CHRONOLOGICAL CHANGES IN NARROW-BAND IMAGES OF LARYNGEAL CANCER: A CASE REPORT

Abstract

We could observe chronological changes of early laryngeal cancer over a 20-month period by narrow-band imaging (NBI). A 74-year-old man with unresectable advanced esophageal cancer was treated by chemoradiation therapy. After 5 courses of fluorouracil and cisplatin with radiation therapy, a brownish area (BA) of about 2 mm in diameter was detected on the left aryepiglottic fold during gastroduodenoscopy to evaluate the effect of chemotherapy for esophageal cancer. Thirty-five days after detection of the BA, the lesion had enlarged to about 3 mm and obtained a clearer margin. One hundred fifty-five days after detection, the lesion had enlarged to about 8mm and an NBI magnifying image revealed meandering dilated vessels of irregular caliber with varied form. At this point, we diagnosed the BA as a neoplastic lesion; however, pathologic examination of a biopsy specimen revealed non-neoplastic inflammatory squamous epithelium. The advanced esophageal cancerous lesion was judged as stable disease, and we decided to follow the small BA lesion. Two hundred thirty-six days after detection, the lesion had enlarged to about 10 mm and obtained a more irregular edge. Five hundred thirty-four days after detection, the lesion had enlarged and progressed to the left ventricular fold. Six hundred one days after detection, a biopsy specimen was obtained and pathologic examination revealed squamous carcinoma. The recent widespread availability of NBI magnifying gastroduodenoscopy has resulted in increased detection of small asymptomatic brownish areas in the pharyngolarynx. These small BAs have been treated by follow-up, biopsy or resection. Pathologic examination of biopsy specimens of small BAs does not always reveal an accurate diagnosis. It is often difficult to obtain biopsy specimens in the pharyngolarynx. Therefore, endoscopists have to follow BAs in the pharyngolarynx that are suspected as being neoplastic lesions regardless of their size.