Successful treatment for hypopharyngeal cancer in a patient with superficial esophageal cancer by endoscopic submucosal dissection.

yngectomy for laryngeal cancer 3 years earlier was diagnosed with superficial esophageal squamous cell carcinoma (ESCC). In addition, a slightly elevated le− sion (1.6 cm) was detected synchronously in the posterior wall of the hypopharynx (l" Fig. 1 a). Using a narrow−band ima− ging (NBI) system with magnifying en− doscopy (GIF TYPE H260Z; Olympus), this lesion displayed a clearly demarcated brownish area (l" Fig. 1 b) and the intra− papillary capillary loop (IPCL), which was advocated by Inoue et al. [1], took on ir− regular shapes (l" Fig. 1 c). For treatment of the hypopharyngeal lesion, endoscopic submucosal dissection (ESD) was per− formed under general anesthesia fol− lowed by subtotal esophagectomy. A mu− cosal incision was made with the flex knife and the subepithelial tissue was cut with a hook knife. Macroscopic examina− tion of the resected specimen (3.5 ” 3.0 cm) revealed cancer spread over an area of 1.7 ” 1.3 cm (l" Fig. 2 a). Histologi− cally, noninvasive squamous cell carcino− ma was limited to the epithelial layers without either vessels or lymphatic infil− tration, and both horizontal and vertical margins were sufficient (l" Fig. 2 b). Im− munohistochemistry revealed that p53− positive cells were widespread in the out− er basal cell layer (l" Fig. 2 c). This obser− vation led to a diagnosis of squamous cell carcinoma of the hypopharynx, not a dys− plastic lesion or regenerative changes. One of the hallmarks of ESCC is synchro− nous or metachronous tumors arising in the head and neck [2]. An NBI system with magnifying endoscopy is useful for acquiring valuable information about small lesions of the hypopharynx [3], and ESD is a more favorable method than en− doscopic mucosal resection for early− stage hypopharyngeal cancer located in anatomically complex areas [4]. In con− clusion, an NBI system with magnifying endoscopy has increased the chance of early detection of hypopharyngeal cancer, and ESD would be the optimal method of treatment at least for early−stage hypo− pharyngeal cancer.