Superficial squamous cell carcinoma arising in Laimer's diverticulum: a rare case highlighting the importance of anatomical differentiation.

Abstract

Introduction: Laimer's diverticulum (LD) is a rare pharyngoesophageal diverticulum that originates from the posterior wall of the cervical esophagus and beneath the cricopharyngeal muscle (CPM). Carcinoma arising in pharyngoesophageal diverticula occurs predominantly in association with Zenker's diverticulum (ZD), whereas its occurrence in LD is exceptionally rare. We report a rare case of superficial squamous cell carcinoma that originated in LD.

Case presentation: A 78-year-old man with a known esophageal diverticulum presented with a 9-year history of progressive dysphagia and regurgitation of food. Esophagography and contrast-enhanced computed tomography demonstrated a large posterior diverticulum originating from the cervical esophagus below the cricoid cartilage. Diverticulectomy was performed through a left cervical approach. Intraoperative findings confirmed that the diverticulum originated from the posterior wall of the cervical esophagus, inferior to the CPM, consistent with LD. Histopathological examination revealed an intra-diverticular 15 mm × 10 mm squamous cell carcinoma in situ (pT1a-EP). Surgical margins were negative, and the postoperative course was uneventful.

Discussion: Accurate anatomical differentiation among types of cervical esophageal diverticula is essential because treatment strategies may differ substantially among LD, ZD, and Killian-Jamieson diverticulum. Endoscopic identification may be difficult because retained food debris, chronic inflammatory changes, and the narrow diverticular lumen can conceal superficial lesions; meticulous cleaning and enhanced endoscopic observation, including narrow-band imaging or Lugol chromoendoscopy, may improve detection in similar cases. Misdiagnosis of LD as ZD may result in inappropriate treatment selection, particularly when endoscopic septotomy is considered.

Conclusion: We report a rare case of superficial squamous cell carcinoma originating in LD. Careful anatomical assessment is essential for accurate diagnosis and appropriate surgical management of cervical esophageal diverticula. This case underscores the importance of early surgical excision or regular surveillance when cervical esophageal diverticula are managed nonoperatively.