Hypopharyngeal Mass Research Articles

Undifferentiated Small Round Cell Sarcoma of the Hypopharynx in a 7-Month-Old Patient.

Undifferentiated small round cell sarcoma is an extremely rare and highly aggressive tumor touching the soft tissues and bones. Here, we report the case of a 7-month-old girl who presented to our department with respiratory distress due to a hypopharyngeal mass causing airway obstruction. The patient underwent a tracheotomy and had a direct laryngoscopy. Histological examination confirmed the diagnosis of an undifferentiated small round cell sarcoma. The patient received chemotherapy and radiotherapy and underwent neck dissection. One year later, the patient was diagnosed with local recurrence as well as metastatic cervical nodes and liver and pulmonary metastases. The case is original by the tumor's location and the age of onset. To the best of our knowledge, this could be the first case in English and French literature reporting an undifferentiated small round cell sarcoma affecting the hypopharynx among infants. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its prognosis and treatment options.

Neurofibrolipoma of Hypopharynx: A Rare Entity.

A Large pedunculated neurofibrolipoma involving the hypopharynx is a very rare entity. Patient with hypopharyngeal polyp usually presents with progressive dyaphagia, sensation of persistent lump in throat and difficulty in breathing. Regurgitation of the mass into the airway can led to fatal asphyxiation on several occasions and may rarely cause death also if not evaluated and treated timely. Malignant degeneration of these large polyps occurs infrequently. We encountered a case with similar complaints in our outpatient department. After complete clinical examination, radiological investigations and anaesthetic evaluation; patient was taken for elective tracheostomy first and subsequently followed by successful transoral endoscopic excision of hypopharyngeal polypoidal mass. The histopathological examination of mass revealed it to be a neurofibrolipoma.

A lump in the throat

A 73-year-old man with hypertension, gastroesophageal reflux disease, and no history of smoking, drinking, or previous cancer, presented to the emergency department at the University of California, Irvine Medical Center (Orange, CA, USA) after acute onset of a protruding oral mass, difficulty breathing, and dysphagia. The patient had been walking his dog on a leash when the dog jerked him forwards, resulting in an episode of coughing, choking, and emesis. Before this event, the patient reported intermittent dysphagia, and feeling as if something was stuck in his throat, which improved with swallowing. The incident while walking his dog caused dislodging of a large non-tender soft-tissue mass (figure A) into the oral cavity and out of his mouth. The patient had never experienced this before, although he did recall a couple of episodes of coughing after which he felt a lump in his throat that resolved. (A) Hypopharyngeal mass protruding from the mouth. The patient's tongue is inside of his mouth. (B) Endoscopic view of mass.

A case report of anaplastic thyroid cancer and papillary thyroid cancer lymph node metastasis: an unusual presentation as an invasive hypopharyngeal mass

Anaplastic thyroid carcinoma is a rare undifferentiated tumour of the thyroid follicular epithelium. It almost always develops from a pre-existing well-differentiated thyroid cancer with a co-existent thyroid malignancy varying from 5 to 17% . The co-existence of papillary thyroid cancer (PTC) with anaplastic thyroid cancer is a rare occurrence in metastases outside the primary thyroid lesion. Traditionally, this has been regarded as an aggressive form of cancer associated with a dismal prognosis. Recently, the focus has shifted to the development of novel therapies based on the availability of comprehensive genomic profiling platforms (CGP) with a rapid turn-around to identify molecular aberrations in tumours which acts as potential therapeutic targets. In the United Kingdom, we report the case of a 60-year-old woman with an unusual presentation of (metastatic) anaplastic thyroid carcinoma and concomitant papillary thyroid cancer metastasis within a contralateral lymph node. This was initially perceived as a left pyriform fossa mass involving and compressing her left hemi-larynx on clinical and radiological examination. Following the identification of BRAF V600E mutation on CGP, she was started on targeted therapy with the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib and demonstrated excellent clinical and radiological response following 7 months of treatment. She has subsequently undergone total thyroidectomy alongside with bilateral neck dissection, and is due to start radioactive iodine treatment to reduce the risk of recurrence of disease.

Role of Diffusion-Weighted Magnetic Resonance Imaging in Laryngeal and Hypopharyngeal Cancer in Comparison to Histopathological Finding

Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) has the ability of tissue characterization and can differentiate between benign and malignant tissues, including differentiation between benign post-radiotherapy changes and residual or recurrent malignancy. Objective: This study aimed to assess the role of diffusion-weighted magnetic resonance imaging in the evaluation of laryngeal and hypopharyngeal cancer as an initial diagnosis and the post-treatment surveillance protocol. Patients and methods: This study was a cross-sectional analytical study including twenty-five patients who presented with laryngeal or hypopharyngeal masses, thirteen cases were pretreatment cases, and twelve cases were post-treatment cases after completion of treatment. Seven cases had a hypopharyngeal origin, and eighteen cases had a laryngeal origin. The patients were assessed using history taking, a telescopic examination of the larynx and hypopharynx, computed tomography scanning, and diffusion-weighted magnetic resonance imaging on the neck. Direct laryngoscopic examination and biopsy taking from suspicious lesions were done. Biopsies were subjected to histopathological examination with a correlation between pathological and DW- MRI radiological results. Results: DW-MRI had a 100% sensitivity, 82.4 % specificity, and 88% accuracy compared to histopathological findings of biopsies from the studied group. There was a non-significant difference between DW-MRI and biopsy findings for either pretreatment or post-treatment cases of both laryngeal and hypopharyngeal origin of the lesions (p-value > 0.05 for all). Conclusion: DW-MRI is a sensitive tool for detecting laryngeal and hypopharyngeal cancers in new cases and excluding tumor residual after chemo-radiotherapy in cases with suspicious lesions after completion of treatment.

S2093 Case Report of Hypopharyngeal Extraesophageal Cancer Incidentally First Visualized and Diagnosed at Esophagogastroduodenoscopy With Tumor Mass Biopsies

INTRODUCTION: A gastroenterologist standardly concentrates on examining the esophagus, stomach, and duodenum at esophagogstroduodenoscopy (EGD), while an otolaryngologist concentrates on examination of the hypopharynx, vocal chords, and larynx during flexible laryngoscopy. Therefore, a laryngologist is almost always the first to diagnose hypopharyngeal cancer by laryngoscopy with biopsies. However, the gastroenterologist gets a fleeting look at hypopharyngeal structures during EGD. A case is reported of a gastroenterologist incidentally diagnosing hypopharyngeal (extraesophageal) cancer during EGD. CASE DESCRIPTION/METHODS: A 68-year-old female, with a 50-pack-year history of smoking cigarettes, long history of alcoholism, and no known GERD presented with 10 weeks of dysphagia to solids and liquids associated with 10-kg-involuntary weight loss during 6 weeks. Physical examination revealed cachexia (BMI = 16.0 Kg/m2), and temporal and intercostal muscle wasting. The hemoglobin level was 13.6 g/dl. Routine liver function tests were within normal limits. EGD performed by gastroenterology revealed mild antral gastritis, and an endoscopically normal esophagus and duodenum. During endoscopic extubation, a friable 2.0-cm-wide exophytic left arytenoid/hypopharyngeal (extraesophageal) mass, with overlying exudate that was not obstructing the airway or esophagus was identified and biopsied (Figure 1). Pathologic analysis of these biopsies revealed moderately well-differentiated invasive squamous cell carcinoma (Figure 2), which was confirmed by positive immunohistochemistry for p40, and p16 (not illustrated), which are markers for squamous cell cancer. Neck CT scan revealed a 2.5-cm-wide hypopharyngeal mass (Figure 3). Positive emission tomography scan showed the same hypopharyngeal mass. After undergoing prophylactic PEG placement, the patient received daily radiation to the hypopharynx and bilateral neck area for a total of 70 gy during 7 weeks, with concurrent chemotherapy with 3 rounds of cisplatin. Follow-up neck CT 6 months later showed near complete resolution of tumor bulk. DISCUSSION: This work shows that a gastroenterologist can incidentally diagnose major hypopharyngeal lesions during EGD, and successfully diagnose hypopharyngeal cancer by endoscopic biopsies. Gastroenterologists may avoid biopsying lesions next to the vocal chord due to the risks of inducing laryngospasm. Incidental diagnosis during EGD by gastroenterologists may reduce medical costs and improve patient prognosis by earlier cancer detection.Figure 1.: Image obtained during esophagogastroduodenoscopy showing a 2.0 cm wide hypopharyngeal mass, not obstructing the vocal chords which are seen distally.Figure 2.: Medium power photomicrograph of hematoxylin & eosin (H&E) stained section of endoscopic biopsies of hypopharyngeal mass shows non-keratinizing squamous cell carcinoma (arrows), with tumors cells showing high nuclear-to-cytoplasmic ratio, high-grade, pleomorphic cytologic features, and having intimately associated lymphoplasmocytic infiltrates.Figure 3.: Axial view image of CT scan of the neck with IV contrast showing a heterogeneously enhancing mass (arrow) in the supraglottic region, arising from the left aryepiglottic fold, measuring 2.5 × 1.8 cm.

Incidentally Detected Hypopharyngeal Mass during Endotracheal Intubation

Hypopharyngeal mass is an uncommon condition in the aerodigestive tract. There were only a few cases have been published in the medical literature. We experienced a case of incidentally detected hypopharyngeal mass during endotracheal intubation. Hypopharyngeal mass was located at the right posterior pharyngeal wall. The hypopharyngeal mass was small and not obstruct the glottis, and endotracheal intubation was performed successfully. We have also briefly discussed symptoms, diagnosis, and related problems during general anesthesia of hypopharyngeal mass. Key words: Airway obstruction; Hypopharynx; Airway management; Intratracheal intubation

Endoscopic submucosal dissection for the treatment of synchronous hypopharyngeal mass and esophageal superficial carcinoma

Endoscopic submucosal dissection for the treatment of synchronous hypopharyngeal mass and esophageal superficial carcinoma

Coughing up a Polyp: A Rare Cause of Dysphagia!

Fibrovascular polyps are rare, benign intraluminal lesions composed of fibrous, vascular and adipose tissues. They tend to be large and pedunculated and most commonly arise in the proximal esophagus. The incidence is higher in men and typically present in the 6th or 7th decade of life. A 74-year-old male presented with intermittent symptoms of dysphagia and episodes of choking in which he would cough up a mass and then swallow it again. He denied any odynophagia or respiratory distress between the episodes. There were no reports of weight loss or anemia. Upper endoscopy showed a proximal cervical submucosal lesion. A CT scan revealed a low-density lesion within the superior esophagus and a barium swallow showed a large pedunculated filling defect with a visible stalk extending superiorly within the upper esophagus. Further examination by endoscopic ultrasound showed a long esophageal polyp from the area immediately below the vocal cords extending down about 5cm. The polyp was estimated to be at the level of the upper esophageal sphincter area/hypopharynx (Figure 1). The patient was ultimately referred to ENT for endoscopic resection of the hypopharyngeal mass. The polyp, measuring about 6cm in length and 3cm in width, was resected en bloc (Figure 2). The patient tolerated the procedure well and was discharged the following day with only moderate odynophagia that soon resolved. Pathology was benign with the polyp described as a fibroepithelial lesion with focal surface erosion, reactive epithelial changes, and marked vascular congestion. Fibrovascular polyps are rare, benign polyps. While the exact etiology is unknown, it is thought that these types of polyps arise from redundant mucosal folds that slowly elongate over time due to constant traction from peristaltic activity. They tend to be slow growing and are often able to reach a large size before discovery. The most common presentation is dysphagia followed by globus sensation, but they can also cause anemia, weight loss and odynophagia. The most severe complication is regurgitation of the polyp into the oral cavity which can lead to asphyxiation. Despite different imaging modalities, these polyps are often misdiagnosed or missed, especially on EGD where they can resemble normal mucosa or lay flat against the lumen. Prompt removal by endoscopic or surgical resection is important to prevent potentially fatal complications.1815_A Figure 1. Imaging1815_B Figure 2. fibrovascular polyp

The Role of a Gastroenterologist in Detection of a Hypopharyngeal Cancer: A Case Report

Introduction: Current guidelines do not recommend routine oropharyngeal evaluation on esophagogastroduodenoscopy (EGD). We present a case of hypopharyngeal cancer missed on two consecutive EGDs.Figure: Hypopharyngeal mass as seen during the EGD.Case: A 71-year-old male with history of prostate cancer status post radiation therapy presented with complaints of globus sensation, and gradually worsening dysphagia and odynophagia to solids and liquids for 2 months. He denied food regurgitation, heartburn, hematemesis, melena, allergies, weight loss, smoking or alcohol consumption. An EGD was performed which showed LA grade D esophagitis, small hiatal hernia and a duodenal bulb ulcer. He was started on high dose proton-pump inhibitors. Biopsies were negative for H. pylori. A repeat EGD after 2 months showed good resolution of esophagitis and well healed duodenal ulcers, as well as esophageal biopsies were negative for eosinophilic esophagitis. The patient's dysphagia persisted and further work up with an esophagram and a motility study were unrevealing. A third EGD was performed for attempted impedance evaluation to assess for association of reflux symptoms. Upon insertion of the endoscope in the hypopharynx, a 2cm friable, non-ulcerated hypopharyngeal mass was observed. Results of the biopsies revealed invasive poorly differentiated squamous cell carcinoma. A direct laryngoscopy confirmed the mass was originating from the post-cricoid mucosa, posterior to the arytenoids without arytenoidal mucosal involvement. A PET/CT scan was done and the tumor was classified as T1N0M0. Patient received radiation therapy with resolution of symptoms. Discussion: Hypopharyngeal cancers (HPC) are aggressive with majority diagnosed at advanced AJCC stages III or IV. Diagnosis of HPC at earlier stages might improve survival outcomes. In US, 7 million routine EGDs are performed per year. Oropharyngeal structures are also visible during EGDs. Therefore, EGDs could be a valuable tool in HPC screening, especially in high-risk patients. Currently, there are no guidelines regarding routine evaluation of the oropharyngeal anatomy during EGD. Since prior EGDs had missed the HPC lesion, this case raises several important questions. Should complete visualization of the oropharyngeal structures be part of a routine EGD? Does prolonged oropharyngeal evaluation during EGD raise the aspiration risk? Are there any specific sedation protocols better suited for oropharyngeal evaluation? Further studies are required to answer such questions.

Successful tracheal intubation with video laryngoscope when awake fiberoptic bronchoscopy failed in a patient with hypopharyngeal mass

Video laryngoscope is one of best alternative in managing difficult airways. Our patient presented with left side neck pain and hoarseness of voice for three months, dysphagia to solids for two months. Computed tomography revealed large hypopharyngeal mass and a diagnosis of carcinoma of hypopharynx was made. As endoscopic Ryle’s tube insertion by gastroenterologist was unsuccessful so he was posted for Feeding jejunostomy under general anaesthesia. We anticipated difficult endotracheal intubation. Our first attempt to secure airway with awake fiberoptic bronchoscopic intubation was unsuccessful. Using an alternative method with bougie and video laryngoscopy, the trachea was successfully intubated. In rare clinical scenario fiberoptic bronchoscopic intubation may fail, hence we need to be prepared with the backup plan for airway management. A video laryngoscope might be useful in such situations.

An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review.

Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.

Hypopharyngeal venous malformation presenting with foreign body sensation and dysphagia

ObjectiveReview the importance of imaging selection and clinicoanatomic correlation for a vascular malformations presenting with unique symptomatology. MethodsCase study and literature review. ResultsA 64-year-old female presented with globus and dysphagia ongoing for 40years. Esophagogastroduodenoscopy discovered a hypopharyngeal mass. A CT scan showed a soft tissue mass with shotty calcifications. Flexible laryngoscopy revealed a bluish compressible mass. MRI showed T2 hyperintensity with heterogeneous enhancement resulting in the diagnosis of a low-flow vascular malformation. ConclusionsAll globus is not equal. Attention to symptoms, anatomy, and imaging selection is crucial for the diagnosis and treatment of vascular malformations uniquely presenting with dysphagia.

Time to competency, reliability of flexible transnasal laryngoscopy by training level: a pilot study.

To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Prospective case control study. Academic otolaryngology department. Medical students, otolaryngology residents, and otolaryngology attending physicians. Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class and compare competency versus attending interpretations. Intraclass correlation of residents compared to attending physicians demonstrated significant improvements by year for left and right vocal fold immobility, subglottic stenosis, laryngeal mass, left and right vocal cord abnormalities, and level of concern. Additionally, pooled vocal cord mobility and pooled results in categories with good attending reliability demonstrated stepwise improvement as well. For these categories, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. There were no trends for base of tongue abnormalities, pharyngeal abnormalities, and pharyngeal and hypopharyngeal masses. Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by the PGY-3 year over key facets of the examination.

Dysphagia, hoarseness, and a hypopharyngeal mass.

We describe a patient who developed a hypopharyngeal mass (in the setting of a cervical osteophyte) while taking clopidogrel and aspirin for coronary artery disease. He had a 2-month history of progressive dysphagia and hoarseness. Physical examination and computed tomography scan revealed a soft tissue retropharyngeal mass of unclear etiology yet with a stable airway. He was admitted to the intensive care unit for a 48-hour clopidogrel washout followed by surgery. A hematoma and cervical osteophyte were removed with scant bleeding. This case report emphasizes the need to consider the medication history of a patient when assessing the cause of an otherwise unexpected finding.

Time to Competency: Reliability of Flexible Transnasal Laryngoscopy by Resident Training Level

Objectives: Determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Methods: Prospective study of flexible transnasal laryngoscopy interpretations. Seventeen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally-recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class, and competency compared to attending interpretations. Results: Intraclass correlation of residents compared with attending physicians demonstrated significant improvements by year for left vocal fold immobility (ICC 0.85-0.96), right vocal cord immobility (ICC 0.80-0.97), subglottic stenosis (ICC 0.70-0.97), and level of concern (ICC 0.72-0.87). There were no trends for base of tongue abnormalities, pharyngeal abnormalities, pharyngeal masses, and hypopharyngeal masses. For vocal cord immobility, subglottic stenosis, and level of concern, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. Conclusions: Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by PGY-3 over key facets of the examination. Flexible laryngoscopy may be a useful metric for procedural competency assessment during residency training.

Cervical limbus vertebra presenting as a hypopharyngeal mass

A 59-year-old female patient was referred to our radiology department with the complaints of cervical bolus sensation and dysphagia for 10 years. She had no history of significant medical problems. Endoscopic examination revealed a protrusion located through the posterior wall of the hypopharynx (Fig. 1). The initial diagnosis was a hypopharyngeal neoplasm, and magnetic resonance imaging and plain radiography were performed. Magnetic resonance imaging of neck showed a triangular smooth bone fragment at the superior end plate of C4 vertebrae and bulging of the posterior hypopharyngeal wall (Fig. 2).

A Hypopharyngeal Ductal Cyst Masquerading as a Laryngopharyngeal Reflux Disease

The ductal cyst of the hypopharynx is a very rare tumor. We report a case of hypopharyngeal ductal cyst in a 63-year-old man presenting with globus sensation. It was removed by a laryngomicrosurgical technique, using a microdissection electrode. Masses of the hypopharynx may not always be easily visible on routine examination of the hypopharynx with flexible fiberoptic laryngoscopes. Particularly in cases of benign tumors, the diagnosis may be delayed due to a prolonged history of mild and subtle symptoms. We missed the hypopharyngeal mass at the initial presentation, but could detect the mass in the pyriform sinus with a double contrast barium swallow study. We describe the diagnostic method to detect hypopharyngeal tumors and the treatment of benign hypopharyngeal masses.

Ciddi Hava Yolu Tıkanıklığına Sebep Olan ve Endolarengeal Lazer Eksizyonu ile Tedavi Edilen Dev Hipofarengeal Lipom

Lipomas are the most common benign tumors of mesenchymal origin. Although they are rarely seen in the head and neck region, their most common location in the head-neck are the posterior neck. Lipomas of larynx and hypopharynx are very rare. The aim of this paper is to report a case of a giant hypopharyngeal lipoma causing severe respiratory distress. A 76-year-old man with respiratory distress, stridor and voice changes present for 5 months was referred to our department. Videolaryngoscopic examination revealed a pedicled left piriform sinus mass with smooth and yellowish surface which was obstructing the laryngeal inlet during respiration. It was removed via endolaryngeal laser excision without any complications. The histopathologic investigation was reported as lipoma. Lipoma should be kept in mind in case of a hypopharyngeal large mass with a smooth and yellowish surface. Computerized tomography is useful in the differential diagnosis, and endolaryngeal laser excision is a good surgical treatment option for removal.

Carcinosarcoma of the Hypopharynx—A Rare Entity with Unique Surgical Procedure

Background: Carcinosarcoma of hypopharynx is a rare neoplasm with both malignant epithelial and mesenchymal components. They are highly aggressive in nature with controversial histogenesis. To our knowledge, there is no case reported of carcinosarcoma of hypopharynx managed with wide LASER excision and modified radical neck dissection followed by chemoradiation. Method and Result: 42-year-old male presented complaints of foreign body sensation in throat, and difficulty in swallowing and hoarseness for 4 months. On examination, a large smooth globular mass filling the supraglottis obscuring the view of endolarynx was noted and right side level-II cervical lymphadenopathy was found. CECT neck revealed a large hypopharyngeal mass abutting the supraglottis. Microlaryngoscopic biopsy was reported as high grade carcinosarcoma and PET scan was done after 1 week which revealed no any distant metastasis. The patient was taken for transoral pulsed carbon dioxide LASER excision with modified radical neck dissection, and postoperative chemoradiation was done and after two years of closed follow-up MRI was done which revealed no disease and the patient is absolutely free of disease till now. Conclusion: It was a rare case which was managed with complete LASER excision with neck dissection and postoperative chemoradiation and the patient is absolutely free of disease till now after 2 years of follow-up.