A 45-year-old man presents with progressive dysphagia and a neck mass. Imaging reveals a hypopharyngeal tumour at the pyriform sinus with bilateral lymphadenopathy. Which elective neck nodal level does pyriform sinus carcinoma characteristically metastasize to first, and what is the highest-risk occult contralateral nodal level?

• A Level III ipsilaterally first; Level IV contralaterally
• B Level V ipsilaterally first; retropharyngeal contralaterally
• C Level II ipsilaterally first; Level II contralaterally ✓
• D Retropharyngeal nodes first; Level III contralaterally

Explanation

Pyriform sinus (hypopharyngeal) carcinoma most commonly metastasizes first to ipsilateral Level II (jugulodigastric) nodes, with subsequent spread to Levels III and IV. The contralateral occult metastasis rate is significant because pyriform sinus tumours cross the midline via the posterior hypopharyngeal wall; Level II nodes are also at greatest risk contralaterally. This drives bilateral neck treatment in most cases.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.