A Hypopharyngeal Ductal Cyst Masquerading as a Laryngopharyngeal Reflux Disease
A 64-year-old man presented with a four-year history of globus sensation. He was referred for intractable symptoms despite having taken reflux medication for two months. Despite continued medication, his symptoms developed to dysphagia, even when swallowing liquid. He denied hoarseness or dyspnea. His medical history included a transurethral resection for bladder cancer 3 years previously. He had experienced weight loss of 3 kg over the previous 2 months. On his first presentation, flexible fiberoptic laryngoscopy showed pooling saliva, but no mass-like lesion in the hypopharynx. Vocal fold mobility was intact. The patient underwent a double-contrast pharyngoesophagogram due to persistent symptoms. An ovoid submucosal mass with a smooth contour in the left pyriform sinus was revealed (). Subsequently, computed tomography (CT) scans showed a 3×4 cm mass with central low attenuation in the left hypopharynx (). With the patient under general anesthesia, the lesion was removed via direct laryngoscopy using a microdissection electrode for endoscopic electrosurgery. The mass originated from the lateral wall of the pyriform sinus. It appeared as a pedunculated mass with a smooth, well-encapsulated surface. It was removed by means of submucosal dissection with the microelectrode. The resected specimen consisted of a 2×3×4 cm cystic mass with proteinaceous fluid (). Histologic examination showed a true epithelial-lined cyst consisting of cuboidal epithelium (). The final diagnosis, made by a pathologist, was a ductal cyst of the hypopharynx. Postoperative recovery of the patient was uneventful. The patient was free of symptoms after one month. Five years of follow-up showed no tumor recurrence and normal swallowing.