PMC6091365_01
Pharyngolaryngoscopy. A superficial, smooth tumorous lesion with red color is observed (a). A protruding lesion with atypical blood vessel formation in the mucosa surface is also observed (b).
CRIOT2018-1463218.001.jpg
PMC6091365_01_CRIOT2018-1463218.001.jpg
fig1
In addition, a protruding tumor with atypical blood vessel formation was observed on the mucosal surface in the right piriform recess of the hypopharynx (Figure 1).
Contrast-enhanced CT and FDG PET/CT. Thickening of the pharyngeal wall with irregular contrast enhancement is observed on the right side of the tongue base and in the right piriform recess. SUVmax is 2.0 on the right side of the tongue base and 4.2 in the right piriform recess.
CRIOT2018-1463218.002.jpg
PMC6091365_01_CRIOT2018-1463218.002.jpg
fig2
On contrast-enhanced CT, thickening of the pharyngeal wall showing irregular contrast enhancement was observed at the right tongue base and in the right piriform recess of the hypopharynx (Figure 2). On fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), accumulation was observed for maximum standardized uptake values (SUVmax) of 2.0 and 4.2 in the lesions of the oropharynx and hypopharynx, respectively (Figure 2).
Histopathological findings for hypopharyngeal tumor biopsy. Features observed include increased nuclear chromatin, disparity between large and small nuclei, and signs of mitosis. These findings are indicative of squamous cell carcinoma.
CRIOT2018-1463218.003.jpg
PMC6091365_01_CRIOT2018-1463218.003.jpg
fig3
Based on tissue biopsies, the histopathological diagnosis for the lesion in the right piriform recess of the hypopharynx was squamous cell carcinoma (Figure 3).
Histopathological findings for transorally resected nasopharyngeal tumor. HE staining: low magnification (a) and high magnification (b). Proliferation of plasma cells and unevenly distributed nuclei are observed. Immunostaining shows negative results for kappa (c) and positive results for lambda (d).
CRIOT2018-1463218.004.jpg
PMC6091365_01_CRIOT2018-1463218.004.jpg
fig4
Subsequent histopathological examination revealed proliferation of plasma cells in the tumor, and immunostaining findings were as follows: kappa(-), lambda(+), CD3(-), CD20(-), CD138(-), CD79a(+), and MUM-1(+) (Figure 4).
Distribution map of radiotherapy.
CRIOT2018-1463218.005.jpg
PMC6091365_01_CRIOT2018-1463218.005.jpg
fig5
After irradiating the whole neck with 40 Gy in 20 fractions, the irradiation field was reduced to target the tumor in the hypopharynx only, and additional radiotherapy comprising 30 Gy in 15 fractions was conducted (Figure 5).