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Clinical Challenge
Pathology
December 15, 2016

Retropharyngeal Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
  • 2Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
  • 3Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online December 15, 2016. doi:10.1001/jamaoto.2016.3008

A woman in her 30s with no significant medical history presented with progressive sore throat, globus sensation, and dysphagia. She was prescribed multiple rounds of antibiotics without notable improvement. Physical examination revealed a submucosal right retropharyngeal mass extending from the level of the soft palate to the postcricoid. Cranial nerve function and neck range of motion were normal. Contrast-enhanced computed tomography (CT) demonstrated a 4 × 3 × 3-cm right retropharyngeal mass with narrowing of the pharyngeal airway, subtle permeative destruction and cortical breakthrough of the C2 vertebral body. Magnetic resonance imaging (MRI) with contrast showed a T2 hyperintense, enhancing mass in the retropharyngeal and prevertebral spaces with marrow replacement of the C2 vertebral body extending to the odontoid (Figure, A). The patient underwent a combined otolaryngology-neurosurgical procedure with a transoral approach via an inferiorly based myomucosal flap to C1-C3 with microsurgical resection of C2 tumor and corpectomy, placement of the halo device, tracheotomy, and staged interval occiput-C6 posterior spinal fusion (Figure, B). Her postoperative course was uneventful, and she was decannulated prior to hospital discharge. Histopathologic findings showed sheets and cords of tumor cells with eosinophilic granular, clear, or bubbly cytoplasm on a basophilic myxoid stromal background (Figure, C), and scattered physaliphorous cells were also noted. Results from immunohistochemical analysis were positive for brachyury (Figure, D).

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