Solitary Fibrous Tumor of the Postcricoid Region: A Case Report and Literature Review

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere in the body. Presentations in the hypopharynx are extremely rare with only two previous cases reported. We report the first case of postcricoid SFT occurring in a 58-year-old male requiring a microsuspension laryngoscopy excision following an unsuccessful transoral robotic attempt. The excision was uneventful, and the patient is currently without recurrence. Current management strategies of the hypopharyngeal SFT, the unique differential diagnosis, and challenges in surgical approaches in the postcricoid region are discussed. 1. Introduction Solitary fibrous tumor (SFT) is a rare spindle cell, mesenchymal neoplasm characterized by the proliferation of thin-walled vessels and collagen producing cells [1]. SFT has been described in almost every organ in the human body, but presentation in the hypopharynx is extremely rare, with only two previously reported cases [2, 3]. We present the first case of SFT ever reported in the English literature originating from the postcricoid region of the hypopharynx. A literature review of current management strategies of the hypopharyngeal SFT, the unique differential diagnosis, and challenges in surgical approaches in the postcricoid region is then presented. 2. Case Report The patient is a 58-year-old African-American male with a past medical history of hypertension, hypothyroidism, and asthma, who initially presented to an otolaryngologist with complaints of one-year history of intermittent tightness in the throat, progressive shortness of breath, dysphagia, and dysphonia. The patient denied any history of tobacco or alcohol use. The patient was referred to USC Department of Otolaryngology in October 2010. Clinical evaluation was unremarkable. There was no neck mass or lymphadenopathy. Video stroboscopy demonstrated a large mass in the postcricoid region encroaching the laryngeal inlet. The left vocal fold appeared to be immobile (Figure 1). Figure 1: Video stroboscopy image of the postcricoid SFT demonstrating a large soft tissue mass in the postcricoid region encroaching the laryngeal inlet. Computerized tomography scan demonstrated a heterogeneous, diffusely enhancing mass of the postcricoid region extending to the left pyriform sinus. It measured 4.1？cm right to left and 3.6？cm anteroposteriorly, and it displaced the left thyroid cartilage and arytenoid cartilage a few millimeters anteriorly. There was adjacent thickening of the left aryepiglottic fold. Direct laryngoscopy and biopsy were performed in November 2010. A