Pharyngeal pouch carcinoma: two unusual cases

Abstract

Two patients with carcinomata arising in pharyngeal pouches are reported. In one, the tumour was detected preoperatively by a contrast radiographic study. In the second the lesion was a carcinoma in situ. The English literature is reviewed with reference to these two unusual features.

Post-laryngectomy neopharyngeal diverticulae

“…Foreign body impaction may also occur as illustrated by Case 3. Carcinoma within a neopharyngeal diverticulum, unlike carcinoma within a Zenkers diverticulum has not, to our knowledge, been described yet although it is a theoretical risk (Burton and Lund, 1990;Saunders et al, 1993).…”

Carcinoma Arising in a Pharyngeal Pouch Previously Treated by Endoscopic Stapling

“…Used in combination, contrast imaging and endoscopy should diagnose the majority of cases of carcinoma. However, these modalities may miss a carcinoma in situ or a small invasive cancer: as many as 90% of cases of carcinoma in situ occurring in a pharyngeal pouch may not be suspected or detected at any point before histopathologic examination 8,10,11,13 . Westmore 14 described 2 of 18 cases where a microscopic squamous cell carcinoma was found in the fundus of a macroscopically normal diverticulum that was excised.…”

“…The most common symptom suggesting malignant change within a pharyngeal pouch is a change in the character of the dysphagia associated with the pouch, most notably a rapid increase in the degree of dysphagia. 1,6,8,10,11 Other less common symptoms include weight loss, pain, and the presence of blood in the regurgitated material. The recurrence of a previously treated pouch may indicate an associated pathology such as esophageal dysmotility or malignancy.…”

Esophageal diverticula and cancer

“…Outcomes are usually quoted as dismal because of a delayed diagnosis. In fact, most cases are advanced tumors at the time of the operation 7,10,18,40 . However, several cases of superficial carcinoma have been described 26,28,37,40,45,47 …”

“…In fact, most cases are advanced tumors at the time of the operation. 7,10,18,40 However, several cases of superficial carcinoma have been described. 26,28,37,40,45,47 The treatment follows the same principals as the therapy for esophageal cancer.…”