An Atypical Presentation of Primary Hypopharyngeal Carcinoma Mimicking Secondary Lymphadenopathy of the Neck

Hypopharyngeal cancers are rare, comprising less than 0.5% of all malignancies, with the pyriform fossa being the most common subsite involved. These tumors often present at an advanced stage due to their concealed anatomical location and aggressive nature. We present a rare and diagnostically challenging case of a 57-year-old male with a left-sided neck swelling initially suspected to be a secondary lymph node metastasis. Clinical examination and imaging revealed an ulceroproliferative lesion originating from the left pyriform fossa, extending laterally through the thyrohyoid membrane into the superficial neck, mimicking a lymph node. Fine Needle Aspiration Cytology (FNAC) and biopsy confirmed poorly differentiated squamous cell carcinoma. Advanced imaging further staged the disease as T4a N2a M0 (Stage IVa), prompting definitive chemoradiotherapy. The uniqueness of this case lies in the unusual spread pattern of the primary tumor, which breached the anatomical barriers typically limiting lateral extension. Literature review revealed no similar cases with a primary hypopharyngeal lesion mimicking a nodal mass via subcutaneous spread. This case emphasizes the importance of considering primary tumors in atypical neck swellings and highlights the need for thorough clinical and radiological assessment. Accurate diagnosis is crucial as it significantly alters management strategies, particularly when surgical options become limited in advanced disease. This report contributes to the limited body of evidence on unusual presentations of hypopharyngeal carcinoma and reinforces the significance of anatomical knowledge in head and neck oncology.