Squamous cell carcinoma arising in a Zenker diverticulum

Abstract

Squamous cell carcinoma (SCC) arising in a Zenker diverticulum (ZD) is an extremely rare entity. Approximately 50 cases have been reported worldwide. We report a case of a 74-year-old man who presented to our institution with chronic regurgitation, dysphagia and halitosis. The patient was initially seen in 2015 at which point he reported a 10-year history of these symptoms and was diagnosed with ZD. A barium swallow was done revealing a large posterior esophageal diverticulum with significant residual contrast within the diverticulum lumen. Given these findings, he was taken for open surgical excision where a SCC was identified. Although it is extremely rare for a SCC to occur in a ZD, patients with ZD must undergo regular surveillance endoscopy of the esophagus and the diverticulum itself to identify any suspicious mass or lesion arising in within.

Squamous Cell Carcinoma Arising in a Zenker’s Diverticulum

“…Advanced age and male gender are risk factors for developing ZD [ 5 ]. Its prevalence ranges from 0.01 to 0.11% [ 3 ]. ZD is associated with complications like aspiration pneumonia, ulceration and bleeding, fistula formation between diverticulum and adjacent organs, vocal cord paralysis, and SCC in very rare cases [ 6 ].…”

“…ZD is associated with complications like aspiration pneumonia, ulceration and bleeding, fistula formation between diverticulum and adjacent organs, vocal cord paralysis, and SCC in very rare cases [ 6 ]. Halstead provided the first description of an SCC occurrence in a ZD in 1904 [ 3 ]. The diagnosis of SCC in the pouch is usually made after a full histopathological examination of the specimen after a complete surgical resection [ 7 , 8 ].…”

“…Treatment is aimed at relieving the symptoms of the patient. The most common modality used is endoscopic stapling or diverticulectomy [ 3 ].…”

“…The incidence ranges from 0.3 to 7% [ 2 ]. ZD is accompanied by complications like ulceration and recurrent aspiration pneumonitis, which can be treated by surgery [ 3 ]. It is crucial to perform an early assessment to rule out the development of SCC.…”