Advanced hypopharyngeal squamous cell carcinoma mimicking thyroid abscess in a young male: Case report and literature review

INTRODUCTION AND IMPORTANCE: Thyroid gland involvement by hypopharyngeal carcinoma is due to their close proximity. Initial presentation of such cancer as a thyroid abscess is rare in clinical practice thus risk of potential misdiagnosis. To the best of our knowledge, this is the first reported case in Tanzania. CASE PRESENTATION: We present a 17-year old male who presented with difficulty in swallowing, hot potato voice, difficulty in breathing and a wound at the anterior aspect of the neck. He was managed at peripheral health facilities as having thyroid abscess so had serial incision and drainage and prescribed antibiotics. He was referred to us where he undergone tracheostomy, direct laryngoscopy coupled with taking biopsy. CLINICAL DISCUSSION: Computerized tomography (CT scan) of the head and neck showed an ill-defined heterogeneously enhancing mass with calcifications seen at the hypopharynx extending to the larynx and thyroid gland causing destruction of cricoid cartilage. It measured approximately 7.6 × 6.5 × 4.4 cm. The submandibular and sublingual glands are slightly infiltrated. Multiple enlarged lymph nodes are seen at anterior upper jugular IIa and posterior upper jugular IIb with the largest having central necrosis and measures approximately 2.9 × 1.7 cm. Histopathology showed an ulcerated epithelium with an infiltrative tumor containing dense chromatin. Such features were consistent with invasive squamous cell carcinoma, Grade II.(TNM staging being T4bN2cM0). The patient undergone tracheostomy to relieve upper airway obstruction and sent to oncology center for chemoradiation. CONCLUSION: Clinicians should have a high index of suspicion of a possible underlying hypopharyngeal cancer whenever encountering patients with thyroid abscess.