Zenker’s diverticulum (ZD) is an abnormally protruding space in the Killian triangle due to weakness between the inferior pharyngeal constrictor muscle and cricopharyngeal muscle. A rare disease that is found more often in the West than in the East, it occurs in the elderly, inducing dysphagia, globus symptom, reflux and etc. For the treatment, various transoral endoscopic techniques have been developed over the past 20 years: these include flexible and rigid endoscopy are used and several devices like scissors, staplers, CO2 laser and energy device. We report here the first case using the endoscopic energy device assisted diverticulostomy of ZD in Korea. Transoral endoscopic treatment is less invasive than classical transcervical approach treatment, showing better clinical course and results. Both rigid endoscope and energy device are also very familiar to head and neck surgeons, so this approach can be one of the best treatments for ZD.

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm characterized by sustained neutrophilia, splenomegaly, and hypercellular bone marrow without Philadelphia chromosome. Diagnosis of CNL requires exclusion of identifiable causes of reactive neutrophilia, such as infection and tumors. Our patient presented with general weakness and weight loss. Computed tomography (CT) showed a mass in the distal rectum, which was confirmed to be an adenocarcinoma by colonoscopic biopsy. Positron emission tomography-CT showed multiple liver, bone, and lymph node metastases. Liver and lymph node biopsies revealed neutrophilic infiltration with no evidence of adenocarcinoma. The pathological findings of the bone marrow were compatible with CNL. Cytogenetic analysis revealed a normal karyotype, and molecular analysis was negative for BCR/ABL. Here, we present a 73 year-old man diagnosed with concurrent CNL and rectal cancer.
Adenocarcinoma ; Biopsy ; Bone Marrow ; Cytogenetic Analysis ; Diagnosis ; Electrons ; Humans ; Karyotype ; Leukemia ; Leukemia, Neutrophilic, Chronic* ; Leukemoid Reaction ; Leukocytosis ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Neutrophils ; Philadelphia Chromosome ; Rectal Neoplasms* ; Rectum ; Splenomegaly ; Weight Loss