Hypopharyngeal schwannoma.

A 57-year-old man presented with a 5-month history of globus and dysphagia. The dysphagia was worse when he ingested solids (vs. liquids), and he reported that he had lost 5 lbs during the preceding 6 months.

Transnasal esophagoscopy (TNE) revealed the presence of a 4-cm, pedunculated, submucosal mass on the posterior aspect of the glottis; the mass extended into the cervical esophagus (figure, A). Findings on TNE distal to the mass were within normal limits (figure, B). A biopsy specimen was taken at the completion of the TNE (figure, C). Examination of the specimen identified rows of spindle cells with palisading nuclei (Verocay's bodies), a finding that was consistent with a schwannoma. The patient underwent endoscopic extirpation of the lesion.

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Most laryngeal schwannomas arise from the superior laryngeal nerve. However, this patient experienced right vocal fold paralysis after surgical removal, which suggests that this neoplasm arose from the recurrent nerve.

From the Department of Otolaryngology--Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento (Dr. Belafsky), and the Center for Voice and Swallowing Disorders of Wake Forest University, Department of Otolaryngology, Winston-Salem, N.C. (Dr. Postma).