hypopharyngeal case presentation
DESCRIPTION
ENT Head and Neck surgeryTRANSCRIPT
CASE REPORT
Dr. Junaid Shahzad
Post-graduate Resident
Otolaryngology Department
Capital Hospital, Islamabad
CASE PRESENTATION
PATIENT PROFILE Name: XYZ Age: 62 Gender:Female Residence: Islamabad Profession: Housewife
PRESENTING COMPLAINTS Patient presented to OPD in OCTOBER
2013 with history of DYSPHAGIA- 4 months
HISTORY OF PRESENTING COMPLAINTS Patient was in normal state of health till 4
months back,when she experienced dysphagia for solids which progressed slowly and for the last one month she had dysphagia for liquids as well.
There are no alleviating factors Dysphagia was also associated with pain
(odynophagia) during swallowing. This was also associated with weight loss. There is no history of voice change and
breathlessness or otalgia. No history of cough or recurrent chest
infection.
PAST HISTORY Patient was a known hypertensive since
the past decade, but not compliant on medication.
PERSONAL HISTORY Patient was a housewife. She has 3 children,2 daughters and 1
son, all married. She lives with her son and daughter in
law.
DRUG HISTORY Patient has been taking anti
hypertensive medications off and on since the past 10 years.
Sone times takes medications for heartburn.
No history of SMOKING or ADDICTION
SOCIAL HISTORY Belongs to a low socioeconomic back
groung.
GENERAL PHYSICAL EXAMINATION An old lady sitting on bed, well oriented
in time,place and person. Jaundice Clubbing NAD Cyanosis
GPE:BP: 50/90 mmHgTEMP: AfebrileR/R: 18/minPULSE: 80/min
ENT EXAMINATION
EAR EXAMINATION:External ear unremarkableTympanic membranes intact bilaterally with
normal landmarks.Hearing test OK
NOSE:Septum, turbinates and nasal mucosa
appeared normal.Normal patency
THROAT: Lips, tongue, cheek mucosa, palate, floor of
mouth, gums, teeth, pillars, tonsills and PPW – Normal.
Tongue mobility, Gag reflex, cough reflex and palatal movements were normal
Laryngeal crepitus was present Videolaryngoscopy: Revealed
Epiglottis, Vallecular, Py. Sinuses, aryepiglottic fold, vocal cords, PPW all appear normal
Exophytic growth post cricoid area. Vocal cords mobile.
NECK NODES: No neck nodes palpable
SYSTEMIC EXAMINATION
CVS: S1+S2 audible in all four areas
RESP: Normal vesicular breathing
GIT:NAD
CNS:
LAB INVESTIGATIONS Hb: 11.9g/dl Na: 138mmol/l K: 3.6mmol/l Cl: 92mmol/l Urea:22mg/dl Creatinine:0.8mg/dl
DIAGNOSTIC INVESTIGATION: DIRECT LARYNGOSCOPY AND
OESOPHAGOSCOPY:
Exophytic growth involving post cricoid region and extending to BOTH Pyriform Sinuses,and Vallecula.
Sample taken by punch biopsy, sent for Histopathology.
Glottis and subglottis clear.
HISTOPATHOLOGY:
POORLY DIFFERTIATED NON KERATINIZING SQUAMOUS CELL CARCINOMA
IMMUNOHISTOCHEMISTRY:P-63- Positive.
RADIOLOGICAL INVESTIGATIONS CT SCAN NECK AND CHEST WITH
CONTRAST:
Obliteration and stenosis oropharyngeal cavity with effacement of vallecula and pyriform sinuses.
Enlarged lymph nodes in bilateral parapharyngeal spaces and Carotid spaces.
Non specific nodule in right middle lobe adjacent to mediastinal pleura.
DIAGNOSIS
Poorly differentiated Non keratinizing Squamous Cell Carcinoma Hypopharynx.
STAGE: T2 N2C M1
TREATMENT SENT TO N.O.R.I for
CHEMOTHERAPY/RADIOTHERAPY. RADIOTHERAPY
13 Cycles 39 Gy completted SUPPORTIVE
Magic mouth washTab chymoral forte BDSyp Mucain 2tsf tdsSyp Brufen 2tsf x tds
FOLLOW UP Monthly follow up maintained. AT 5 months follow up:
VIDEOLARYNGOSCOPY: Normal.
DIRECT LARYNGOSCOPY/OESOPHAGOSCOPY: Normal.
CT SCAN NECK AND CHEST WITH CONTRAST: Normal.
THANK YOU