An Atypical Lipomatous Tumor of the Hypopharynx: Case Report

Nearly 20% of all mesenchymal tumors are liposarcoma in origin, mostly occurring in extremities and trunk. However, few cases of liposarcoma in the hypopharynx have been documented. This atypical localization of liposarcoma warrants a great interest in reporting such a case. Here, we report an 81-year-old Saudi male who presented to our clinic complaining of progressive dysphagia and globus sensation for two months. On examination, using a flexible nasopharyngoscopy, a hypopharyngeal mass occupying the left piriform sinus originating from the mucosa of the posterior pharyngeal wall and anteriorly from the anterior and medial piriform sinus mucosa was observed. Contrasted head and neck CT-scan revealed a benign-looking well-defined left-sided submucosal cyst aligned along the left aryepiglottic fold encroaching and narrowing the laryngeal inlet with dimensions of 1.8×2.1×2.7 cm. The mass was resected successfully using a trans-oral approach. A histopathological review showed spindle stromal cells that reacted positively for CD34 (Qbend10) on immunohistochemical staining and positive result for MDM2 (12q15) Amp. The pathology result indicates an abnormal amplification of the MDM2 gene region. The patient was followed for almost two years without evidence of recurrence. In conclusion, atypical lipomatous tumors (ALTs) of the hypopharynx are rarely diagnosed, and the gold standard for diagnosis is biopsy. Transoral endoscopic approach has a better outcome than cervical approach. Follow-up of patients with ALT is crucial, due to the highly recurring nature of the disease. Here we present a rare case of ALT, the patient had complete remission without complication.