A huge retropharyngeal lipoma: a rare cause of dysphagia: a case report and literature review

Pharyngeal Lipoma-A Potentially Life Threatening Presentation

Pharyngeal lipoma of the upper aero-digestive system is extremely rare. It is typically benign, slow growing and symptoms would depend on its size and location. Surgical intervention is often needed especially for large tumour with impending airway obstruction. Here we present a case of potentially life threatening presentation of pharyngeal lipoma.

A Giant Retropharyngeal Lipoma: A Case Report and Review of Literature

Lipoma is a common benign soft tissue lesion that can virtually develop anywhere in the body. However, the retropharyngeal space is an extremely rare location for lipoma. We report the case of a 48-year-old man who presented with progressive dysphagia of 3 months duration. It was associated with a weight loss of 6 kg. There was no history of cough, regurgitation, or heartburn. He was a heavy smoker, but he denied consuming alcohol. On examination, the patient was noted to have a hoarse voice. Examination of the oral cavity revealed a bulge in the posterior pharyngeal wall with intact and smooth overlying mucosa. Examination of the neurological system revealed normal findings. The patient was referred to undergo a computed tomography of the neck, which demonstrated a well-defined homogeneous lesion with fat density in the retropharyngeal space. Subsequently, magnetic resonance imaging revealed a well-encapsulated midline retropharyngeal mass, measuring 4.6 x 10.2 x 13.8 cm, filling the retropharyngeal space and extending from the C2 vertebra superiorly to the inferior border of C7 inferiorly. The mass has a high signal intensity on T1- and T2-weighted images with complete suppression of the signal on the fat-saturated sequences, likely representing a retropharyngeal lipoma. The patient underwent surgical resection of the tumor by the lateral cervical approach. Histopathological examination showed lobules of mature adipose tissue, representing a lipoma. Retropharyngeal space is a very rare location of lipoma. The case highlights the importance of considering retropharyngeal lesions when encountering a patient with progressive dysphagia.

A prevertebral desmoplastic fibroblastoma presenting with sleep-related breathing dysfunction

Desmoplastic fibromas exceedingly rarely present in the retro/parapharyngeal space but should be considered in differential diagnosis for benign lumps in these anatomical regions.

Large airway-obstructing retropharyngeal lipoma in an asymptomatic patient: a case report

Background

Lipomas are common benign mesenchymal tumors that appear in the head and neck region in approximately 25% of cases where they are noted. Lipomas of the airway region are exceedingly rare, accounting for less than 1% of airway obstruction tumors. Correlation of radiographic findings from cone beam computed tomography (CBCT), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) of a rare retropharyngeal lipoma has not been previously reported. CBCT studies acquired for implant and/or other diagnostic purposes may be the first line of detection as an incidental finding.

Case presentation

A 66-year-old female presented for a pre-implant CBCT with no history of other complaints or signs/symptoms. CBCT imaging depicts a large, well-defined, low-attenuation/soft tissue density lesion with an undulating appearance extending from the posterior left pharyngeal wall and occluding two-thirds of the airway from C2 to C4. The lesion extends laterally into the left parapharyngeal space and inferiorly beyond the field of view of the study. Evidence of faint internal septations was noted. The patient was immediately referred for an ENT consult. Laryngoscopy, MRI, and contrast-enhanced MDCT imaging were conducted to determine the full extent and nature of the lesion, as well as to potentially plan for biopsy and/or surgical resection. Removal of the lesion was successful, and histopathologic evaluation confirmed lipoma. Periodic follow-up was recommended to monitor for possible recurrence.

Discussion

The slower growth pattern of some benign lesions may obscure any symptoms as changes the patient may normally notice take place over an extended period. Furthermore, soft tissue lesions and especially those in the posterior midline, such as in this case, may not be easily visible on routine panoramic imaging or clinical exam, allowing for substantially large growth before detection. While the soft tissue contrast of the CBCT volume is poor, enough information was present to establish an initial differential diagnosis and the need for more advanced imaging modalities. With the growing popularity and adoption of CBCT in maxillofacial imaging, a thorough understanding of the appearance of hard and soft tissue lesions, as well as a strong understanding of the baseline appearance of normal anatomy, is important to ensure no incidental pathoses go undiagnosed.