of the tongue [59] (Figure 6.26). These tumors can also invade the palatine tonsils, valleculae, or pharyngoepiglottic folds. Lymph node metastases are present in about 70% of cases at the time of presentation [52].
The supraglottic laryngeal structures (epiglottis, aryepiglottic folds, mucosa overlying the muscular process of the arytenoid cartilages, false vocal cords, and laryngeal ventricle) arise from pharyngobuccal anlage, forming a portion of the anterior wall of the hypopharynx [1]. Supraglottic cancers (Figures 6.27 and 6.28) are often classified as a subsite of “laryngeal” rather than pharyngeal tumors. These lesions frequently cause coughing and choking [60]. Hoarseness occurs in patients with supraglottic and laryngeal carcinomas as well as carcinomas of the medial piriform sinus infiltrating the arytenoid cartilage or cricoarytenoid joint [61]. The supraglottic region has an extensive lymphatic bed; supraglottic cancers therefore tend to spread throughout the supraglottic region and into the pre‐epiglottic space. Cervical lymphadenopathy is detected in one‐third to one‐half of these patients [52, 54].
Figure 6.17 Lateral pharyngeal pouches. (A) Line drawing of the pharynx in lateral view shows the area of weakness (arrow) that a lateral pharyngeal pouch protrudes through, bounded by the hyoid bone (b) superiorly, the posterior border of the thyrohyoid muscle (m) anteriorly, the superior cornu of the thyroid cartilage (c), and the insertion of the stylopharyngeal muscle (s) posteriorly. The ala of the thyroid cartilage (T) is identified.
Source: Reproduced from Rubesin et al. [2], with permission.
(B) Frontal view of the pharynx just as the bolus reaches the valleculae shows no evidence of lateral pharyngeal pouches. (C) Frontal view of the pharynx as the bolus passes through the pharyngoesophageal segment shows 1.5 cm and 1 cm barium‐filled sacs (arrows) on the left and right pharyngeal walls, respectively. The tilting epiglottis is identified (arrowhead).
Squamous cell carcinomas of the piriform sinuses are usually bulky masses that already have spread to lymph nodes in 70–80% of patients at the time of presentation [52] (Figure 6.29). Tumors of the medial piriform sinus wall may invade the ipsilateral aryepiglottic fold, arytenoid and cricoid cartilage, and paraglottic space, often resulting in hoarseness [61]. Tumors of the lateral piriform sinus wall may invade the thyroid cartilage, thyrohyoid membrane, and neck, including the carotid sheath [52].
Figure 6.18 Lateral pharyngeal diverticulum. A 0.8 cm barium‐filled sac (arrow) persists outside the left lateral wall of the pharynx after the bolus has passed.
Figure 6.19 Branchial pouch sinus. (A) Frontal view of the pharynx shows an 8 cm long track (arrows) that courses inferiorly from the floor of the mouth. (B) Steep right posterior oblique view of the pharynx demonstrates the track (arrows) arising from the retromolar trigone/anterior portion of the tonsillar fossa. Dentures are in place.
Source: Reproduced from Rubesin and Glick [23], with permission.
Squamous cell carcinomas of the posterior pharyngeal wall (Figure 6.30) are large, bulky tumors that cause few symptoms, often presenting as painless neck masses resulting from metastases to cervical lymph nodes [62]. More than half of these patients have lymph node metastases at the time of diagnosis. These exophytic tumors may spread superiorly or inferiorly into the nasopharynx or cervical esophagus and posteriorly into the retropharyngeal space. These tumors are the pharyngeal cancers most frequently associated with a synchronous or metachronous squamous cell carcinoma of the oral cavity, pharynx, or esophagus [62].
Postcricoid carcinomas (Figure 6.31) are an uncommon form of pharyngeal squamous cell carcinoma, except in Scandinavia. These tumors may also spread superiorly or inferiorly into the hypopharynx or cervical esophagus.
Figure 6.20 Candida pharyngitis. Innumerable nodules and plaque‐like elevations have disrupted the normally smooth surface of the pharynx.
Lymphoma
About 10% of pharyngeal malignancies are non‐Hodgkin’s lymphomas arising in the abundant lymphoid tissue of Waldeyer’s ring: the adenoids, palatine tonsils, and lingual tonsil [63]. Hodgkin’s disease involving the pharynx is uncommon, even though it is often first detected in cervical lymph nodes [64]. Patients with pharyngeal lymphoma frequently present with a neck mass, and cervical lymph nodes are initially involved in 60% of cases [63]. Other patients may present with nasal obstruction, sore throat, or dysphagia.
The palatine tonsil is the primary site of involvement by pharyngeal lymphoma in 40–60% of patients (Figure 6.32), the nasopharynx in 18–28%, and the lingual tonsil in 10% [40, 63]. Multiple sites are involved in about 25% of patients, but the hypopharynx is rarely involved by this tumor. Pharyngeal lymphomas typically appear on barium studies as large, bulky, lobulated masses (Figure 6.32). The mucosal surface may be smooth; however, because of the submucosal location of these tumors [31] (Figure 6.33).
Figure 6.21 Scarring from corrosive ingestion. Lateral view of the pharynx shows a thick radiolucent band of soft tissue (thick black arrow) crossing the hypopharynx. Obstruction is implied by a large standing column of barium (thin black arrow) in the oropharynx. The hypopharynx is small and contracted (thin white arrow). Barium pours into the open laryngeal vestibule (thick white arrow).
Source: Reproduced from Rubesin SE. The pharynx: structural disorders. Radiol Clin North Am1994; 32:1083–1101, with permission.
Other rare tumors involving the pharynx include Kaposi’s sarcoma, carcinoma of the minor salivary glands, synovial sarcoma, and cartilaginous tumors of the larynx or cricoid cartilage.
Radiation change