A case report of giant inflammatory mass in the hypopharynx

Rationale: Hypopharyngeal inflammatory masses are rare conditions that may occur in association with factors such as intubation, trauma, or reflux. Their clinical and imaging features often closely mimic those of malignant tumors, necessitating a definitive diagnosis through the histopathological examination of surgical specimens. Although surgical excision remains the primary intervention for large lesions, vigilant postoperative surveillance is imperative because of the high recurrence rates. Patient concerns: We detail the case of a 26-year-old female admitted for a traumatic brainstem injury. Following 21 days of endotracheal intubation and over 2 months of nasogastric tube placement, flexible laryngoscopy revealed a mass in the left pyriform sinus, prompting referral to the Department of Otolaryngology-Head and Neck Surgery. The patient exhibited dysphagia and mild hoarseness as her sole symptoms. Diagnoses: Computed tomography and neck magnetic resonance imaging demonstrated a mass measuring approximately 32 mm × 27 mm at its largest cross-section, with ill-defined borders, heterogeneous density, and multiple bilateral cervical lymph nodes. Biopsy revealed inflammatory necrosis and granulation tissue. Interventions: Given the large size of the mass, persistent dysphagia, the inability to completely exclude malignancy based on imaging findings, and limited biopsy results, complete resection was performed under general anesthesia to alleviate symptoms and establish a definitive diagnosis. Subsequent pathological examination confirmed the presence of an inflammatory mass composed of necrotic and proliferative granulation tissue. Outcomes: The patient recovered well after the surgical removal of the lesion. During the 4-month follow-up period, a laryngoscopy performed 11 weeks after surgery revealed no recurrence of the mass. At the final telephone follow-up at 4 months after surgery, the patient reported no throat-related symptoms. Lessons: This case suggests that prolonged tube placement may be a potential contributing factor in the development of inflammatory masses in the pyriform sinus. In patients with a history of long-term tube placement who present with a pyriform sinus mass, inflammatory masses may be considered among the differential diagnoses.