PMC8403079_01
Preoperative images of this patient. (A) laryngoscopic image. (B) CT without contrast. (C) CT with contrast.
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Fiberoptic laryngoscopy showed a large smooth nodular mass in the postcricoid region of the hypopharynx (Figure 1A). The mass showed heterogeneous enhancement on contrast HRCT (Figure 1B and C).
Intraoperative images of this patient. (A) the tumor presented as an oval, pale yellow, smooth mass with a thin envelope. (B) the mass was a solid tumor. (C) Postoperative field with smooth mucosa.
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Therefore, the tumor was removed completely without an expanded margin (Figure 2A-C).
Follow-up images of this patient. (A) follow-up laryngoscopic image under NBI. (B) follow-up laryngoscopic image. (C) follow-up CT scans with contrast.
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After the surgery, he was fed using a nasogastric tube until the restoration of the surgical field 3 weeks later, when he underwent a reexamination via fiberoptic laryngoscopy (Figure 3A and B). There were no definite signs of tumor progression at the latest follow-up more than 9 months after the diagnosis of USRCS (Figure 3C).
Histopathological findings. (A) The view of the tumor tissue slice (Hematoxylin-eosin stain). Nodular neoplasm with hyperchromatic nucleus, small blue round cells with hypochromatic cytoplasm, collagenization of tumor stroma, microvascular proliferation and a few pyknotic nuclei were observed (Original magnification x40, x400). (B-G) Immunohistochemical staining of positive expression (Original magnification x40, x400). (B) Intense positive expression of CD56, (C) strong positive expression of Cyclin D1, (D) strong positive expression of TLE-1, (E) the over expressed protein of Ki-67 (50%), (F) focal positive expression of P53, (G) partial positive expression of CD99.
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Microvascular proliferation and a few pyknotic nuclei were observed, but other types of cells, such as spindle cells, and nuclear division were not observed (Figure 4A). Strong immune expression of CD56, Cyclin D1 and TLE-1 (Figure 4B-D) with a high proliferation index (Ki-67: 50%) (Figure 4E) were observed by using the microscope (Zeiss, Germany). Moreover, focal positivity for p53 (Figure 4F), partial positivity for CD99 (Figure 4G) and complete negativity for PCK, CK7, p63, CK5/6, S-100, Des, SMA, CD34, STAT-6, myogenin, and myoD1 were observed.