carcinoma of the cervix treated with multimodal therapy. She is rushed to our hospital because of a generalized tonic-clonic seizure. After performing computed axial tomography and magnetic resonance imaging studies of the skull, an occipital lesion was evident that was located above the tentorium cerebellum in relation to her right transverse sinus. An occipital approach is performed where said lesion is completely

Primary pulmonary hyalinizing clear cell carcinoma with vocal-cord squamous cell carcinoma: a case report with systematic review

BackgroundPrimary pulmonary hyalinizing clear cell carcinoma (HCCC) is a low-grade salivary gland-type carcinoma. Until now, 23 cases of pulmonary HCCC have been reported.Case presentationHere, we present a patient with primary pulmonary HCCC along with vocal-cord squamous cell carcinoma (SCC) revealed by biopsy examination. The patient underwent radiotherapy for vocal-cord SCC, followed by right upper lobectomy and lymph node dissection 10 months later. Histology revealed polygonal cells with eosinophilic or clear cytoplasm in the myxoid matrix together with hyaline degeneration. The tumor involved the whole layer of the segmental bronchus and regionally involved the alveolar tissue along with one intrapulmonary lymph node. Targeted RNA sequencing revealed Ewing Sarcoma Breakpoint Region 1 (EWSR1)- activating transcription factor 1 (ATF1) fusion. We analyzed the data on pulmonary malignant tumors between 2000 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database and reviewed all cases of pulmonary HCCC with EWSR1 fusion by searching PubMed. The results showed that head and neck (HN) adenoid cystic carcinoma (ACC) (47.89%) and HNSCC (22.54%) were the most common carcinomas occurring with pulmonary salivary gland-type malignant tumors. Screening of 24 cases of pulmonary HCCC with EWSR1 fusion revealed that five cases demonstrated lymph node metastases and only two had documented tumor recurrences. HCCC is rare and easily misdiagnosed as SCC, but the treatment regimen differs between pulmonary HCCC and SCC.ConclusionsHence, pulmonary tumors with clear cells must be diagnosed with caution. Next-generation sequencing (NGS) may be useful for diagnosis, especially in cases with a history of squamous cell carcinoma (SCC).

Metastasis to Ascending Colon from Squamous Cell Carcinoma Cervix: Unusual Presentation

Ascending colon is an unusual site of metastasis from primary carcinoma cervix. Unusual sites of metastasis from squamous cell carcinoma (SCC) cervix include bones, stomach, duodenum, colon, skin. Squamous cell carcinoma is a rare malignancy of gastrointestinal tract (GI). Metastasis of SCC of cervix to GI tract is uncommon and has been reported only in a handful of cases. It may present with intestinal obstruction requiring debulking surgery. Management is palliative and role of chemotherapy or radiation is unclear. In this report we discuss a 47 year old female with history of squamous cell carcinoma of cervix treated in 2014. She developed local recurrence in 2019 and received pelvic re radiation. She presented with intestinal obstruction and on evaluation diagnosed to have metastatic squamous cell carcinoma of ascending colon.

The Utility of EBUS-Guided Transbronchial Forceps Biopsy With or Without an Electrocautery Knife for the Diagnosis of Mediastinal and Hilar Lymphadenopathy.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to have a high diagnostic yield for mediastinal and hilar lymph node sampling, particularly in diagnosing and staging non-small cell lung cancer. However, the diagnostic yield is lower in patients with granulomatous and lymphoproliferative disorders. We prospectively compared the feasibility, safety, and diagnostic yield of EBUS-guided lymph node forceps biopsy (EBUS-TBFB) with electrocautery knife compared to EBUS-TBNA of lymph nodes in patients with suspected granulomatous and lymphoproliferative disease. Patients over 18 years of age with mediastinal/hilar lymph node >10 mm in size in short axis (on CT chest) who had suspected sarcoidosis/lymphoma radiologically/clinically were included in the study. Patients had EBUS-TBNA first with 21 or 22G needles which were followed by biopsy of the node with small forceps (EBUS-TBFB) through the same aspiration site to obtain samples. Electrocautery knife at 20W was used in patients where mucosal penetration was difficult, followed by passage of forceps through that site. A total of 30 patients were enrolled in the study, of which 25 patients underwent EBUS-TBFB. Eight patients had a history of lymphoma, one patient had history of squamous cell carcinoma, and one patient had history of chronic lymphocytic leukemia. A 22 gauge needle was used for aspiration in all the cases that were performed, and 1.5 mm or 1.8 mm forceps were used for the biopsy.The use of electrocautery knife at 20W (Olympus America Inc.) was required in 10/25 patients.The EC knife allowed all 10 of those to have successful entry of forceps into the lymph node. The cytology (aspiration from EBUS needle) and histopathology (from forceps) were concordant in 17 patients while it was discordant in eight patients. One patient developed pneumomediastinum after needle and forceps biopsy that required no intervention. EBUS-guided forceps biopsy is a safe procedure. EC knife did successfully allow forceps entry into the lymph node in all EC knife procedures. The diagnostic yield was 73% (22/30) which improved to 86% (26/30) when both techniques were combined (TBNA and TBFB).

Calcinosis Cutis and Calciphylaxis Mimicking Skin Infection

Abstract Calcinosis cutis refers to the deposition of calcium salts into the skin or subcutaneous tissue, and when these calcium deposits involve the vasculature, it is known as calciphylaxis (http://www.ncbi.nlm.nih.gov/books/NBK448127/). These conditions can both mimic and predispose patients to infections; thus, diagnoses may be confused between the two. We present 3 cases involving cutaneous wounds due to calcium deposition and discuss their infectious considerations. The first case is a 74-year-old male patient with myeloid sarcoma and B-cell acute lymphoblastic leukemia who was evaluated for calciphylaxis of the bilateral lower extremities. The second case is a 70-year-old female patient with a history of squamous cell carcinoma with subsequent surgical resection and radiation therapy of the right elbow who presented with right elbow cellulitis. The third case is a 68-year-old male patient with a history of myositis ossificans and multiple surgical excisions of calcium deposits who presented with a draining wound of the left upper extremity.

Orbital Lipolysis.

HomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyOrbital LipolysisTuba Kalelioglu , Sohil H. PatelTuba Kalelioglu , Sohil H. PatelAuthor AffiliationsFrom the Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, 1st Floor, Charlottesville, VA 22903.Address correspondence to T.K. (email: [email protected]).Tuba Kalelioglu Sohil H. PatelPublished Online:Jan 24 2023https://doi.org/10.1148/radiol.221947MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 47-year-old man with a history of squamous cell carcinoma of the oral tongue, alcohol-induced chronic pancreatitis with gastrostomy tube dependence, and chronic diarrhea presented to the emergency department with altered mental status. The patient was cachectic, with a body mass index of 14.3 kg/m2.MRI of the brain demonstrated diffuse loss of expected fat signal intensity with T1-weighted imaging, including within the orbits, bone marrow, and subcutaneous scalp (Figure). This appearance is similar to a fat-saturated T1-weighted image; hence, it is called “pseudo fat-saturated” (1). It is due to excessive lipolysis and lipid peroxidation induced by cachexia from chronic malnutrition in the setting of anorexia nervosa or systemic cancer. Furthermore, endothelial injury results in edema and contrast enhancement in the involved areas, conspicuous in the postseptal orbit (2).Images in a 47-year-old man with cachectic state. (A) T1-weighted image before cachectic state for comparison shows expected normal high signal intensity of the orbital, scalp, and bone marrow fat. (B) Axial T1-weighted image without fat suppression shows lack of expected hyperintense fat in the orbits, subcutaneous scalp, and bone marrow. The imaging appearance mimics a fat-saturated T1-weighted image. The volume of subcutaneous fat in temporal regions is decreased. (C) Postcontrast T1-weighted image shows diffuse contrast enhancement of the affected areas secondary to increased vessel wall permeability. (D) Noncontrast CT scan shows increased attenuation in the retrobulbar fat, consistent with edema.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: T.K. No relevant relationships. S.H.P. No relevant relationships.

Various Presentations Associated with Enhancement of the V2 Branch of the Trigeminal Nerve

The two patients discussed in this case report presented with radiologic enhancement of the V2 segment of the trigeminal nerve. The first patient discussed in this case report is a 78-year-old female with a history of squamous cell carcinoma of the face who presented with paresthesias involving the left V2 segment of the trigeminal nerve. A maxillofacial MRI was performed that showed subtle, thin enhancement along the outer margin of the left maxilla, and enhancement along the anterior course of V2. These findings suggested the possibility of V2 perineural spread of a tumor secondary to squamous eccrine duct carcinoma. The second case discusses a 71-year-old female who presented with symptoms of trigeminal neuralgia. An MRI was performed and showed thickening and enhancement of the right infraorbital nerve within the maxillary sinus with no significant neurovascular contact at the root entry zone. Further assessment by neurosurgery suggested this patient likely had isolated neuritis of the right infraorbital nerve, causing severe classic neuralgic symptoms. The third case presents a 28 year old male with MRI findings showing bilateral V2 enhancement within the anterior maxillary infraorbital foramina bilaterally. These three cases emphasize the importance of understanding the anatomy of the trigeminal nerve and maintaining a comprehensive knowledge of the common pathologies that affect cranial nerves. This awareness is critical in appropriately recognizing and diagnosing V2 pathologies and identifying their unique characteristics on various imaging modalities.

An unusual case of angioleiomyoma of the vocal cord in a patient with oral cancer

&lt;p class="abstract"&gt;Angioleiomyomas, as the name suggests, are tumors arising from smooth muscle of vascular tissue. We report a case of angioleiomyoma arising from the right vocal cord in a 45-year-old male with a history of squamous cell carcinoma (SCC) of the oral cavity who had restricted mouth opening owing to previous surgery and adjuvant radiation therapy because of which accessing the vocal cord tumour was difficult by conventional laryngoscopy. Initial bronchoscopy guided excision of the tumour was done. After a month, an emergency tracheostomy had to be performed as he presented with stridor due to recurrence of tumour. Laryngofissure was performed and tumour was excised. The patient is on regular follow up with no recurrence of tumour. We present in this case report, the clinical presentation, diagnosis, management options, pathological features and outcomes of this rare entity known as laryngeal angioleiomyoma.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Late Complication of Orthotopic T-Pouch Ileal Neobladder Diversion

A 69-year-old female with history of squamous cell carcinoma of the bladder who underwent anterior pelvic exenteration with an orthotopic T-pouch ileal neobladder 20 years ago was referred to the urology clinic because of worsening renal function. At time of urologic evaluation, the patient was voiding volitionally with a low post-void residual. Despite complete bladder emptying and a fluoroscopic cystogram demonstrating no evidence of reflux, she was recommended by her local urologist to perform clean intermittent catheterization 4-5 times/day, but her renal function continued to deteriorate. Laboratory evaluation revealed a decline in estimated glomerular filtration rate to 29 ml/min/1.73m2 from a baseline of 50 ml/min/1.73m2. A non-contrast computed tomography scan is shown below (Figure) and demonstrated bilateral hydroureteronephrosis and a dilated afferent limb (arrow) of the T-pouch despite a decompressed neobladder (asterisk).

S2060 Localized Lymphoid Hyperplasia of the Colon Mimicking MALT-Lymphoma in a Patient With Ulcerative Colitis

Introduction: Localized lymphoid hyperplasia (LLH) of the colon, also known as rectal tonsil, is a rare clinical entity. When present, LLH almost always presents in the rectum. LLH can appear as a polyp of varying sizes, nodule, or a mass. Rectal bleeding is usually the most common presenting symptom of LLH. In most cases, LLH resolves without any intervention; however endoscopic differentiation from extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is challenging. We present a case with ulcerative colitis (UC) having a diagnosis of LLH of rectum. Case Description/Methods: A 54-year-old male with a history of ulcerative colitis for 6 years was admitted to our hospital after an observation of abnormal metabolic activity in the rectum on a positron emission tomography/computed tomography (PET/CT) scan. He had a past medical history of squamous cell carcinoma of the lung, for which he underwent resection 16 years prior to his present admission. In his subsequent follow-ups, the present PET/CT scan was performed and he was consulted to our division. His UC was under remission and he had no symptoms. His laboratory tests were unremarkable and CMV viral tests were negative. His medications included oral mesalamine 4 g/d. He never required steroids or any immunomodulatory therapy. A decision to perform a colonoscopy was made. A horseshoe-shaped area with ulceration in the middle was observed in the rectum. Multiple biopsies were taken. Histopathological analysis revealed superficial mucosal fragments of lymphoid hyperplasia between lamina propria and submucosa. Cytokeratin AE1/AE3 immunostaining was negative, and dysplasia was not present. The patient was diagnosed with LLH of the rectum. A control colonoscopy was scheduled for 3 months later, and the regression of the lesion was observed (Figure). Discussion: Despite rectal bleeding being the most common presentation of LLH, patients can be asymptomatic, as seen in our case. LLH is usually considered a benign lesion, however some reports suggest its association with MALT-lymphoma. Histopathological analysis is essential to exclude a malignant process, and to make the correct diagnosis.Figure 1.: A: Horseshoe-shaped area with ulceration in the middle in rectum. B: Control rectoscopy showed no lesion. C: Hematoxylin-eosin staining of the lesion shows lymphoid nodular hyperplasia.

34954 Cutaneous microbial markers of squamous cell carcinoma risk in solid organ transplant recipients

Solid organ transplant recipients (SOTRs) are 100-times more prone to aggressive cutaneous squamous cell carcinoma (SCC) compared with the general population. Despite this increased mortality, our ability to prognosticate risk of cancer in SOTRs is still poor. Accumulating evidence suggests a detrimental influence of microbial dysbiosis on transplant outcomes and immunosuppressant metabolism. Additionally, altered skin microbiome, specifically excessive colonization of the skin by Staphylococcus aureus, has been found in cutaneous SCCs of immunocompetent individuals. We hypothesized that cutaneous dysbiosis is a potential modifier to the risk of SCC in SOTRs and that the microbiome of SOTRs with a history of SCC (>4 instances) is distinct from the microbiome of SOTRs without a history of SCC. To investigate this theory, we generated microbial genomic data from the skin samples of 2 matched cohorts: SOTRs with and without history of SCC. Analyses included testing for differences in microbial diversity measures and differentially relatively abundant microbiome species between cohorts. In the cutaneous microbiomes of SOTRs with SCC history, we identified a significantly reduced abundance of Roseomonas mucosa, which is a S aureus–suppressive species. This suggests a protective effect of R mucosa against the development of SCC through suppression of a bacterial species hypothesized to initiate inflammation-related signaling involved in SCC-genesis. Overall, these findings not only point to a potential role of cutaneous microbiomes as predictive biomarkers for the development of SCC in SOTRs but also suggest that the microbiome can be used for potential preventive and interventional strategies.

Life Expectancy in Survivors of Esophageal Cancer Compared with the Background Population

It is unknown whether the survival of patients cured of esophageal cancer differs from that of the corresponding background population. This nationwide and population-based cohort study included all patients who survived for at least 5 years after surgery for esophageal cancer in Sweden between 1987 and 2015, with follow-up throughout 2020. Relative survival rates with 95% confidence intervals (95% CI) were calculated by dividing the observed with the expected survival. The expected survival was assessed from the entire Swedish population of the corresponding age, sex, and calendar year. Yearly relative survival rates were calculated between 6 and 10 years postoperatively. Among all 762 participants, the relative survival was initially similar to the background population (96.1%, 95% CI 94.3–97.9%), but decreased each following postoperative year to 83.5% (95% CI 79.5–87.6%) by year 10. The drop in relative survival between 6 and 10 years was more pronounced in participants with a history of squamous cell carcinoma [from 94.5% (95% CI 91.2–97.8%) to 70.8% (95% CI 64.0–77.6%)] than in those with adenocarcinoma [from 96.9% (95% CI 94.8–99.0%) to 91.5% (95% CI 86.6–96.3%)], and in men [from 96.0% (95% CI 93.8–98.1%) to 81.8% (95% CI 76.8–86.8%)] than in women [from 96.4% (95% CI 93.4–99.5%) to 88.1% (95% CI 81.5–94.8%)]. No major differences were found between age groups. In conclusion, esophageal cancer survivors had a decline in survival between 6 and 10 years after surgery compared with the corresponding general population, particularly those with a history of squamous cell carcinoma of the esophagus and male sex.

Right arm rash

A 66-year-old man with a history of squamous cell carcinoma in-situ presented to the Family Medicine Skin Care Clinic with a rash of several weeks’ duration on his right forearm. The patient had been prescribed topical 5-fluorouracil (5-FU) for treatment of actinic keratoses on his right arm. Over the previous 3 weeks, he’d noticed increasing weeping, scabbing, and redness along his forearm. He reported occasional pruritus and discontinued use of the 5-FU 1 week prior to presentation.What’s your diagnosis?

69-Year Old Man With Dysphagia and Nasal Regurgitation

69-Year Old Man With Dysphagia and Nasal Regurgitation

Cytomorphologic Features of Extramammary Paget’s Disease of The Vulva in a patient with history of Squamous Cell Carcinoma of The Cervix, Status Post Chemoradiation and Neoadjuvant Therapy. The Importance of Basic Principles

Abstract Introduction/Objective Extramammary Paget disease (EMPD) is a rare neoplasm commonly affects postmenopausal women. It usually presents in the anogenital area where apocrine sweat glands are abundant, most commonly in the vulva. The disease is characterized by slow grow and high local recurrence rates. Clinically, EMPD present as well demarcated erythematous lesion or plaques that may ulcerated. Microscopically, it shows a group of atypical cells with abundant clear cytoplasm and nuclear pleomorphism. Methods/Case Report Here in we present a 58-year-old female with history of vulvar intraepithelial neoplasia III (VIN III) status post wide local excision, and poorly differentiated squamous cell carcinoma status post radical hysterectomy and bilateral salpingo-oopherectomy and chemoradiation who presented for perineal pain, itching and discomfort. She also noticed skin changes on her left labia without bleeding or discharge. Punch biopsies of the vulva and periurethral areas revealed acanthosis of the epidermis with intraepidermal scattering of single or clusters of large cells with round/ovoid nuclei and abundant clear cytoplasm. The cells are positive for p16, CK19, CK7, PAX8 supporting the diagnosis of EMPD without evidence of dysplasia. The concurrent PAP smear shows hypercellular specimen composed of hyperchromatic fragments of tissue with high nuclear-to-cytoplasmic rations, and apoptotic bodies. The presence of intracytoplasmic mucin and the tridimensionality of the fragments supported the diagnosis of adenocarcinoma. The HPV testing was positive for HPV-16. Results (if a Case Study enter NA) N/A Conclusion This study compares the histological and cytomorphological features of EMPD with high-grade squamous intraepithelial lesion (HSIL), since the molecular pathways, precursor lesions, etiologic associations, staging, clinical treatment, and prognosis differ substantially and may have a significant clinical impact for the patient’s treatment.

S2062 Sudden Dysphagia After Total Laryngopharyngectomy

Introduction: Total laryngopharyngectomy is done for extensive laryngeal and hypopharyngeal cancers, including squamous cell carcinoma and advanced thyroid cancer. The surgery’s aim is to remove cancer, and restore continuity of the oral cavity and esophagus. Most commonly a skin flap is used to recreate a neopharynx connecting the mouth to the esophagus. A favored method is to use the anterior thigh flap. Common sequelae of this surgery include fistula formations and strictures. We present a case of food impaction in the post surgical period of an anterolateral thigh flap reconstruction after squamous cell carcinoma of the larynx. Case Description/Methods: A 58 y male with a history of squamous cell carcinoma of the larynx complicated by tumor invasion of the cervical esophagus and epiglottis status post total laryngopharyngectomy, tracheostomy, G tube, and cricothyroidotomy presented to the ED with discomfort after eating lasagna. His post surgical course had been complicated by recurrent fistula formation and was therefore recommended NPO status and a salivary bypass tube was placed. Following his meal he felt a foreign body sensation, dysphagia, and vomited. On physical exam he was noted to be uncomfortable but was able to tolerate his oral secretions. An esophagram revealed occlusion of the proximal salivary bypass tubing and an EGD was subsequently performed. Using a pediatric scope the salivary bypass tubing was entered and retained food was seen. Using gentle suctioning, water, and forceps, the food was pushed into the native esophagus. The patient's symptoms resolved following the procedure and he was discharged on tube feeds. Discussion: Pharyngoesophageal reconstruction with an anterolateral thigh flap reconstruction is a favored surgical technique after total laryngectomy. To prevent or treat a post surgical fistula or stricture, a salivary bypass tube may be placed. While studies show that the majority of patients are eventually able to tolerate nutrition by mouth, gastroenterologists should be aware of the risk of food bolus given the narrow diameter and lack of distensibility and motility of the bypass tubing.Figure 1.: Endoscopy image showing. Red arrow: Inlet patch Blue arrow: melanocytosis.