Author(s)
Tom C Zhou MD, Paul E Wakely Jr MD, Brad W deSilva MD
Affiliation(s)
Ohio State University
Abstract:
Objective: To present a case of pseudosarcomatous myofibroblastic proliferation, or inflammatory pseudotumor (IPT), of the hypopharynx along with a literature review of presentation, diagnosis, and management of IPT.Method: A case of IPT in the hypopharynx is reported from a tertiary referral center and a retrospective review of cases of IPT in the head and neck is discussed.Results: IPT is a benign pseudoneoplastic proliferation related to idiopathic inflammation that has been found to occur in various sites but is exceedingly rare in the head and neck. We report a case of hypopharyngeal IPT in a 36-year-old male presenting with dysphagia and orthopnea. Computerized tomography (CT) of the neck with contrast revealed a 4.1 cm lobulated mass from the hypopharynx extending to posterior oropharynx. Flexible fiberoptic laryngoscopy demonstrated a smooth and lobulated mass causing near complete obstruction of laryngeal inlet. The patient underwent awake fiberoptic intubation with surgical excision via direct microlaryngoscopy. Histopathologic analysis using immunostains confirmed diagnosis of Pseudosarcomatous Myofibroblastic Proliferation (Inflammatory Pseudotumor). Follow-up at 3 weeks revealed unremarkable post-operative course.Conclusion: Only two cases of hypopharyngeal IPT have been previously reported in the literature. Presentation is related to mass effect and obstructive nature of the lesion. Workup should include flexible fiberoptic laryngoscopy and CT neck with contrast. Excision via direct microlaryngoscopy is an effective minimally-invasive surgical approach. IPT should be considered in patients with head and neck mass as inaccurate diagnosis of malignant lesion could potentially lead to improper management.