Globus sensation and dysphagia: A rare case of retropharyngeal lipoma

Retropharyngeal lipoma are rare and mostly published as case reports. This case report shows the variability of clinical presentation and therapy of reported retropharyngeal lipoma and illustrates an exemplary complicated case with multiple surgical interventions. This article reports a 72-years old male patient who consulted the department of otorhinolaryngology, head and neck surgery at the university hospital in Mannheim, Germany with globus sensation and dysphagia. Cervical MRI and CT suspected a retropharyngeal lipoma in the area of the left sided posterior pharyngeal wall. In 2012 the patient had a laryngo- and pharyngoscopy with enoral excision of an oropharyngeal tumor and histopathological proof of a fibrolipoma. Combined transcervical and transoral tumor resection was performed and the histological examination yielded again the proof of a lipomatosis tumor formation. Annual clinical and radiological control examinations were recommended. In 2023 the patient presented again with a cervical CT proven size progression of the before known lipoma and yet again progressive dysphagia. Surgical treatment with left sided transcervical tumor resection was performed again. During tumor resection a accidentally laceration occurred of the left pharynx wall. Multiple lipoma-suspected, 3mm mucosa variations of the pharynx were detected and precisely removed. The histopathological report showed an atypical lipomatous tumor (G1) with proof of a high level amplification for MDM2 and CDK4, thus surgical treatment without adjuvant therapy was sufficient. Retropharyngeal lipomas and atypical lipomatous tumors can recur and require regular annual follow-ups including MRI scans.