Left Piriform Sinus Research Articles

Granular Cell Tumor of the Hypopharynx: A Rare Case Report

Aims: Granular cell tumor is an extremely rare tumor, accounting for 0.5% of all soft tissue tumors. This rare neoplasia have variable age, sex and ethnicity predilection. Positive staining for S-100 protein confirms the diagnosis and no harmonized treatment guideline is established. We report true this manuscript a rare case of benign of granular cell tumor of the hypopharynx. Materials and Methods: Case report. Results: We add to the literature arsenal of this entity by reporting this rare case of benign of granular cell tumor of the hypopharynx in A 74 years-old female patient with hypertension, suffered from dysphonia for about 6 months. Examination identified a budding tumor in the left piriform sinus. Ct scan showcased a 1 cm irregular, spontaneously hypodense, slightly enhanced after injection mass, infiltrating the left piriform sinus. Excisional biopsy confirmed the diagnosis and follow-up was uneventful. Conclusion: Originating from the Schwann cells; Granular cell tumor has nonspecific symptoms and usually displays as small, smooth, submucosal lesion. Variant of this tumor can be classified as either as synchronous or metachronous, or either malignant, begin or atypical.

Isolated hypopharynx lipoma: a case presentation and literature review

BackgroundLipomas are the most common benign mesenchymal tumors. They are defined as subcutaneous neoplasms of mature adipocyte cells that can occur wherever fatty tissue is. Lipomas are rare in the upper aerodigestive tract. Usually asymptomatic, they may be painful, uncomfortable, or even life-threatening especially if voluminous and located in the upper aerodigestive tract.Case presentationA 67-year-old female patient has presented with dyspnea on mild effort and chronic orthopnea. The physical examination was normal while the fiber optic endoscopy revealed a submucosal round-shaped mass rising from the left side of the post-cricoid region. CT scan revealed a well-circumscribed fatty mass of the left piriform sinus for which the patient underwent an endoscopic transoral approach for a complete removal with good results.Discussion and conclusionPharyngeal lipomas are rare entities that might be life-threatening. Although clinical manifestations are not specific, imaging techniques, especially MRI, help set the diagnosis showing a fatty mass of the upper aerodigestive tract. However, pathology examination is crucial to rule out low-grade liposarcomas. Surgical management is not well-codified and has benefited from the development of endoscopic techniques.

Cervical Fracture with Piriform Sinus Laceration

Abstract Particular case of complex cervical trauma by associating a cervical fracture with piriform sinus laceration. The trauma is located in the anatomo-topographic zone II. Delayed onset at 24 hours of digestive symptoms, swallowing disorders, sialorrhea, dysphagia, subcutaneous cervical emphysema. CT with Optiray contrast agent is performed, an investigation that reveals a gap in the left piriform sinus of 5-6 mm. The evolution is favourable under conservative treatment, nasogastric tube, broad spectrum antibiotic treatment.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children

IntroductionCongenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. ObjectivesThis study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. MethodsWe performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. ResultsChildren from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1year after the surgery. No recurrence occurred in any patient. ConclusionCongenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Acute suppurative thyroiditis caused by thyroid papillary carcinoma in the right thyroid lobe of a healthy woman

BackgroundThe thyroid gland is resistant to microbial infection, because of its organ characteristics such as encapsulation, iodine content, and rich blood supply. Therefore, acute suppurative thyroiditis (AST), as a bacterial infection of the thyroid gland, is rarely seen. AST typically takes places on the left side the neck region in children, because of the coincidence of the left piriform sinus fistula, as a most common route of infection. AST is also usually seen in immunocompromised hosts. Herein, we report a rare case of AST in the right thyroid lobe of adult woman without any immunocompromised condition.Case presentationA 59-year-old woman was introduced to our hospital for the further examination with fever, sore throat, and right anterior neck swelling. The patient appeared not to be immunodeficient. Neck ultrasonography showed a 47-mm, hypoechoic, heterogeneous nodule with ill-defined margins and irregular form, suggesting a right thyroid malignant nodule. Fine needle aspiration (FNA) biopsy specimen revealed numerous number of neutrophils in the background without nuclear atypia. Based on the clinical course and cytology, AST was confirmed to be diagnosed. Complete response was obtained by an intravenous administration of antimicrobial agents within a week. Image findings such as CT scan did not show any piriform sinus fistula. Four months later, neck ultrasonography showed a significant decrease in size of the nodule in the right thyroid gland to 27 mm, but the lesion still resembled a malignant nodule. So, FNA was repeated again and cytological examination confirmed papillary thyroid carcinoma (PTC). The patient subsequently underwent total thyroidectomy and bilateral level D1 lymph node dissection. Histological findings revealed a 20-mm PTC in the right lobe with sternothyroid muscle invasion of the tumor.ConclusionsThis report represents a rare case of AST associated with PTC on the right side of thyroid gland, found in a healthy adult woman. The reason why AST coincided with malignant thyroid tumor is unclear. We have to take it into our account that malignant tumor may exist in the background when AST is identified on the right side of thyroid gland with a healthy subject.

Diagnosis and management of laryngeal fracture: a case report

<p class="abstract">Laryngeal fracture is a rare and potentially fatal traumatic injury. Because of the rarity of this type of injury, many laryngeal fractures are often undiagnosed or poorly managed, leading to significant problems with airway patency, voice production, and swallowing. We report a case of a 49 year old man admitted to the emergency room after a motor cycle accident with cervical trauma. The patient presented with hoarseness, anterior neck pain, cervical subcutaneous emphysema, and increasing respiratory distress that led to the tracheostomy of the patient. The computed tomography (CT) of the neck revealed a comminuted fracture of the thyroid cartilage, a hematoma of the left piriform sinus and cervical subcutaneous emphysema. The three-dimensional CT showed a double fracture of thyroid cartilage with displaced intermediate fragment. The patient underwent an open reduction and internal fixation of the thyroid cartilage with miniplates along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. We conclude that early diagnosis and appropriate therapy favorably alters the prognosis in terms of long-term voice and airway outcome.</p>

A Rare Cause of Ortner's Syndrome: Pulmonary Artery Aneurysm

A 37-year-old non-smoker male patient with a 6-month history of hoarseness admitted to our hospital. Laryngoscopic examination revealed left vocal cord paralysis with immobile vocal cord in paramedian position. The patient underwent neck and chest CT imaging. Neck CT demonstrated thickening and medial deviation of the left vocal cord, dilatation of the left piriform sinus suggesting left vocal cord palsy. Chest CT showed a fusiform aneurysmal dilatation of the proximal left pulmonary artery with 51 mm diameter. Left laryngeal nerve had been compressed between pulmonary artery aneurysm and arcus aorta.

Well-differentiated, pedunculated liposarcoma of the hypopharynx

IntroductionLiposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia. Case reportThe authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma. DiscussionWell-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence.

Second Primary Mucosal Malignant Melanoma in Hypopharynx

Primary mucosal melanomas of the head and neck are rare. In addition, second primary mucosal melanoma following primary cutaneous malignant melanomas is very rare. We report a second primary mucosal melanoma. A 76-year-old woman, who had a previously cutaneous malignant melanoma of the left foot, visited with a complaint of a foreign body sensation of the throat. Endoscopy revealed a black mass at the left piriform sinus of the hypopharynx. After wide surgical excision of the lesion and reconstruction with a radial forearm free flap, the histopathology was confirmed to be a second primary mucosal malignant melanoma of the hypopharynx. Five months postoperatively, masses were palpated in the neck, and metastasis was diagnosed. The patient was treated with adjuvant chemotherapy and radiotherapy. Eight months postoperatively, computed tomography scans showed other metastatic masses in the liver, spleen, both adrenal glands, soft tissues of the abdominal wall, and both lungs. After that, the patient died 9 months postoperatively. We report a rare case of second primary mucosal malignant melanoma of the hypopharynx. Although rare, this case shows that a detailed examination of the hypopharynx and the head and neck should be a part of the follow-up examination in all cutaneous malignant melanoma patients.

How to handle laryngeal specimens?

Laryngohypopharyngectomies encompass the larynx with a dorsal covering of the mucosa of the hypopharynx subdivided in left and right piriform sinus and the median postcricoid area. Cranially, the specimen may include parts of the base of the tongue and caudally a varying number of tracheal rings. Endolaryngeally, one discerns between (1) supraglottic, (2) glottis, and (3) subglottic tumors. For examination of endolaryngeal tumor position and extension, the larynx has to be opened through a median vertical dorsal incision. For hypopharyngeal cancers, the larynx should not be opened to avoid compromising assessment of tumor margins in this area. For gross sampling, specimens are cut in horizontal slices. Margin assessment depends on location: base of the tongue for supraglottis, trachea for endolarynx and postcricoid region for hypopharynx. Postcricoid cancers may extend into the adjacent cervical oesophagus. Piriform sinus cancers may extend cranially into the oropharynx or craniomedially into the supraglottic larynx, thereby crossing the aryepiglottic fold. Issues of special interest are perforation of laryngeal cartilages with extralaryngeal soft tissue spread, endolaryngeal extension of a hypopharyngeal tumor that may involve the tracheal margin and hypopharyngeal cancers growing submucosally into the caudal surgical margin through the postcricoid area. Glottic cancers may spread dorsally into the submucosal soft tissues of the postcricoid area.

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.

Spindle-cell carcinoma of the hypopharynx presenting with a pedunculated appearance: CT and MR features

Spindle-cell carcinoma (SPCC) is a rare tumor that presents biphasic components: squamous-cell carcinoma and sarcomatous features without any differentiation. We present a case of SPCC of the hypopharynx in a 60-year-old man. A well-demarcated mass occupying the hypomesopharynx and presenting a pedunculated appearance was observed originating from the lateral wall of left piriform sinus. High signal intensity on T2-weighted magnetic resonance (MR) images corresponded to the myxoid matrix of the tumor on MR pathologic correlation.

Effects of chemotherapy for superficial meso and hypopharyngeal cancers with concomitant esophageal cancer.

134 Background: Recently, the frequency of superficial meso and hypopharyngeal cancer (Ph ca) has increased and elucidation of its biological behaviors is needed. There are no reports to analyze if superficial Ph ca responds to chemotherapy. Therefore, the aim of this study was to clarify the effects of chemotherapy for esophageal cancer on superficial Ph ca. Methods: A total of 48 patients and 57 lesions with superficial Ph ca with concurrent esophageal cancer were enrolled from November 2007 to December 2010. Among these, 29 patients and 31 lesions for which no chemotherapy had been administered for the esophageal cancer, and two patients for whom details of the treatment regimen or evaluation after chemotherapy were not available were excluded. So 17 patients with 24 lesions were included. The maximum diameter of the Ph ca was measured before and after the treatment by endoscopy, the lesion was graded as CR, PR, NC and PD, and the response rate (CR + PR) was analyzed retrospectively. Results: All patients were male with a mean age of 61.1 years. The Ph ca was located in the left piriform sinus in 9 lesions, right piriform sinus in 10 lesions, posterior wall of the hypopharynx in one lesion, and mesopharynx in 4 lesions. The mean diameter of the tumor was 16.3 mm. Among the concurrent esophageal cancers, 6 were classified into the superficial type and 11 into the advanced type. For treatment, DCF was administered for 4 patients and 5 lesions, FP for 8 patients and 11 lesions, FAN (doxorubicin + 5FU + nedaplatin) for one patient and two lesions, CPT11 + CDDP for one patient and one lesion, VP-16 + CDDP for one patient and two lesions, and weekly docetaxel for one patient and one lesion. Radiation therapy for concurrent esophageal cancer was administered in 8 cases. As a treatment response, 7 lesions showed CR, 7 showed PR, 9 showed SD, and one showed PD, so a total response rate was 58.3%. Especially for the 15 lesions whose tumor diameter was less than 20 mm, the response rate was 67%. Conclusions: The response rate was 58.3%, which is relatively good. We believe that the results of this study would serve as important indicators for determining the treatment strategy for superficial Ph ca with concurrent esophageal cancer.

A Case of Intramuscular Hemangioma of the Posterior Cricoarytenoid Muscle

Intramusucular hemangioma is a benign neoplasm frequently arising from the skeletal muscles of the trunk and extremities. Involvement of the head and neck by this tumor is rare, even though the majority of such tumors originate from the masseter and the trapezius. Preoperative diagnosis is very difficult because of the rarity and the distribution of these tumors in the deep space. We report on a rare case of intramuscular hemangioma, involving the posterior cricoarytenoid muscle. A 82-year-old female patient with an abnormal sensation in her throat, was found to have a tumor in the left piriform sinus. Thus we performed biopsies twice, but the pathology was not confirmed, with a report of just normal mucosa. However we speculated that the tumor was benign and so performed a lateral neck exploration. The tumor was completely removed. Histological examination revealed it to be an intramuscular hemangioma of the skeletal muscle. Based on the intraoperative findings of the tumor, we diagnosed it as an intramuscular hemanginoma originating from the posterior cricoarytenoid muscle. As the posterior cricoarytenoid muscle opens the glottal space, the left vocal cord was fixed medially after the surgery. Nevertheless its tonus appeared fine and phonetic function remained normal.

Pharyngeal Stasis of Secretions in Patients with Zenker Diverticulum

To determine whether patients with Zenker diverticulum are more likely to have stasis of secretions in the left piriform sinus, on in-office endoscopy, than patients with nonspecific dysphagia. A case-control study. A subspecialty swallowing clinic. All patients with radiographically confirmed Zenker diverticulum who were evaluated over a 5-year period were selected. A control group with dysphagia due to radiographically confirmed esophageal dysmotility, prominent cricopharyngeal bar, or stricture was identified. Two blinded laryngologists reviewed the recorded laryngopharyngoscopies. Thirty-four patients with Zenker diverticulum were identified; 11 were excluded because of previous surgery or other neurological conditions. Twelve (52.17%) of the remaining 23 Zenker diverticulum patients and 2 of the 73 (2.74%) control patients had greater pooling in the left versus right piriform sinus (2-tailed t test, P < .0001). The sensitivity of this physical examination finding in identifying patients with Zenker diverticulum was 52.17% (95% confidence interval, 31.08%-72.58%) and specificity was 97.26% (95% confidence interval, 89.56-99.52%). Patients with Zenker diverticulum less than 4 cm in size had increased pooling in the left versus right piriform compared with larger diverticulums. After surgical intervention, there was a statistically significant decrease in the asymmetrical pooling (2-tailed t test, P = .0067). Increased pooling in the left compared with the right piriform, on in-office endoscopy, is predictive of the presence of a Zenker diverticulum. This information can sharpen clinical acumen in evaluating patients with dysphagia. In turn, it will help the clinician counsel the patient regarding diagnosis and radiographic imaging.

Pharyngeal Pooling in Patients with Zenker’s Diverticulum

Objective: Determine if patients with a diagnosis of Zenker diverticulum are more likely to have pooling of secretions in the left piriform sinus on in-office endoscopy compared with patients with non specific dysphagia without motion abnormality or known neurologic disorder. Method: A retrospective review was performed of patients evaluated at a subspecialty swallowing clinic, over a 5-year period, with radiographically confirmed Zenker’s diverticulum. A control group with dysphagia due to radiographically confirmed esophageal dysmotility, prominent cricopharyngeal bar, or stricture was identified. Two blinded laryngologists reviewed the recorded laryngoscopies. Results: A total of 29 Zenker patients were identified; 7 were excluded due to previous surgery. Of the 22 remaining patients, the mean age was 68.45 years (range, 26-95 years). Fourteen (59.09%) of the Zenker diverticulum patients had greater pooling in the left versus right piriform sinus. The average age of the 16 control patients was 61.31 years (range, 18-84 years). One of the 16 (6.25%) had greater pooling in the left piriform (2-tailed t test, P &lt; less than .0005). While the sensitivity of this physical examination finding in identifying patients with Zenker diverticulum is 60.09%, specificity is 93.75% and the positive predictive value is 92.86%. Conclusion: Increased pooling in the left compared with the right piriform, on in-office endoscopy, is significantly associated with the presence of a Zenker diverticulum. This information can sharpen clinical acumen in evaluating patients with dysphagia. In turn, it will help the clinician counsel the patient regarding diagnosis and radiographic imaging.

Pathology Quiz Case 1

A 15-YEAR-OLDBOYPRESENTEDWITHA1-MONTH history of hoarseness, shortness of breath with exertion, and a globus sensation. He denied any dysphagia, odynophagia, or localized pain. He was otherwise healthy and had no family history of childhood cancers or anemia. Fiberoptic laryngoscopyrevealeda2-cm,nonulcerated, submucosalsoft-tissuemassepicenteredintheanterior left false vocal fold (Figure 1). The results of the physical examination were otherwise unremarkable, with no palpable lymphadenopathy.Combinedpositronemission tomographyandcomputedtomographyrevealeda2.2 1.6-cmsofttissuemass in the left supraglottic larynxthatpartiallyobliterated the left piriform sinus (Figure 2). The mass had a maximal standard uptake variable of 14.2. The patient was taken to the operating room for direct laryngoscopyandabiopsy.Microscopicexaminationshowed sheetsofmonotonous,discohesivemedium-sizedcellswith highnuclear tocytoplasmicratios,vesicularchromatin,and prominent nucleoli in the submucosa. Frequent apoptotic debris, tingiblebodymacrophages,andmitotic figureswere present (Figure3). Immunostains were diffusely positive for CD20 (Figure 4), CD10, and CD45 and weakly positive forBCL-2 .Thetumorcellswerenegative forCD3,TdT, and CD34. A Ki-67 study showed a proliferative index of approximately80%.Fluorescenceinsituhybridization(FISH) showednorearrangements involving c-myc, bcl-2, or bcl-6. What is your diagnosis?

Acute Suppurative Thyroiditis Caused by Methicillin - ResistantStaphylococcus Aureusin Healthy Children

Acute suppurative thyroiditis is an uncommon condition because the thyroid gland is remarkably resistant to infec- tion. In children, anatomic defects, such as a left piriform sinus fistula, predispose subjects to this infection. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis; and if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. Bacterial infections with staphylococ- cus and streptococcus species are the most common causes of acute suppurative thyroiditis. Occasionally, the thyroid gland can be infected with fungi, parasites, or mycobacterium. An 8-year-old boy presented with acute fever and tender neck swelling. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed methicillin-resistant staphylococcus aureus (MRSA). The patient's condition improved after the use of antibiotics and drainage. There was no evidence of fistula formation between the thyroid and the pyriform sinus on a computed tomography (CT) scan. Here we describe rapidly progressive thyroid abscesses caused by MRSA in healthy children. (J Korean Soc Pediatr Endocrinol 2011;16: 128-132)

Patent Piriform Sinus Fistula in a Third Branchial Cleft Cyst

OBJECTIVE: To determine if a patent branchial cleft fistula is identifiable and treatable via direct laryngoscopy. BACKGROUND: Third branchial cleft cyst fistula tracts are rare. Complete surgical excision is the treatment of choice; however complications can include recurrent abscess and fistula tract formation. RESULTS: This report illustrates the use of suction cautery to close a patent fistula found within the piriform sinus after multiple resections. CONCLUSION: We believe thorough endoscopy should be performed with every surgical excision of branchial cleft cyst. Case Continued: The decision was made at that time to take the patient to the OR for cauterization of the fistula. The patient was taken to the OR on 7/28/09 where she underwent general anesthesia and endotracheal intubation without difficulty. A Dedo laryngoscope was inserted into the left piriform sinus and using a zero degree Hopkin’s rod a patent fistula was identified (Figure 2). A probe was inserted into the fistula and under direct visualization suction electrocautery was used to scar the fistula tract closed (Figure 3 and 4). The patient tolerated this procedure well and was admitted overnight for airway observation. She was discharged home on post operative day one with a soft diet for two weeks. The patient returned to clinic for follow up and underwent indirect laryngoscopy which demonstrated a well healed left piriform sinus and normal true vocal cord mobility. The patient is currently four months post operative without any complications.

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus