Epidermoid carcinoma occurring in a pharyngoesophageal diverticulum

Riberi, A; Battersby, J. S.; Vellios, Frank

doi:10.1002/1097-0142(1955)8:4<727::aid-cncr2820080415>3.0.co;2-2

Cited by 19 publications

(7 citation statements)

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“…However, SCC in the pouch was usually diagnosed mainly after obtaining full histopathologic examination of the specimen following complete surgical resection [4,6]. Malignancy of the esophageal diverticula was mostly reported to be in the cervical esophagus, and the common locations of the malignancy in the pouch usually include the fundus or the lateral wall of the distal two thirds of the pouch [4,7]. The risk factors for developing cancer of the pouch are the patient's old age, large pouch size, and long pouch life duration; a high frequency of food retention and manual emptying of the pouch by digital pressure increases cancer risk from the prolonged and direct irritation and inflammation [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Malignancy of the esophageal diverticula was mostly reported to be in the cervical esophagus, and the common locations of the malignancy in the pouch usually include the fundus or the lateral wall of the distal two thirds of the pouch [4,7]. The risk factors for developing cancer of the pouch are the patient's old age, large pouch size, and long pouch life duration; a high frequency of food retention and manual emptying of the pouch by digital pressure increases cancer risk from the prolonged and direct irritation and inflammation [4][5][6][7][8]. Signs and symptoms suggesting malignancy of the pouch according to frequency, are changes in the character of dysphagia, rapid dysphagia progression, and less frequently weight loss, pain, blood in the regurgitated materials, and pouch recurrence after treatment [4].…”

Section: Discussionmentioning

confidence: 99%

“…Some reported cases of early SCC of the pouch showed normal morphology on endoscopic observation and did not present any alerting clinical symptoms or signs [6][7][8]. Contrast imaging and endoscopic observations are used to diagnose most of the cases of Zenker's Diverticulum but it could miss carcinoma in situ because the detection rate usu-…”

Section: Discussionmentioning

confidence: 99%

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Squamous Cell Carcinoma Arising in Zenker’s Diverticulum: A Case Report and Review of the Literature

et al. 2018

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INTRODUCTION Pharyngeal pouches were first described by Ludlow in 1769, and after more than a century, Zenker published a full clinical pathological description in 1877 [1,2]. The occurrence of squamous cell carcinoma (SCC) arising in Zenker's diverticulum is a very rare entity. However, the published incidence rates fall between 0.3% and 7% among occasional reports in the literature [3]. SCC in the pouch is diagnosed mainly after obtaining full histopathologic examination of the specimen following surgical resection [4]. For this reason, the procedure of choice for suspected SCC in the pouch is by complete surgical excision of the pouch. We report a rare case of recurrent Zenker's diverticulum and SCC development in the pouch. CASE PRESENTATION A 71-year-old British male patient presented to our institute with a history of dysphagia and regurgitation for the past 20 years. Endoscopy was done earlier, and he was diagnosed with Zenker's diverticulum. He underwent endoscopic stapling of the diverticulum in the years 2006, 2009, and 2011 without any symptomatic improvement. At that time, he denied any history of weight or appetite changes. He complained of new symptoms such as dysphagia and regurgitation mostly to soft food and liquids, which aggravate with coughing, and also of a decrease in weight and appetite. The patient is a smoker and an occasional alcohol consumer. On physical examination, it was found that he was healthy, and all systems exam were unremarkable. All laboratory investigations were normal. Barium swallow showed pharyngeal pouch as Zenker's diverticulum (Figures 1, 2). A written consent was obtained from the patient for surgery and publications. The patient underwent left neck incision, diverticulectomy, and cricopharyngeal myotomy under general anesthesia. Postoperative recovery was uneventful. He was discharged home after few days in a good stable condition. Histology results showed an esophageal pouch consisting of a cyst-like lesion measuring 4.03.51.0 cm 3 (Figure 3). The cyst wall was thickened. The inner mucosal surface showed fungating mass lesion measuring 1.51.00.5 cm 3 , tan white in color, and friable in consistency. The resection margins were free of the lesion and were marked with staples. Microscopic results showed moderately differentiated SCC (Figures 4a, b).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Squamous Cell Carcinoma Arising in Zenker’s Diverticulum: A Case Report and Review of the Literature

et al. 2018

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Section: Methodsmentioning

confidence: 99%

“…Odd symptoms have been described and must alert to the possibility of malignancy, such as the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, and hemathemesis. 10,11,21,[32][33][34][35] The main risk factors for the development of malignancy are frequently quoted as old age of the patient, the duration over which the pouch has been present, and its size. 34 In the 49 squamous cell carcinoma cases we collected ( Table 1) the mean age of the patients was 69 years.…”

Section: Pharyngoesophageal Diverticula (Zenker and Killian)mentioning

confidence: 99%

Esophageal diverticula and cancer

Herbella

Dubecz

Patti

2011

Diseases of the Esophagus

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Esophageal diverticula are rare. The association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. The correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. The incidence of cancer in a diverticulum is 0.3-7, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. The treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable.

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Chronic Esophagitis

Kay¹,

Cross²

1956

AMA Arch Intern Med

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Epidermoid carcinoma occurring in a pharyngoesophageal diverticulum

Cited by 19 publications

References 3 publications

Squamous Cell Carcinoma Arising in Zenker’s Diverticulum: A Case Report and Review of the Literature

Squamous Cell Carcinoma Arising in Zenker’s Diverticulum: A Case Report and Review of the Literature

Esophageal diverticula and cancer

Chronic Esophagitis

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