Incidental Squamous Cell Carcinoma In Situ in a Large Pharyngoesophageal (Zenker's) Diverticulum

摘要

Pharyngeoesophageal (Zenker's) Diverticulum (ZD) is the most common type of esophageal diverticulum, usually occurring in the seventh or eighth decade.1 The prevalence is 0.01 to 0.11 per cent in the general population, and the incidence is higher in patients who present with dysphagia (1.8—2.3%). It is a pulsion (false) diverticulum of the dorsal pharyngoesophageal wall, through a region of relative weakness called Killian's triangle, bounded by the inferior pharyngeal constrictor and cricopharyngeal muscles. Dysphagia arises from two mechanisms: incomplete opening of the upper esophageal sphincter and extrinsic compression by the ZD. Finding occult malignancy within the ZD is rare. A 63-year-old white male presented with progressive dyspnea over six months. He reported unintentional weight loss of 70 pounds over three years, with 30 pounds in the last four months (50.4 kg, BMI 14.25). He complained of progressive dysphagia to both solids and liquids, regurgitation of undigested food, cough associated with eating, and the sensation of food sticking in the mid chest. He endorsed nausea, vomiting, belching, and night sweats over the last year. He denied chest or abdominal pain. His history included prostatitis and no prior surgeries. Family history was notable for abdominal aortic aneurysm (AAA) in his father, lymphoma in his mother, and lung cancer in his brother. He had a 45-pack-year history of tobacco abuse (1 pack/day) and drank 11.8 oz liquor/ week. He was a retired house painter, lived independently with his sister, and was uninsured.