Abstract
Solitary fibrous tumors are rare mesenchymal neoplasms that are increasingly being described in the head and neck. Clinical presentations may include compression by these tumors on vital surrounding structures. While malignant transformation is rare, treatment entails wide local excision. We present the case of a 74 year-old female with an increasingly enlarging symptomatic hypopharyngeal solitary fibrous tumor that was found on carotid duplex ultrasound. Transoral surgical excision resulted in relief of symptoms. Treatment options are discussed and a literature review of this uncommon disorder presented.
1
Introduction
Solitary fibrous tumor (SFT) is an uncommon, slow-growing, mesenchymal neoplasm that was initially described in 1931 arising from the pleura . Since this first case, SFTs have been described in the abdominal cavity, extremities, retroperitoneum, and head and neck region . The first reported case in the upper aerodigestive tract was in 1991, and there are less than 200 reported cases in the head and neck, with the most common sites being the oral cavity and paranasal sinuses . To our knowledge, we present the 3rd reported case of a SFT arising from the hypopharynx, with successful treatment using transoral surgery ( Table 1 ) .
| Study | Tumor Size (cm) | Presenting Symptoms | Surgical Approach | Disease-free follow-up (mo) |
|---|---|---|---|---|
| Mussak et al. | 4.5 × 4 × 3.2 | Progressive Dysphagia, 30 lb wt. loss | Lateral pharyngotomy | 18 |
| Hanna et al. | 4.1 × 3 × 1.2 | Progressive Dysphagia | Transoral | 9 |
| Present Study | 4 × 2 × 2 | Progressive dysphagia, dysphonia | Transoral | 9 |
2
Case report
A 74-year-old female with a one-year history of progressive dysphagia and dysphonia presented to our tertiary academic medical center with a hypopharyngeal mass. This mass was incidentally found on a carotid duplex ultrasound of the neck. An outside biopsy was inconclusive. An MRI was significant for a 4 × 2 × 2 cm hypopharyngeal mass compressing the airway medially and abutting the carotid artery laterally ( Fig. 1 ).
She was then taken to the operating room and underwent microsuspension direct laryngoscopy and biopsy. Intraoperative frozen sections were nondiagnostic. Therefore, transoral CO2 laser debulking was undertaken. The tumor was densely adherent to the lateral hypopharyngeal wall. Final pathology revealed low grade spindle cell neoplasm consistent with SFT ( Figs. 2 and 3 ). Nine-months postoperatively, she is asymptomatic with no mucosal irregularities on flexible laryngoscopy. She has elected conservative management with close clinical and radiologic follow-up.
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