An atypical lipomatous tumor mimicking a giant fibrovascular polyp of the hypopharynx

Abstract

Rationale:Giant fibrovascular polyps (GFVPs) found in the hypopharynx are exceedingly rare. These are benign tumors which are identified by CT or MRI and usually treated based on symptoms. Even more rarely, pathology may identify one of these masses as an atypical lipomatous tumor (ALT). This paper will present a case of an ALT of the hypopharynx that was originally classified as a GFVP, highlighting the difficulty in distinguishing between them and the importance of making the correct diagnosis.Patient Concerns:An 84-year-old man presented to the emergency department with a 6-month history of a pedunculated hypopharyngeal growth, dysphagia, and intermittent dyspnea.Diagnoses:The mass was characterized as a GFVP by barium swallow and MRI.Interventions:The hypopharyngeal mass was resected for obstructive symptoms and to confirm the diagnosis. Final pathology found the mass to be more consistent with an atypical lipomatous tumor (ALT).Outcomes:The patient's dysphagia and dyspnea resolved. He was free of recurrence at 22 months postoperative.Lessons:Both GFVPs and ALTs are very rarely found in the hypopharynx but can be easily misclassified as one another. Imaging is useful to initially characterize the mass, but to definitively differentiate between them, pathological analysis is necessary. Although they are rare, it is important to consider both possibilities on the differential for hypopharyngeal masses. Further, accurate analysis is essential to distinguish between them because their definitive management and follow-up is different.

An Atypical Lipomatous Tumor of the Hypopharynx: Case Report

“…Other clinical manifestations include, but are not limited to, regurgitation of a fleshy mass into the oropharynx or mouth, globus sensation, and odynophagia has also been reported [ 6 ]. The commonly used system to classify liposarcomas is the WHO classification system, which groups the tumor into four subtypes: Atypical lipomatous/well-differentiated, myxoid, pleomorphic and dedifferentiated liposarcomas [ 6 , 8 ]. Well-differentiated liposarcoma accounts for 30-40% of the cases and is the second most common subtype preceding dedifferentiated liposarcomas [ 6 ].…”

“…The commonly used system to classify liposarcomas is the WHO classification system, which groups the tumor into four subtypes: Atypical lipomatous/well-differentiated, myxoid, pleomorphic and dedifferentiated liposarcomas [ 6 , 8 ]. Well-differentiated liposarcoma accounts for 30-40% of the cases and is the second most common subtype preceding dedifferentiated liposarcomas [ 6 ]. Diagnosis of liposarcoma can sometimes be challenging, due to clinical manifestation overlapping with other mass lesions such as lipoma, hamartoma, hemangioma, carcinoid tumor and specifically GFVP.…”

“…Diagnosis of liposarcoma can sometimes be challenging, due to clinical manifestation overlapping with other mass lesions such as lipoma, hamartoma, hemangioma, carcinoid tumor and specifically GFVP. Atypical liposarcomas can be distinguished from GFVP by histopathology [ 6 ].…”

“…Liposarcoma of the hypopharynx is an unusual entity and very few cases have been reported in the literature. It is worth noting that ALT can present clinically as a Giant Fibrovascular Polyp (GFVP), which is a rare benign tumor that usually occurs in the esophagus and to a lesser extent in the hypopharynx [ 6 ].…”

“…ALT is differentiated from GFVP histologically, they present as variable size adipocytes, atypical multivacuolated lipoblast, and nuclear atypia in adipocytes and spindle cells [ 6 ]. The importance of differentiating between ALT and GFVP is due to the malignant nature of ALT, thus, ALT requires surgical intervention and must be closely followed up post-operatively as ALT has the tendency to recur [ 6 ]. Here we report the clinical and pathological findings of a rare case of atypical lipomatous tumor of the hypopharynx that was successfully treated surgically without evidence of recurrence.…”