This document presents a case report of a 70-year-old male farmer who presented with a 6-month history of difficulty swallowing and a 2-month history of a swelling on the left side of his neck. On examination, he was found to have a 2.5x2.5 cm firm lymph node on the left side of his neck. Indirect laryngoscopy revealed normal findings. Based on the history and examination, the provisional diagnosis was a pyriform fossa malignancy extending to the supraglottis, explaining the patient's swallowing difficulties and neck swelling.

1. DEEPIKA KAMATH
Case presentation

2. Particulars
 Thavarya Naik
 70 yrs
 Male
 Farmer
 Davangere

3. Chief complaints
 H/O difficulty in swallowing – 6months
 H/O food sticking in throat – 6months
 H/O swelling over left side of neck – 2 months
 H/O Change of voice – 1 week

4. History of presenting illness
 Difficulty in swallowing
 Insidous, gradually progressive, Initially for solids,
since last week for liquids also.
 Associated with feeling of food being stuck in throat
on attempted swallowing.
 Burning sensation of throat on taking spicy food
items.
 Patient has increased salivation since last 1 week.

5. Swelling in left side of neck
 Insidous, gradually progressive, initially size of pea
when first noticed, which later progressed to present
size of lemon.
 No H/O sudden increase or decrease in swelling
 No H/O pain over the swelling
 No H/O discharge from the swelling.

6. Hoarsness
 Insidious, gradually progressive
 Dull, muffled type
 No diurnal variation
 No aggravating relieving factors

7.  H/O cough since 6 months, associated with yellowish
sputum, scanty, non foul smelling, non blood
stained.
 H/O recurrent fever present since last 6 months,
associated with chills and rigors. More during
evening time.
 H/O loss of appetite since 1 month
 H/O loss of weight since 1 month

8.  No H/O regurgitation of food on lying down.
 No H/O cough on swallowing liquids.
 No H/O bad smell from mouth.
 No H/O earache, ear fullness, decreased hearing, ear
discharge.
 No H/O Respiratory difficulty or noisy breathing
 No H/O Haemoptysis, haematemesis, malena.
 No H/O bone pains.

9. MEDICAL history
 No H/O DM, HTN, TB, BA, Drug allergies,
prolonged medication, Blood transfusions.

10. Treatment history
 Patient has not shown to any other doctor for the
present complaints.
 Post admission patient has been put on symptomatic
treatment.
 Iv fluids (RL and DNS)
 Inj Rantac 150mg BD
 Inj Diclo 50mg BD
 Inj PCT 500mg TID

11. Family history
 No similar complaints in the family

12. Personal history
 Appetite – Decreased
 Diet – Mixed
 B&B – Regular
 Sleep – Altered
 Habits – 1 pack bidi everyday since last 40 years
(abstinence since 1 week)
 Alcohol consumption (Brandy) around 250ml since
40 yrs. (abstinence since 1 week)

13. General examination
 72 year old male patient, moderately built and poorly
nourished
 Conscious, co operative, well oriented to time, place ,
person
 VITALS:
 BP: 120/80 mm hg
 PR: 76/ MIN
 RR: 18/ MIN
 Pallor, clubbing , lymphadenopathy – Present
 Icterus, cyanosis - Absent

14. Systemic examination
 CVS: S1 & S2 heard , no murmurs
 RS: B/L NVBS heard, no added sounds
 P/A: soft, non tender, no organomegaly
 CNS: normal

15. Local examination
 Oral Cavity
 Lips, Angle or mouth, GLS, GBS, tongue, floor of mouth
– Normal
 Mouth opening – adequate
 Teeth – Upper jaw edentilous, lower jaw lower central
incisors absent, rest are nicotine stained
 Buccal mucosa, hard palate – Nicotine stained
 RMT - Normal
 Oropharynx –
 AP, Tonsil, PP, Base of tongue, PPW – Normal
 Palpation of base of tongue – Normal

16. INDIRECT LARYNGOSCOPY

17. Neck examination
 Colour and appearance of skin – Normal
 Laryngeal framework –
 Inspection – normal, no widening, central, no
swelling.
 Palpation – No swelling appreciated.
 Laryngeal crepitus present
 No tenderness

18.  Lymph Node –
 Inspection – Solitary smooth hemispherical Swelling
of size 2.5x2.5 cm present above left middle third of
SCM, margins well defined, no signs of inflammation
seen. (Level III)
 Palpation – Inspectory findings confirmed, no local
rise of temperature, firm to hard in consistency, skin
over swelling pinchable, mobile from side to side,
immobile vertically.

19.  EAR
RIGHT LEFT
 Preauricular normal normal
 Pinna normal normal
 Postauricular normal normal
 EAC normal normal

20. nose
 Cold spatula test:
 External appearance: normal
 ARE Vestibule: normal
 Left sided DNS
 Turbinates pale
 Mucosa normal
 Paranasal sinuses: Non tender
 PRE: NORMAL

21. PROVISIONAL DIAGNOSIS
 Pyriform fossa malignancy extending to supraglottis