A 68-year-old man with a history of laryngectomy for laryngeal cancer 3 years earlier
was diagnosed with superficial esophageal squamous cell carcinoma (ESCC). In addition,
a slightly elevated lesion (1.6 cm) was detected synchronously in the posterior wall
of the hypopharynx ([Fig. 1 ]
a). Using a narrow-band imaging (NBI) system with magnifying endoscopy (GIF TYPE H260Z;
Olympus), this lesion displayed a clearly demarcated brownish area ([Fig. 1 ]
b) and the intrapapillary capillary loop (IPCL), which was advocated by Inoue et al.
[1], took on irregular shapes ([Fig. 1 ]
c). For treatment of the hypopharyngeal lesion, endoscopic submucosal dissection (ESD)
was performed under general anesthesia followed by subtotal esophagectomy. A mucosal
incision was made with the flex knife and the subepithelial tissue was cut with a
hook knife. Macroscopic examination of the resected specimen (3.5 × 3.0 cm) revealed
cancer spread over an area of 1.7 × 1.3 cm ([Fig. 2 ]
a). Histologically, noninvasive squamous cell carcinoma was limited to the epithelial
layers without either vessels or lymphatic infiltration, and both horizontal and vertical
margins were sufficient ([Fig. 2 ]
b). Immunohistochemistry revealed that p53-positive cells were widespread in the outer
basal cell layer ([Fig. 2 ]
c). This observation led to a diagnosis of squamous cell carcinoma of the hypopharynx,
not a dysplastic lesion or regenerative changes.
Fig. 1 Upper endoscopic findings for the hypopharynx. a A slightly elevated lesion with fine granular changes and absence of continuity with
blood vessels, approximately 1.6 cm in diameter, was detected synchronously in the
posterior wall of the hypopharynx. b With the narrow band imaging (NBI) system, this lesion displayed a clearly demarcated
brownish area. c Using the NBI system with a magnifying endoscope, the intrapapillary capillary loop
took on irregular shapes including dilation, tortuosity, caliber change, and meandering.
These observations suggested that the lesion would have malignant potential.
Fig. 2 Macroscopic and pathologic findings. a The resected specimen measured 3.5 × 3.0 cm and macroscopically, resected margins
were almost optimal circumferentially (× 1). The extent of cancer spread was schematically
drawn using yellow color lines, and measured 1.7 × 1.3 cm. b Histologic findings revealed noninvasive, moderately differentiated squamous cell
carcinoma limited to the lamina propria mucosae without vessel or lymphatic infiltration.
In addition, both horizontal and vertical margins were sufficient (× 20). c Immunohistochemistry revealed p53-positive cells were randomly widespread in the
outer basal cell layer (× 200).
One of the hallmarks of ESCC is synchronous or metachronous tumors arising in the
head and neck [2]. An NBI system with magnifying endoscopy is useful for acquiring valuable information
about small lesions of the hypopharynx [3], and ESD is a more favorable method than endoscopic mucosal resection for early-stage
hypopharyngeal cancer located in anatomically complex areas [4]. In conclusion, an NBI system with magnifying endoscopy has increased the chance
of early detection of hypopharyngeal cancer, and ESD would be the optimal method of
treatment at least for early-stage hypopharyngeal cancer.
Endoscopy_UCTN_Code_TTT_1AO_2AG
