Content area
Full text
Correspondence to Dr Muhammad Sami Jabbr, [email protected]
Background
Lipomas of the larynx and hypopharynx are very uncommon tumours. Only about 100 cases have been reported in the literature. Less than 15% of lipomas occur in the head and neck which usually happens in the posterior neck subcutaneous tissue. A solitary lipoma in the hypopharynx makes a clinical diagnosis more difficult and remains undetectable until it achieves a considerable size affecting deglutition, speech progressively and eventually may cause respiratory distress.
Case presentation
A 58-year-old policeman was seen at ear-nose-throat (ENT) clinic with a 1-year history of progressive voice change; he had the typical ‘hot potato voice.’ He developed recently paroxysmal coughing spasms during his meals with swallowing difficulty of solids and sensation of foreign body in the throat. However, there was no stridor nor aspiration or any respiratory distress.
He was a non-smoker and non-alcoholic. His medical history was unremarkable except having type 2 diabetes for which he takes metformin twice daily. Flexible laryngeal endoscopic examination showed a large mass covered by smooth looks like normal mucosa, occupying the right supraglottic area obscuring glottic gap visualisation and causing narrowing of both the hypopharynx and larynx. The clinical impression was that of a retention cyst or an internal laryngocele (figure 1A–E).
Contrast-enhanced CT scan of the head and neck showed a well-defined large oval shaped non-enhancing, more likely fluid-filled cystic lesion measuring 43×27×71 mm, seen in supraglottic region, extending to postcricoid area, in continuity with right laryngeal ventricle and causing mild compression of airway (figure 2A–D). These features are suggesting internal laryngocele or retention cyst.
Once the CT scan is quicker and more readily available and its report included same our clinical differential diagnosis and did not mention the possibility of other pathologies especially rare ones, we did not request a further radiological investigation like MRI of the neck which could had been of great importance in adding another possible rare diagnosis like lipoma as we will see in the discussion below.
Due to its potential to obstruct the airway, the mass was immediately treated by microscopic debulking using direct laryngoscope and microscissors and forceps. A nasogastric tube was inserted at the end of procedure ensuring its position through the right piriform sinus and...