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CC BY 4.0 · Endoscopy 2025; 57(S 01): E143-E144
DOI: 10.1055/a-2522-0331
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Endoscopic submucosal dissection for a symptomatic hypopharyngeal cavernous hemangioma: a new potential method

Xu-Cheng Huo‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
,
Bao-Hui Song‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
,
Rong-Kui Luo
3   Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
,
Yun-Shi Zhong
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
,
Ping-Hong Zhou
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
,
Xu Zhou
4   Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
,
Ming-Yan Cai
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
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The incidence rate of hypopharyngeal hemangioma is low, and there is no unified clinical guideline at present [1]. For smaller-sized hemangiomas, the main treatment is observation and follow-up. Intervention therapy is needed for large-sized lesions or for patients with obvious symptoms. Common treatment methods include surgery, laser therapy, and sclerotherapy [2]. Endoscopic submucosal dissection (ESD) for treatment of esophageal hemangioma has been reported, with good results [3].

A 78-year-old man was referred to our center with a globus sensation persisting for several months. Gastroscopy revealed a submucosal lesion with a smooth bluish surface in the right piriform fossa ([Fig. 1]). Magnetic resonance imaging revealed hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging in the right piriform fossa, indicating a diagnosis of hemangioma ([Fig. 2]). After multidisciplinary discussion, ESD was performed with the patient’s consent.

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Fig. 1 Endoscopic image of the lesion.
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Fig. 2 Appearance of the lesion on magnetic resonance imaging. a Hypointensity on the T1-weighted image. b Hyperintensity on the T2-weighted image.

A HybridKnife (Erbe Elektromedizin GmbH, Tübingen, Germany) was used for submucosal injection and dissection of the main lesion. An insulation-tip knife was used to cut the remaining distal section. Hemostasis was crucial owing to the highly vascular dissection plane ([Video 1]). The pathological diagnosis confirmed cavernous hemangioma with clear margins ([Fig. 3]). The patient was discharged on the second postoperative day. Subsequent follow-up endoscopy at 1 year revealed complete resolution of symptoms with no signs of recurrence ([Fig. 4]).


Quality:
Endoscopic submucosal dissection of a hypopharyngeal cavernous hemangioma.Video 1

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Fig. 3 Histological examination of the resected specimen.
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Fig. 4 Follow-up endoscopy at 1 year. a White-light endoscopy. b Narrow-band imaging.

This is the first case of hypopharyngeal hemangioma radically removed with ESD. Our preliminary result indicates that ESD can be a potential new method for the treatment of hypopharyngeal hemangioma, with good effectiveness and safety; however, further clinical research is needed to verify our initial findings.

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Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Almothahbi A, Bukhari M, Almohizea M. et al. Recent updates in laryngeal hemangioma management: a scoping review. Eur Arch Otorhinolaryngol 2024; 281: 2211-2222
    Search in Google Scholar
  • 2 Huang CM, Lee KW, Huang CJ. Radiation therapy for life-threatening huge laryngeal hemangioma involving pharynx and parapharyngeal space. Head Neck 2013; 35: E98-E101
    Search in Google Scholar
  • 3 Shen XC, Zhou YB, Zhu YJ. et al. A large cavernous hemangioma of esophagus. Am J Gastroenterol 2021; 116: 236
    Search in Google Scholar

Correspondence

Ming-Yan Cai, MD, PhD
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University
180 Fenglin Road
Shanghai 200032
P.R. China   

Publication History

Article published online:
11 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

  • References

  • 1 Almothahbi A, Bukhari M, Almohizea M. et al. Recent updates in laryngeal hemangioma management: a scoping review. Eur Arch Otorhinolaryngol 2024; 281: 2211-2222
    Search in Google Scholar
  • 2 Huang CM, Lee KW, Huang CJ. Radiation therapy for life-threatening huge laryngeal hemangioma involving pharynx and parapharyngeal space. Head Neck 2013; 35: E98-E101
    Search in Google Scholar
  • 3 Shen XC, Zhou YB, Zhu YJ. et al. A large cavernous hemangioma of esophagus. Am J Gastroenterol 2021; 116: 236
    Search in Google Scholar

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Zoom Image
Fig. 1 Endoscopic image of the lesion.
Zoom Image
Fig. 2 Appearance of the lesion on magnetic resonance imaging. a Hypointensity on the T1-weighted image. b Hyperintensity on the T2-weighted image.
Zoom Image
Fig. 3 Histological examination of the resected specimen.
Zoom Image
Fig. 4 Follow-up endoscopy at 1 year. a White-light endoscopy. b Narrow-band imaging.