Difference between revisions of "Zenker's diverticulum"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Pharyngoesophageal diverticulum -- low mag.jpg
| Width      =
| Caption    = Consistent with Zenker's diverticulum (squamous mucosa). [[H&E stain]].
| Synonyms  = cricopharyngeal diverticulum, pharyngoesophageal diverticulum and hypopharyngeal diverticulum
| Micro      = squamous mucosa without [[nuclear atypia]] +/- parakeratosis
| Subtypes  =
| LMDDx      = [[squamous dysplasia of the esophagus]], [[squamous cell carcinoma of the esophagus]], [[squamous cell carcinoma of the head and neck]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[esophagus]]/pharynx
| Assdx      =
| Syndromes  =
| Clinicalhx = elderly
| Signs      =
| Symptoms  = dysphagia
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = excision
}}
'''Zenker's diverticulum''' is an outpouching of the mucosa and submucosa at the junction of the pharynx and [[esophagus]].
'''Zenker's diverticulum''' is an outpouching of the mucosa and submucosa at the junction of the pharynx and [[esophagus]].


It is also known as '''diverticulum cricopharyngeal''', '''pharyngoesophageal diverticulum''' and '''hypopharyngeal diverticulum'''.<ref name=pmid25759630>{{Cite journal  | last1 = Nuño-Guzmán | first1 = CM. | last2 = García-Carrasco | first2 = D. | last3 = Haro | first3 = M. | last4 = Arróniz-Jáuregui | first4 = J. | last5 = Corona | first5 = JL. | last6 = Salcido | first6 = M. | title = Zenker's Diverticulum: Diagnostic Approach and Surgical Management. | journal = Case Rep Gastroenterol | volume = 8 | issue = 3 | pages = 346-52 | month =  | year =  | doi = 10.1159/000369130 | PMID = 25759630 }}</ref>
It is also known as '''cricopharyngeal diverticulum''', '''pharyngoesophageal diverticulum''' and '''hypopharyngeal diverticulum'''.<ref name=pmid25759630>{{Cite journal  | last1 = Nuño-Guzmán | first1 = CM. | last2 = García-Carrasco | first2 = D. | last3 = Haro | first3 = M. | last4 = Arróniz-Jáuregui | first4 = J. | last5 = Corona | first5 = JL. | last6 = Salcido | first6 = M. | title = Zenker's Diverticulum: Diagnostic Approach and Surgical Management. | journal = Case Rep Gastroenterol | volume = 8 | issue = 3 | pages = 346-52 | month =  | year =  | doi = 10.1159/000369130 | PMID = 25759630 }}</ref>


==General==
==General==
*[[Clinical diagnosis]].
*[[Clinical diagnosis]].
*Benign.
*Benign.
**[[Squamous cell carcinoma]] may arise from it.<ref name=pmid26415863>{{Cite journal  | last1 = Acar | first1 = T. | last2 = Savaş | first2 = R. | last3 = Kocaçelebi | first3 = K. | last4 = Ersöz | first4 = G. | title = Squamous cell carcinoma arising from a Zenker's diverticulum: contribution of FDG-PET/CT to the diagnosis. | journal = Dis Esophagus | volume =  | issue =  | pages =  | month = Sep | year = 2015 | doi = 10.1111/dote.12406 | PMID = 26415863 }}</ref>
**A malignancy ([[squamous cell carcinoma]]) may arise from it;<ref name=pmid26415863>{{Cite journal  | last1 = Acar | first1 = T. | last2 = Savaş | first2 = R. | last3 = Kocaçelebi | first3 = K. | last4 = Ersöz | first4 = G. | title = Squamous cell carcinoma arising from a Zenker's diverticulum: contribution of FDG-PET/CT to the diagnosis. | journal = Dis Esophagus | volume =  | issue =  | pages =  | month = Sep | year = 2015 | doi = 10.1111/dote.12406 | PMID = 26415863 }}</ref><ref name=pmid22940699>{{Cite journal  | last1 = Wakita | first1 = A. | last2 = Motoyama | first2 = S. | last3 = Sato | first3 = Y. | last4 = Yoshino | first4 = K. | last5 = Sasaki | first5 = T. | last6 = Saito | first6 = H. | last7 = Minamiya | first7 = Y. | last8 = Ogawa | first8 = J. | title = Squamous cell carcinoma in an esophageal diverticulum below the aortic arch. | journal = Int J Surg Case Rep | volume = 3 | issue = 11 | pages = 574-6 | month =  | year = 2012 | doi = 10.1016/j.ijscr.2012.07.010 | PMID = 22940699 }}</ref> seen in ~0.3% of cases.<ref>{{Ref GLP|7}}</ref>
*Uncommon.<ref name=pmid24055983/>
*Relatively uncommon<ref name=pmid24055983/> - but most common among esophageal diverticula.<ref>{{Ref GLP|6}}</ref>


Clinical:<ref name=pmid24055983>{{Cite journal  | last1 = Law | first1 = R. | last2 = Katzka | first2 = DA. | last3 = Baron | first3 = TH. | title = Zenker's Diverticulum. | journal = Clin Gastroenterol Hepatol | volume = 12 | issue = 11 | pages = 1773-82; quiz e111-2 | month = Nov | year = 2014 | doi = 10.1016/j.cgh.2013.09.016 | PMID = 24055983 }}</ref>
Clinical:<ref name=pmid24055983>{{Cite journal  | last1 = Law | first1 = R. | last2 = Katzka | first2 = DA. | last3 = Baron | first3 = TH. | title = Zenker's Diverticulum. | journal = Clin Gastroenterol Hepatol | volume = 12 | issue = 11 | pages = 1773-82; quiz e111-2 | month = Nov | year = 2014 | doi = 10.1016/j.cgh.2013.09.016 | PMID = 24055983 }}</ref>
*Eldery.
*Eldery.
*Dysphagia.
*Dysphagia - difficultly swallowing.
*May mimic a [[thyroid gland|thyroid]] nodule.<ref name=pmid20665743>{{Cite journal  | last1 = Singaporewalla | first1 = RM. | last2 = Mukherjee | first2 = JJ. | last3 = Thamboo | first3 = TP. | last4 = Cheah | first4 = WK. | title = Pharyngoesophageal diverticulum resembling a thyroid nodule on ultrasound. | journal = Head Neck | volume = 33 | issue = 12 | pages = 1800-3 | month = Dec | year = 2011 | doi = 10.1002/hed.21474 | PMID = 20665743 }}</ref>
*+/-Aspiration of food.
*+/-Aspiration of food.


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</gallery>
</gallery>
==Microscopic==
==Microscopic==
Features:
Features:<ref name=pmid20665743>{{Cite journal  | last1 = Singaporewalla | first1 = RM. | last2 = Mukherjee | first2 = JJ. | last3 = Thamboo | first3 = TP. | last4 = Cheah | first4 = WK. | title = Pharyngoesophageal diverticulum resembling a thyroid nodule on ultrasound. | journal = Head Neck | volume = 33 | issue = 12 | pages = 1800-3 | month = Dec | year = 2011 | doi = 10.1002/hed.21474 | PMID = 20665743 }}</ref>
*Squamous mucosa.
*Squamous mucosa without [[nuclear atypia]] +/- parakeratosis.
 
DDx:
*[[Squamous dysplasia of the esophagus]].
*[[Squamous cell carcinoma of the esophagus]].
*[[Squamous cell carcinoma of the head and neck]].
 
===Images===
<gallery>
Image: Pharyngoesophageal diverticulum -- very low mag.jpg | ZD - very low mag. (WC)
Image: Pharyngoesophageal diverticulum - alt -- very low mag.jpg | ZD - very low mag. (WC)
Image: Pharyngoesophageal diverticulum -- low mag.jpg | ZD - low mag. (WC)
Image: Pharyngoesophageal diverticulum -- intermed mag.jpg | ZD - intermed. mag. (WC)
</gallery>
 
==Sign out==
<pre>
Submitted as "Zenker's Diverticulum", Excision:
- Squamous mucosa with parakeratosis, mild chronic inflammation
  and fibrosis; compatible with Zenker's diverticulum.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
===Alternate===
<pre>
Submitted as "Zenker's Diverticulum", Excision:
- Squamous mucosa with mild chronic inflammation and reactive
  changes; compatible with Zenker's diverticulum.
- Benign skeletal muscle.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.  
</pre>


==See also==
==See also==

Latest revision as of 15:25, 21 January 2016

Zenker's diverticulum
Diagnosis in short

Consistent with Zenker's diverticulum (squamous mucosa). H&E stain.
Synonyms cricopharyngeal diverticulum, pharyngoesophageal diverticulum and hypopharyngeal diverticulum
LM squamous mucosa without nuclear atypia +/- parakeratosis
LM DDx squamous dysplasia of the esophagus, squamous cell carcinoma of the esophagus, squamous cell carcinoma of the head and neck
Site esophagus/pharynx
Clinical history elderly
Symptoms dysphagia
Prognosis benign
Treatment excision

Zenker's diverticulum is an outpouching of the mucosa and submucosa at the junction of the pharynx and esophagus.

It is also known as cricopharyngeal diverticulum, pharyngoesophageal diverticulum and hypopharyngeal diverticulum.[1]

General

Clinical:[5]

  • Eldery.
  • Dysphagia - difficultly swallowing.
  • May mimic a thyroid nodule.[7]
  • +/-Aspiration of food.

Gross

Images

  • Zenker's diverticulum. (WC)

Microscopic

Features:[7]

DDx:

Images

  • ZD - very low mag. (WC)

  • ZD - very low mag. (WC)

  • ZD - low mag. (WC)

  • ZD - intermed. mag. (WC)

Sign out

Submitted as "Zenker's Diverticulum", Excision:
- Squamous mucosa with parakeratosis, mild chronic inflammation 
  and fibrosis; compatible with Zenker's diverticulum.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Alternate

Submitted as "Zenker's Diverticulum", Excision:
- Squamous mucosa with mild chronic inflammation and reactive 
  changes; compatible with Zenker's diverticulum.
- Benign skeletal muscle.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

See also

References

  1. ↑ Nuño-Guzmán, CM.; García-Carrasco, D.; Haro, M.; Arróniz-Jáuregui, J.; Corona, JL.; Salcido, M.. "Zenker's Diverticulum: Diagnostic Approach and Surgical Management.". Case Rep Gastroenterol 8 (3): 346-52. doi:10.1159/000369130. PMID 25759630.
  2. ↑ Acar, T.; Savaş, R.; Kocaçelebi, K.; Ersöz, G. (Sep 2015). "Squamous cell carcinoma arising from a Zenker's diverticulum: contribution of FDG-PET/CT to the diagnosis.". Dis Esophagus. doi:10.1111/dote.12406. PMID 26415863.
  3. ↑ Wakita, A.; Motoyama, S.; Sato, Y.; Yoshino, K.; Sasaki, T.; Saito, H.; Minamiya, Y.; Ogawa, J. (2012). "Squamous cell carcinoma in an esophageal diverticulum below the aortic arch.". Int J Surg Case Rep 3 (11): 574-6. doi:10.1016/j.ijscr.2012.07.010. PMID 22940699.
  4. ↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 7. ISBN 978-0443066573.
  5. ↑ 5.0 5.1 Law, R.; Katzka, DA.; Baron, TH. (Nov 2014). "Zenker's Diverticulum.". Clin Gastroenterol Hepatol 12 (11): 1773-82; quiz e111-2. doi:10.1016/j.cgh.2013.09.016. PMID 24055983.
  6. ↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 6. ISBN 978-0443066573.
  7. ↑ 7.0 7.1 Singaporewalla, RM.; Mukherjee, JJ.; Thamboo, TP.; Cheah, WK. (Dec 2011). "Pharyngoesophageal diverticulum resembling a thyroid nodule on ultrasound.". Head Neck 33 (12): 1800-3. doi:10.1002/hed.21474. PMID 20665743.
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