Squamous cell carcinoma of hypopharynx in a patient with history of celiac disease

Abstract

Celiac disease is a chronic inflammatory condition of the small intestine, and a gluten-induced disease in genetically susceptible children and adults and causes nutrient malabsorption, often accompanied with diarrhea and weight loss [1, 2] . Several types of malignancies are associated with this disease [1][2][3][4][5][6][7][8] . The most common is beings malignant lymphoma, 80% occurring in the small intestine [3] . The next most frequently found malignancy was adenocarcinoma of the small intestine, followed by carcinoma of the esophagus [3] . Other malignancies occurring more frequently than expected are carcinoma of the pharynx lung, breast, testis [3] and melanoma [4] . As to our knowledge, so far only one case of hypopharyngeal carcinoma has been reported [5, 6] , and in this article we presented the second case. Case reportA fifty four years old housekeeper lady with a six years history of celiac disease referred to our Department after taking a biopsy from her hypopharyngeal area that revealed squamous cell carcinoma. She complained from dysphagia, hoarseness and a red painful mass in her neck, that was fistulized to her skin. CT scanning showed a large polypoid mass about 6 cm × 4 cm in the left posterolateral aspect of hypopharynx that was extended to pharynx, larynx and parapharyngeal spaces (Fig. 1).Metastatic work up didn't show any suspicious involvement. The patient received two courses of chemotherapy with cisplatin (100 mg/m 2 ) and continuous infusion of 5-flurouracil (1000 mg/m 2 ) for 96 hours. CT scanning and fiberoptic laryngoscopy were repeated, but response was less than 50% and as a rule she would become a candidate of total pharyngolaryngectomy, however, the patient and her family refused the procedure. Since we didn't have any clinical trial for such situation in our country we decided to try radiation therapy and after three steps of shrinkage tumoral area received 7000 cGy with cobalt 60 machine. One month after completion of radiation therapy course CT scanning was repeated and a mild decrease in tumor size was seen and her symptoms were partially relieved. Six months later her symptoms and specially dysphagia and dyspnea were progressed and due to economic situation we decided to try weekly metotheraxate 40 mg/m 2 , and she became better for several weeks until the disease was progressed, and then she received paclitaxel 175 mg/ m 2 , and carboplatin with AUC = 6, but she died due to progressive disease 14 months after diagnosis.Abstract Celiac disease is a gluten-related malabsorption in small intestine occurring in genetically susceptible patients. In this disease the risk of many malignancies is increased the most important of which being non-Hodgkin lymphoma of small intestine. Other malignancies include adenocarcinoma of small intestine and squamous cell carcinoma of esophagus and melanoma. As to our knowledge so far only one case of celiac disease associated with hypopharyngeal squamous cell carcinoma has been reported. In this article we presented a patient suffering fr...