Journal

Epiglottic Cyst Incidentally Discovered

During Screening Endoscopy: A Case
Report and Review of Literature
Fahreza
2006112033
 INTRODUCTION The incidence of stomach cancer is
high in East Asian countries
including China and South Korea,
compared to Western countries in
Esophagogastroduodenosco
Europe and North America
py (EGD) is a common and
established procedure for the
diagnosis, follow-up, and
treatment of a variety of
upper gastrointestinal (GI)
tract disorders including
gastric neoplasm.

In South Korea, stomach cancer is the

The primary focus of EGD is the
second most common cancer
examination of the esophagus, stomach, and
and third most common cause of
proximal duodenum (usually till 2nd portion).
cancer death
Oral cavity, pharynx, and larynx including
The epiglottis may also be observed during
the insertion withdrawal of the endoscope
(A–D) Typical endos copic
findings of normal anatomy of
oral cavity, pharynx, and larynx
including epiglottis and vocal
cord
CASE REPORT
An asymptomatic 55-year-old woman
with a family history of gastric cancer
visited at the Department of Family
Practice and Community Health, Ajou
University Hospital for routine medical
check-up including a screening EGD for
upper GI cancer. She had hypertension
that was controlled with medication, and
had no other medical illness or surgical
history. The patient did not smoke
tobacco nor drink alcohol.
• On general examination, the patient was healthy-looking in
appearance, but obese (height, 160.3 cm; weight, 71.1 kg,
waist circumference 101.2 cm; body mass index, 27.7 kg/m2 ).
• The patient’s vital signs showed a BP of 115/70 mm Hg, a
regular HR of 70 beats/min, a RR of 18 rates/ min, and a T of
36.7o C.
• Other aspects of the physical examination including abdomen
were unremarkable as well.
• All laboratory tests were all within normal limits.
• Radiologic evaluations including chest X-ray, abdomen
supine/erect X-ray, and abdominal ultrasonography were also
without significant findings
CASE REPORT
Two years previous to this EGD, the patient had At this time, she wanted EGD with
undergone screening EGD with sedation, which was sedation in order to avoid discomfort
without significant findings or complications and anxiety about the procedure.

• When the endoscope was intubated into the oral cavity, an

approximately 15 × 30 mm sized globular yellowish
cystic mass with smooth surface and visible vessels was
seen arising from the right side of epiglottis.
• This lesion had not been present during the index
examination 2 years prior.
• Fortunately, the lesion was not obstructing the airway.
Both the left and right vocal cords were intact, well-
mobile, and free of adhesions. Also, the lesion did not
interrupt the advance of the endoscope, which was
inserted through piriformis fossa into the esophagus.
• The remainder of the examination was without abnormal
findings except for mild chronic superficial gastritis in the
antrum
 CASE REPORT
• Although the patient was asymptomatic, the
patient was referred to the otolaryngology
department because of the accelerated growth of
the lesion to a relatively large size within a 2
year period and the possibility of airway
obstruction and difficulty in intubation in
future emergency situations.

• The cystic-like mass was resected by carbon

dioxide (CO2) laser under operating micro-
laryngoscope and sent for histopathology, after
which the lesion was confirmed to be a benign
epiglottic cyst.
DISCUSSION
• Laryngeal cyst is a rare entity and constitutes
only 4.3% to 6% of all benign laryngeal tumors.
• In 1852, Verneuil first described the presence of
a laryngeal cyst in a post-mortem of an infant.
Also, in 1864, Durham first reported a case of
epiglottic cyst in an 11-year-old boy, which was
successfully treated by surgical incision. Since
then, a variety of cases have been reported, but
the laryngeal cysts, including epiglottic
variants, still present a relatively rare
occurrence.
• The epiglottis is one of nine cartilaginous
structures that make up the larynx; the
laryngeal skeleton consist of nine cartilage
structures, three single (epiglottic, thyroid,
cricoid) and three paired (arytenoid,
corniculate, cuneiform)
• Epiglottic cysts arise in the region of
epiglottis, a thin valve-like structure made of
cartilage that is located behind the base of
tongue. The lingual surface of the epiglottis is
the most common location for these lesions.
Henderson et al. demonstrated that 52% of the
laryngeal cysts originated from the lingual
aspect of the epiglottis in their study
DISCUSSION
• Epiglottic cyst seems to be more prevalent in the 6th decade of life, which
was the case in this patient, although they can affect and have been reported
in all ages.
• most adult epiglottic cysts are benign and asymptomatic.

• Therefore, these anomalies are sometimes discovered unintentionally during

routine otolaryngological examination, induction of general anesthesia,
and upper GI endoscopy, because this area is the passage to going into the
esophagus during endoscopic examination.

In this case, the lesion was incidentally found during screening endoscopy for
gastric cancer, and the patient had been asymptomatic and unaware of the lesion.
However, in accordance with the size and extension into the airway, there were
symptoms associated these lesions such as foreign body sensation in the throat,
hoarseness,
cough, stridor, and dysphagia. Additionally, epiglottic cyst may have a future risk of
airway obstruction
DISCUSSION
• Early intervention may be prudent for incidentally found epiglottic cyst in
adults, though they may be symptomless and small in size.
• Treatment options include endoscopic excision, marsupialization,
unroofing, and lateral pharyngotomy
• Recently, CO2 laser has been successfully applied in nearly all cases due to
superior coagulation of the laser and shorter time to recovery.
• Simple aspiration is no longer recommended due to high recurrence rates,
but can be used for volume reduction prior to surgical or CO2 laser resection.

In this case, the epiglottic cyst of our patient was completely removed using
CO2 laser under operating micro-laryngoscope without complications. Local
recurrence of epiglottic cysts can be minimized by complete removal of the cyst
wall. In certain cases, prophylatic antibiotics may occasionally be helpful after
treatment to avoid acute epiglottitis