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Suspected malignant degeneration in a Zenker's diverticulum: should we biopsy it?

We report the case of an eighty-nine-year-old woman with progressive weight loss, oropharyngeal dysphagia and food regurgitation, presenting a Zenker's diverticulum with a lesion suggestive of malignant degeneration. Conservative management with endoscopic treatment was chosen due to the high surgical risk of the patient. Given the infrequency of these findings, we wondered about the best attitude to follow regarding both diagnosis and treatment according to the patient's characteristics.