Hypopharyngeal squamous cell carcinoma

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Ondynophagia.

Patient Data

Age: 60 years
Gender: Male

Abnormal irregular mucosal thickening centered on the left piriform sinus extends along the aryepiglottic fold as well as the posterior wall of the hypopharynx

Asymmetric left level 2 nodes, but <10 mm in short axis. One has central hypodensity. 

Abnormal enhancing mucosal thickening centered on the left piriform sinus extends along the aryepiglottic fold as well as the posterior wall of the hypopharynx. This extends anteriorly in the paraglottic space along the inner surface of the left thyroid cartilage but no convincing thyroid cartilage infiltration is identified.

Cervical nodes are <10 mm in short axis but are asymmetrically enlarged on the left, with a left level III showing central non-enhancement. 

The patient proceeded to panendoscopy and biopsy of the left piriform sinus mass.

Histopathology:

Sections of the squamous mucosa show features of moderately differentiated squamous cell carcinoma. The tumor forms infiltrative nests and trabeculae, surrounded by desmoplasia. There are foci of keratinization. It invades into the stroma for 1mm. The tumor cells have enlarged hyperchromatic nuclei, prominent nucleoli and small amounts of dense cytoplasm. No evidence of lymphovascular or perineural invasion is seen. p16 immunostain is negative in the tumor cells.

DIAGNOSIS:

Left piriform fossa: Moderately differentiated squamous cell carcinoma. p16 negative.

Case Discussion

The piriform sinus is the most common subsite involved in hypopharyngeal squamous cell carcinomas. They tend to more often p16 negative than other head and neck squamous cell carcinomas, with the associated worse prognosis. 

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