Abstract

Pharyngeal liposarcomas are very rare; still more rare are dedifferentiated liposarcomas in the pharynx. An 82-year-old man presented with dysphagia, voice changes, weight loss, nasal regurgitation of liquids, and coughing spells. A 3.5 cm mass was identified in the hypopharynx. The mass was biopsied and diagnosed as a benign fibroepithelial polyp. Continued symptoms and airway obstruction prompted a pharyngectomy, and the mass was then diagnosed as dedifferentiated liposarcoma. Due to infrequency and subtle histological findings, liposarcomas of the head and neck can be misdiagnosed and recur.

Case Report

An 82-year-old man presented to the clinic for evaluation of a throat mass. He reported dysphagia that began 4 to 5 months previously with associated 17-pound weight loss. He denied throat pain but endorsed voice changes, frequent nasal regurgitation of liquids, food getting stuck, and frequent coughing spells. After a prolonged coughing episode, he went to urgent care and was given an analgesic with symptomatic improvement. However, his dysphagia progressed until he developed difficulty swallowing water. He had no family history of cancer. He went to his primary care physician for evaluation who referred him to gastroenterology for an upper endoscopy and a Modified Barium Swallow Study. The upper endoscopy revealed no concerns with his esophagus, but a referral to otolaryngology was recommended. In the office, a flexible laryngoscopy revealed a benign-appearing mass in his throat. A CT scan of the neck (Figure 1) showed a 3.5 cm in diameter hyperdense mass in the hypopharynx originating in the left dorsal wall and a smaller 1.7 cm mass in the right posterior hypopharynx. A biopsy of the mass was diagnosed as a benign fibroepithelial polyp. Unfortunately, the patient continued to experience airway obstruction; thus, a transoral robot-assisted pharyngectomy was performed to remove this mass. The tissue was sent to pathology for further evaluation. The case was sent for expert consultation where it was diagnosed as dedifferentiated liposarcoma, intermediate grade (grade 2 of 3, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC)) arising from a background well-differentiated liposarcoma.

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