R. NICKBRYANMDS. JAMESZINREICHMD
A 77-YEAR-OLD man presented with a 2-year history of a foreign body sensation in the throat and an intermittent cough. He reported increasing dysphagia when swallowing solids but denied odynophagia, hoarseness, dyspnea, or any other medical problems. Initially, no laryngeal and hypopharyngeal abnormalities were detected by fiberoptic laryngoscopy (Figure 1A). During the examination, the patient started to cough, and a big polypoid mass (Figure 1B, arrow) suddenly appeared, seemingly from the postcricoid region. After the patient stopped coughing, the mass disappeared from our laryngoscopic view. Manual anterosuperior traction was then applied to the prelaryngeal skin to distend the hypopharynx. As the scope was advanced during this maneuver, 1 mass (Figure 1C, arrow) was found in the postcricoid region. The lesion appeared on the videoesophagogram (Figure 2) as a smooth or slightly lobulated intraluminal tumor (arrows) arising from the posterior aspect of the left side of the hypopharyngeal wall into the upper esophagus and connected by a long serpentine stalk (asterisks). It moved with deglutition and changed position during the video recording, as shown in Figure 2B-C. Figure 2A reveals the lesion's resting position before swallowing. Figure 2B shows an early pharyngeal phase, at which stage the lesion was pushed into the upper esophagus, and Figure 2C shows a late pharyngeal phase during swallowing, at which time the recoil of the long stalk could be seen. Computed tomographic scans of the neck revealed a soft tissue mass (Figure 3, asterisk) in the left aryepiglottic fold and postcricoid region. With the patient under general anesthesia, the lesion, which contained proteinaceous fluid, was removed via direct laryngoscopy and carbon dioxide laser. The histologic features are shown in Figure 4. One year after surgery, the patient was free of symptoms and remained healthy. Postoperative videoesophagography revealed normal performance of the pharynx and esophagus.
Guo Y, Chu P, Lee R, Chang S. Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2001;127(1):84. doi:
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