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Clinical Challenge
June 2015

Pyriform Sinus Soft-Tissue Mass Recurring in Esophagus After Excision

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, New York, New York
  • 2Department of Pathology, Mount Sinai Hospital, New York, New York
JAMA Otolaryngol Head Neck Surg. 2015;141(6):573-574. doi:10.1001/jamaoto.2015.0384

A woman in her 50s presented with dysphagia and frequent throat clearing. A right pyriform sinus mass was seen on fiber-optic laryngoscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the finding of a hypopharyngeal mass. The patient underwent an endoscopic laser excision. Immunohistochemical stains revealed tumor cells that were focally positive for myogenin and diffusely positive for desmin and myoglobin. An MRI scan obtained 1 month postoperatively demonstrated a persistent mass or swelling. The patient continued to experience dysphagia, globus, and a choking sensation when coughing. On fiber-optic examination, right pyriform sinus fullness was visualized. During operative laryngoscopy, no mass was identified. An interval MRI demonstrated a 2-cm soft-tissue mass in the cervical esophagus (Figure, A). Using rigid suspension laryngoscopy, we identified a large, smooth-walled ovoid mass herniating from the cervical esophageal opening. A mucosal stalk anchored the mass to the lateral pyriform sinus wall. Endoscopic snare cautery was used to excise the mass. The tumor was well-defined, solitary, tan-red, and composed of sheets of large, round-to-polygonal cells with marked eosinophilic, granular cytoplasm (Figure, B). Most tumor cells exhibited peripherally or centrally located vesicular nuclei with prominent nucleoli. Peripheral intracellular vacuoles indenting the cytoplasm were seen, which represent a processing artifact due to intracellular glycogen loss (Figure, C).

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