Hypopharynx and Proximal Esophagus

  • Ilona M. Schmalfuss
Part of the Medical Radiology book series (MEDRAD)


Cancers of the hypopharynx and proximal esophagus typically present at an advanced stage. They are often underestimated on clinical examination as they tend to grow in a submucosal fashion. On imaging, evaluation of the normally present fat planes within the post-cricoid musculature and around the hypopharynx as well as proximal esophagus is essential for mapping of the tumor boundaries. Cartilage invasion, tumor volume and involvement of the pyriform sinus apex are important variables in stratification of patients into favorable and unfavorable treatment groups. Patients with favorable tumors typically receive radiation therapy while patients with unfavorable tumors usually undergo surgical resection and subsequent reconstructive surgery. Both treatments cause some alteration of the tissue planes with additional marked distortion of the normal anatomy seen with surgical resection. The growth patterns of tumors arising from the different subsites within the hypopharynx and proximal esophagus, pretreatment considerations for staging and treatment planning purposes, as well as posttreatment complications and surveillance issues will be discussed in this chapter.


Synovial Sarcoma Adenoid Cystic Carcinoma Cervical Esophagus Cricoid Cartilage Pyriform Sinus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  2. Anthony JP, Singer MF, Mathes SJ (1994) Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg 21:137–147PubMedGoogle Scholar
  3. Artico R, Bison E, Brotto M (2004) Monophasic synovial sarcoma of hypopharynx: care report and review of the literature. Acta Otorhinolaryngol Ital 24:33–36PubMedGoogle Scholar
  4. Aspestrand F, Kolbenstvendt A, Boysen M (1990) Carcinoma of the hypopharynx: CT staging. J Comput Assist Tomogr 14:72–76PubMedCrossRefGoogle Scholar
  5. Becker M (1998) Larynx and hypopharynx. Radiol Clin North Am 36:891–920PubMedCrossRefGoogle Scholar
  6. Becker M, Zbären P, Laeng H, Stoupis C, Porcellini B, Vock P (1995) Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation. Radiology 194:661–669PubMedGoogle Scholar
  7. Becker M, Zbären P, Delavelle J, Kurst AM, Egger C, Rufenacht DA, Terrier F (1997) Neoplastic invasion of the laryngeal cartilage: reassessment of criteria for diagnosis at CT. Radiology 203:521–532PubMedGoogle Scholar
  8. Becker M, Burkhardt K, Dulguerov P, Allal A (2008) Imaging of the larynx and hypopharynx. Eur J Radiol 66:460–479PubMedCrossRefGoogle Scholar
  9. Bisdas S, Nguyen SA, Anand SK, Glavina G, Day T, Rumboldt Z (2009) Outcome prediction after surgery and chemoradiation of squamous cell carcinoma in the oral cavity, oropharynx, and hypopharynx: use of baseline perfusion CT microcirculatory parameters vs. tumor volume. Int J Radiat Oncol Biol Phys 73:1313–1318PubMedCrossRefGoogle Scholar
  10. Bukachevsky RP, Pincus RL, Shechtman FG, Sarti E, Chodsh P (1992) Synovial sarcoma of the head and neck. Head Neck 14:44–48PubMedCrossRefGoogle Scholar
  11. Castelijns JA, Gerritsen GJ, Kaiser MC, Valk J, van Zanten TE, Golding RG, Meyer CJ, van Hattum LH, Sprenger M, Bezemer PD (1988) Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging. Radiology 167:199–206PubMedGoogle Scholar
  12. Chu PY, Chang SY, Huang JL, Tai SK (2010) Different patterns of second primary malignancy in patients with squamous cell carcinoma of larynx and hypopharynx. Am J Otolaryngol 31:168–174PubMedCrossRefGoogle Scholar
  13. Damiani JM, Damiani KK, Hauck K, Hyams VJ (1981) Mucoepidermoid-adenosquamous carcinoma of the larynx and hypopharynx: a report of 21 cases and a review of the literature. Otolaryngol Head Neck Surg 89:235–243PubMedGoogle Scholar
  14. De Campora E, Croce A, Biocciolo G, Radici M (1987) Adenoid-cystic carcinoma (cylindroma) of the pyriform sinus in pediatric age. Int J Pediatr Otorhinolaryngol 14:235–242PubMedCrossRefGoogle Scholar
  15. Espinosa LA, Daniel BL, Jeffrey SS, Nowels KW, Ikeda DM (2005) MRI features of mucosa-associated lymphoid tissue lymphoma in the breast. AJR Am J Roentgenol 185:199–202PubMedGoogle Scholar
  16. Fatterpekar GM, Mukherji SK, Rajgopalan P, Lin Y, Castillo M (2004) Normal age-related signal changes in the laryngeal cartilages. Neuroradiology 46:678–681PubMedCrossRefGoogle Scholar
  17. Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB (1985) Normal mediastinal lymph nodes: number and size according to American thoracic society mapping. AJR Am J Roentgenol 144:261–265PubMedGoogle Scholar
  18. Hermans R, Pameijer FA, Mancuso AA, Parsons JT, Mendenhall WM (1998) CT findings in chondroradionecrosis of larynx. AJNR Am J Neuroradiol 19:711–718PubMedGoogle Scholar
  19. Hermans R, Pameijer FA, Mancuso AA, Parson JT, Mendenhall WM (2000) Laryngeal and hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone? Radiology 214:683–687PubMedGoogle Scholar
  20. Hirsch RJ, Yousem DM, Loevner LA, Montone KT, Chalian AA, Hayden RE, Weinstein GS (1997) Synovial sarcomas of the head and neck: MR findings. AJR Am J Roentgenol 169:1185–1188PubMedGoogle Scholar
  21. Kitamoto Y, Hasegawa M, Ishikawa H, Saito J, Yamakawa M, Kojima M, Nakano T (2003) Mucosa-associated lymphoid tissue lymphoma of the esophagus: a case report. J Clin Gastroenterol 36:414–416PubMedCrossRefGoogle Scholar
  22. Kraus DH, Pfister DG, Harrison LB, Shah JP, Spiro RH, Armstrong JG, Fass DE, Zelefsky M, Schantz SP, Weiss MH (1994) Larynx preservation with combined chemotherapy and radiation therapy in advanced hypopharyngeal cancer. Otolaryngol Head Neck Surg 111:31–37PubMedGoogle Scholar
  23. Kraus DH, Zelefsky MJ, Brock HA, Huo J, Harrison LB, Shah JP (1997) Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx. Otolaryngol Head Neck Surg 116:637–641PubMedCrossRefGoogle Scholar
  24. Mamelle G, Richard J, Luboinski B, Schwaab F, Eschwege F, Micheau C (1986) Synovial sarcoma of the head and neck: an account of four cases and review of the literature. Eur J Surg Oncol 12:347–349PubMedGoogle Scholar
  25. Matsuki A, Nishimaki T, Suzuki T, Kanda T, Hatakeyama K (1999) Esophageal mucoepidermoid carcinoma containing signet-ring cellos: three case reports and a literature review. J Surg Oncol 71:54–57PubMedCrossRefGoogle Scholar
  26. Million RR (1994) Pharyngeal walls, pyriform sinus, postcricoid pharynx. In: Million RR (ed) Management of head and neck cancer. JB Lippincott, Philadelphia, pp 502–532Google Scholar
  27. Miyazaki T, Kato H, Masuda N, Nakajima M, Manda R, Fukuchi M, Tsukada K, Kojima M, Nakajima T, Kuwano H (2004) Mucosa-associated lymphoid tissue lymphoma of the esophagus: case report and review of the literature. Hepatogastroenterology 51:750–753PubMedGoogle Scholar
  28. Mouret P (1999) Liposarcoma of the hypopharynx. A case report and review of the literature. Rev Laryngol Otol Rhinol 120:39–42Google Scholar
  29. Mukherji SK, Mancuso AA, Kotzur IM, Mendenhall WM, Kubilis PS, Tart RP, Lee WR, Freeman D (1994a) Radiologic appearance of the irradiated larynx. Part I. Expected changes. Radiology 183:141–148Google Scholar
  30. Mukherji SK, Mancuso AA, Kotzur IM, Mendenhall WM, Kubilis PS, Tart RP, Freeman D, Lee WR (1994b) Radiologic appearance of the irradiated larynx. Part II. Primary site response. Radiology 183:149–154Google Scholar
  31. Munoz A, Ramos A, Ferrando J et al (1993) Laryngeal carcinoma: sclerotic appearance of the cricoid and arytenoids cartilage—CT-pathological correlation. Radiology 189:433–437PubMedGoogle Scholar
  32. Ng SH, Chan SC, Liao CT, Chang JT, Ko SF, Wang HM, Chin SC, Lin CY, Huang SF, Yen TC (2008) Distant metastases and synchronous second primary tumors in patients with newly diagnosed oropharyngeal and hypopharyngeal carcinomas: evaluation of (18)F-FDG PET and extended-field multi-detector row CT. Neuroradiology 50:969–979PubMedCrossRefGoogle Scholar
  33. Nowak B, Di Martino E, Janicke S, Cremerius U, Adam G, Zimny M, Reinartz P, Bull U (1999) Diagnostic evaluation of malignant head and neck cancer by F-18-FDG PET compared to CT/MRI. Nuklearmedizin 38:312–318PubMedGoogle Scholar
  34. Pameijer FA, Mancuso AA, Mendenhall WM, Parson JT, Mukherji SK, Hermans R, Kubilis PS (1998) Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 pyriform sinus carcinoma treated with definitive radiotherapy. Head Neck 20:159–168PubMedCrossRefGoogle Scholar
  35. Prehn RB, Pasic TR, Harari PM, Brown WD, Ford CN (1998) Influence of computed tomography on pretherapeutic tumor staging in head and neck cancer patients. Otolaryngol Head Neck Surg 119:628–633PubMedCrossRefGoogle Scholar
  36. Quint L, Glazer G, Orringer M (1985) Esophageal imaging by MR and CT: study of normal anatomy and neoplasms. Radiology 156:727–731PubMedGoogle Scholar
  37. Rangheard AS, Vanel D, Viala J, Schwaab G, Casiraghi O, Sigal R (2001) Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients. AJNR Am J Neuroradiol 22:851–857PubMedGoogle Scholar
  38. Reece GP, Schusterman MA, Miller MJ, Kroll SS, Robb GL, Baldwin BJ, Luethcke DR (1995) Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg 96:1307–1316PubMedCrossRefGoogle Scholar
  39. Ribeiro KB, Levi JE, Pawlita M, Koifman S, Matos E, Eluf-Neto J, Wunsch-Filho V, Curado MP, Shangina O, Zaridze D, Szeszenia-Dabrowska N, Lissowska J, Daudt A, Menezes A, Bencko V, Mates D, Fernadez L, Fabianova E, Gheit T, Tommasino M, Boffetta P, Brennan P, Waterboer T (2011) Low human papillomavirus prevalence in head and neck cancer: results from two large case-control studies in high-incidence regions. Int J Epidemiol 40(2):489–502PubMedCrossRefGoogle Scholar
  40. Righi PD, Kelley DJ, Ernst R, Deutsch MD, Gaskill-Shipley M, Wilson KM, Gluckman JL (1996) Evaluation of the prevertebral muscle invasion by squamous cell carcinoma. Can computed tomography replace open neck exploration? Arch Otolaryngol Head Neck Surg 122:660–663PubMedCrossRefGoogle Scholar
  41. Roychowdhury S, Loevner LA, Yousem DM, Chalian A, Montone KT (2000) MR imaging for predicting neoplastic invasion of the cervical esophagus. AJNR Am J Neuroradiol 21:1681–1687PubMedGoogle Scholar
  42. Saleh E, Mancuso AA, Stringer S (1993) Relative roles of computed tomography and endoscopy for determining the interior extent of pyriform sinus carcinoma: correlative histopathologic study. Head Neck 15:44–52PubMedCrossRefGoogle Scholar
  43. Schmalfuss IM, Mancuso AA, Tart R (2000) Postcricoid region and cervical esophagus: normal appearance at CT and MR imaging. Radiology 214:237–246PubMedGoogle Scholar
  44. Schuller DE (1980) Limitations of the pectoralis major myocutatenous flap in head and neck cancer reconstruction. Arch Otolaryngol 106:709–714PubMedCrossRefGoogle Scholar
  45. Spector JG, Sessions DG, Haughey BH, Chao KS, Simpson J, El Mofty S, Perez CA (2001) Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx. Laryngoscope 111(6):1079–1087PubMedCrossRefGoogle Scholar
  46. Surkin MI, Lawson W, Biller HF (1984) Analysis of the methods of pharyngoesophageal reconstruction. Head Neck 6:953–970CrossRefGoogle Scholar
  47. Takahara Y, Kawashima H, Han YS, Sugimura N, Nakatani T, Tanaka K, Hino M (2005) Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the urinary bladder. Hinyokika Kiyo 51:45–48PubMedGoogle Scholar
  48. Terhaard CH, Bongers V, van Rijk PP, Hordijk GJ (2001) F-18-fluoro-deoxy-glucose-positron-emision tomography scanning in detection of local recurrence after radiotherapy for laryngeal/pharyngeal cancer. Head Neck 23:933–941PubMedCrossRefGoogle Scholar
  49. Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talaat M (1996) Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106:589–594PubMedCrossRefGoogle Scholar
  50. Tom LW, Wurzel JM, Wetmore RF, Lowry LD (1981) Mucoepidermoid carcinoma of the hypopharynx. Otolaryngol Head Neck Surg 89:753–757PubMedGoogle Scholar
  51. Uppaluri R, Sunwoo JB (2005) Neoplasms of the hypopharynx and cervical esophagus. In: Cummings CW (ed) Otolaryngology—Head and Neck Surgery. Elsevier Mosby, Philadelphia, pp 1859–1931Google Scholar
  52. Vandecaveye V, De Keyzer F, Vander Poorten V et al (2006) Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases. Br J Radiol 79:681–687PubMedCrossRefGoogle Scholar
  53. Weber RS, Marvel J, Smith P, Hankins P, Wolf O, Goepfert H (1993) Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus. Otolaryngol Head Neck Surg 108:11–17PubMedGoogle Scholar
  54. Wenig BL, Ziffra KL, Mafee MF, Schild JA (1995) MR imaging of squamous cell carcinoma of the larynx and hypopharynx. Otolaryngol Clin North Am 28:6009–6019Google Scholar
  55. Yeager VL, Lawson C, Archer CR (1982) Ossification of laryngeal cartilages as it relates to computed tomography. Invest Radiol 17:11–19PubMedCrossRefGoogle Scholar
  56. Yousem DW, Tufano RP (2002) Laryngeal imaging. Magn Reson Imaging Clin N Am 10:451–465PubMedCrossRefGoogle Scholar
  57. Zbären P, Egger C (1997) Growth pattern of piriform sinus carcinomas. Laryngoscope 107:511–518PubMedCrossRefGoogle Scholar
  58. Zbären P, Begger M, Laeng H (1996) Pretherapeutic staging of laryngeal cancer: clinical findings, computed tomography and magnetic resonance imaging versus histopathology. Cancer 77:1263–1273PubMedCrossRefGoogle Scholar
  59. Zbären P, Weidner S, Thoeny HC (2008) Laryngeal and hypopharyngeal carcinomas after (chemo)radiotherapy: a diagnostic dilemma. Curr Opin Otolaryngol Head Neck Surg 16:147–153PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Department of Radiology, Division of NeuroradiologyNorth Florida/South Georgia Veterans Administration and University of Florida College of MedicineGainesvilleUSA

Personalised recommendations