Clin Endosc.  2016 May;49(3):289-293. 10.5946/ce.2015.092.

Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula

• Odagiri H
• Iizuka T
• Kikuchi D
• Kaise M
• Takeda H
• Ohashi K
• Yasunaga H

• KMID: 2165024
• DOI: http://doi.org/10.5946/ce.2015.092

Abstract

Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.

Keyword

Superficial uvula cancer; Minimally invasive surgical procedures; Endoscopic submucosal dissection

MeSH Terms

Anesthesia, General
Deglutition
Endoscopy, Gastrointestinal
Gastrointestinal Tract
Humans
Hypopharynx
Male
Minimally Invasive Surgical Procedures*
Pharyngeal Neoplasms
Respiration
Uvula*

Figure

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  Fig. 1. Images of case 1. (A) Gastrointestinal endoscopy with white light revealed a small red area on the patient’s uvula, and (B) magnifying endoscopy with narrow- band imaging showed the redness as a brownish area. (C) Endoscopic submucosal dissection was performed to resect the mucosal lesion surrounding the uvula (H&E stain, ×4). (D) The lesion including an affected mucous membrane around the uvula was removed as an en bloc specimen. (E, F) Histopathological examination of the resected specimen showed oropharyngeal carcinoma in situ (H&E stain, ×200).

• 

  Fig. 2. Images of case 2. (A) Gastrointestinal endoscopy with white light revealed a small nodule on the posterior aspect of the patient’s uvula, and (B) magnifying endoscopy with narrow-band imaging clearly showed an outgrowth with atypical dilated vessels on the uvula. (C) Magnifying endoscopy with narrow-band imaging and iodine staining revealed that the lesion was limited to the uvula (H&E stain, ×4). (D) Simple uvulectomy without endoscopic submucosal dissection of the surrounding mucosa was performed. (E, F) Histopathological examination of the resected specimen showed the en bloc removal of the lesion with negative surgical margins; however, the tumor had invaded into the submucosa, with a basaloid pattern (H&E stain, ×200).

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