PMC6398402_01
Strobolaryngoscope revealed a large mass arising from the posterior hypopharynx (red arrow).. Notes: Cyclic cartilage posterior region found white neoplasm with poor exposed glottis and invisible vocal cords. Magnification x10.
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A strobolaryngoscope revealed a large mass arising from the posterior hypopharynx, and movements of both the glottis and vocal cords were invisible (Figure 1).
(A, B) MRI revealed the mass (red arrow) was strongly enhanced and the integrated lymph node (blue arrow) was peripherally enhanced.
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T2-weighted images were hyperintense, and diffusion-weighted imaging was hyperintense. The lesion underwent heterogeneous enhancement following administration of gadolinium-DTPA; the mass was strongly enhanced and the integrated lymph node was peripherally enhanced (Figure 2A and B).
(A, B) PET/CT showed high SUV of FDG in the left hypopharyngeal regions (SUVmax=8.9) (red arrow) and left cervical lymph node (SUVmax=9.5) (blue arrow), but there were no high FDG lesions in other parts of the body.. Abbreviations: FDG, fluoro-2-deoxy-D-glucose; PET/CT, positron emission tomography/computed tomography; SUV, standardized uptake values.
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PET/CT showed high standardized uptake values (SUVs) of FDG in the left hypopharyngeal regions (SUVmax=8.9) and left cervical lymph node (SUVmax=9.5), but there were no high FDG lesions in other parts of the body (Figure 3A and B).
Routine pathological image.
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Routine pathology (Figure 4) revealed that the small tumor cells were uniform in size, exhibited marked heteromorphy, and were arranged into nests and cords with sparse cytoplasm.
Immunohistochemical staining revealed that the primary tumor was positive for cytokeratins (A), CD56 (B), chromogranin A (C), synaptophysin (D), and Ki-67 (E).
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Immunohistochemical staining revealed that the primary tumor was positive for cytokeratins (Figure 5A), CD56 (Figure 5B), chromogranin A (Figure 5C), and synaptophysin (Syn; Figure 5D) and negative for p63, CK7, and CD45. The Ki-67 (Figure 5E) mitotic index approached 80%.
CT revealed that the lesion in the hypopharynx had shrunk markedly and the metastatic left lymph nodes had disappeared.. Abbreviation: CT, computed tomography.
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On March 14, 2017, CT revealed that the lesion in the hypopharynx had shrunk markedly and the metastatic left lymph nodes had disappeared (Figure 6).
CT revealed the presence of irregular soft tissue in the left side of the anterior chest wall (red arrow), sized ~2.7x4.7 cm, invading the corresponding ribs, and multiple high-density nodules (blue arrow) in the bilateral lungs.. Abbreviation: CT, computed tomography.
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On March 21, 2017, CT revealed the presence of irregular soft tissue in the left side of the anterior chest wall, sized ~2.7x4.7 cm, invading the corresponding ribs, and multiple high-density nodules in the bilateral lungs (Figure 7).
Ultrasonography revealed a hypoechoic lesion in the left liver (red arrow).
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Ultrasonography revealed a hypoechoic lesion in the left liver (Figure 8).
Whole body bone imaging revealed tracer concentrated in the right skull, left rib 4, left rib 8, rib 9, right scapula, the vertebral body of lumbar 5, the left superior iliac spine, and right sacroiliac joint.
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Whole body bone imaging revealed tracer concentrated in the right skull, left rib 4, left rib 8, rib 9, right scapula, the vertebral body of lumbar 5, the left superior iliac spine, and right sacroiliac joint (Figure 9).
CT revealed multiple liver metastatic lesions (red arrow), and swollen metastatic lymph nodes appeared in the hepatogastric gap and porta (blue arrow).. Abbreviation: CT, computed tomography.
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On April 8, 2017, CT revealed multiple liver metastatic lesions, and swollen metastatic lymph nodes appeared in the hepatogastric gap and porta (Figure 10).
CT revealed no invisible swollen lymph nodes bilaterally.. Abbreviation: CT, computed tomography.
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On June 14, 2017, CT revealed no invisible swollen lymph nodes bilaterally (Figure 11).