Chapter 69 The hypopharynx is the most caudad portion of the pharynx. The superior margin of the hypopharynx is at the level of the pharyngoepiglottic fold. This location can be approximated by the vallecula and the hyoid bone. The inferior border of the hypopharynx is at the cricopharyngeus muscle, which forms the “esophageal verge.” On cross-sectional imaging, this is located at the inferior margin of the cricoid cartilage. The postcricoid region permits passage of food into the esophagus. There is no defined superior margin, however it may be considered to begin just below the arytenoids. The anterior wall of the postcricoid region is the mucosa on the posterior aspect of the cricoid cartilage. This is a common wall shared with the posterior wall of the subglottis and is often referred to as the “party wall.” The inferior aspect of the postcricoid region is the esophageal verge formed by the cricopharyngeus muscle. These are rare lesions. They are more common in elderly males. Specific risk factors have not been thoroughly investigated due to the rarity of these tumors but are probably similar to other subsites of squamous cell carcinoma (SCCA). The staging of hypopharyngeal carcinoma is presented in Table 69–1. The symptoms are nonspecific and similar to other subsites in the hypopharynx. These include sore throat, difficulty swallowing, dysphagia, and weight loss. The majority of postcricoid region tumors are SCCA. Tumors arising from the posterior wall tend to remain on the posterior wall. Lesions originating from the anterior wall may invade the posterior cricoarytenoid muscle and arytenoid cartilages. Advanced lesions may encircle the lumen. The prognosis tends to be poor due to advanced stage at presentation and rich lymphatics. Up to 75% of patients will have nodal metastases at initial presentation. The apex of the pyriform sinus exits into the postcricoid region. Therefore, postcricoid carcinomas may extend superiorly to involve the apex of the pyriform sinus and its lymphatic drainage.
Squamous Cell Carcinoma of the Postcricoid Region
Epidemiology
Clinical Findings
