The Silent Masquerade: Hypopharyngeal Squamous Cell Carcinoma Presenting as Recurrent Deep Neck Abscess in a Young Adult: A Case Report and Literature Review
Keywords:
Squamous Cell Carcinoma of Head and Neck, Retropharyngeal Abscess, Head and Neck Neoplasms, Carcinoma, Squamous CellAbstract
Background:
Deep neck space infections are common otolaryngologic emergencies that usually have a bacterial origin. However, a rare subset of head and neck squamous cell carcinomas (HNSCC) can present as cystic, necrotic masses that clinically mimic abscesses. Moreover, this type of presentation is exceptionally rare in young adults (<40 years) which leads to significant diagnostic delays.
The Case:
We present here a case of a 33-year-old male who presented with a six-month history of progressive dysphagia and recurrent neck swelling. He was initially diagnosed with retropharyngeal abscess and underwent incision and drainage (I&D) at two separate facilities. Despite antibiotic therapy and surgical drainage, the swelling recurred. The patient later developed airway compromise requiring tracheostomy. Subsequent imaging and biopsy revealed Stage IV hypopharyngeal squamous cell carcinoma with extensive necrotic cervical lymphadenopathy. The patient was planned for palliative care and supportive oncologic management. This report analyzes the "diagnostic trap" created by the confluence of young age and inflammatory presentation. In this case report, we discuss the pathophysiology of "cystic" nodal metastasis, the anatomical basis for retropharyngeal involvement (Nodes of Rouviere), and the critical dangers of performing open incision and drainage on malignant nodes that include surgical displacement.
Conclusion:
It concludes that clinicians must maintain a high level of suspicion for malignancy in an adult that presents with atypical deep neck abscess. Because these inflammatory episodes often mask an underlying squamous cell carcinoma. Fine-needle aspiration (FNA) with cytology is the preferred initial diagnostic step because open drainage of unrecognized malignancy increases morbidity and complicates future cancer resection.
Key Words: "Squamous Cell Carcinoma of Head and Neck"[Mesh], "Retropharyngeal Abscess"[Mesh], "Head and Neck Neoplasms"[Mesh], "Carcinoma, Squamous Cell"[Mesh]
References
1. Garneau JC, Bakst RL, Miles BA. Hypopharyngeal cancer: A state of the art review. Oral Oncol. 2018 Nov;86:244–50. doi:10.1016/j.oraloncology.2018.09.025 PubMed PMID: 30409307.
2. Maier H, Dietz A, Gewelke U, Heller WD, Weidauer H. Tobacco and alcohol and the risk of head and neck cancer. Clin Investig. 1992;70(3–4):320–7. doi:10.1007/BF00184668 PubMed PMID: 1521046.
3. Révész M, Oberna F, Slezák A, Ferenczi Ö, Kenessey I, Takácsi-Nagy Z. The characteristics of head and neck squamous cell cancer in young adults: A retrospective single-center study. Pathol Oncol Res POR. 2023;29:1611123. doi:10.3389/pore.2023.1611123 PubMed PMID: 37168050; PubMed Central PMCID: PMC10164923.
4. Zoumalan RA, Kleinberger AJ, Morris LGT, Ranade A, Yee H, DeLacure MD, et al. Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study. J Laryngol Otol. 2010 Dec;124(12):1284–8. doi:10.1017/S0022215110001453 PubMed PMID: 20573293; PubMed Central PMCID: PMC3005594.
5. Qureshi FG, Newman KD. Lymph Node Disorders. In: Pediatric Surgery [Internet]. Elsevier; 2012 [cited 2026 Mar 11]. p. 737–43. Available from: https://linkinghub.elsevier.com/retrieve/pii/B978032307255700057X doi:10.1016/B978-0-323-07255-7.00057-X
6. Krishnatreya M, Kataki AC, Sharma JD, Baishya N, Rahman T, Bhattcharyya M, et al. A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study. Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(S1):798–804. doi:10.1007/s12070-018-1556-4
7. Hong X, Quimby AE, Mavedatnia D, Pickett AT, Corsten M, Zhang T, et al. Oral Cavity Squamous Cell Carcinoma in Young Patients: A Multi-Institutional Study of the Canadian Head & Neck Collaborative Research Initiative. J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale. 2025;54:19160216251351562. doi:10.1177/19160216251351562 PubMed PMID: 40844831; PubMed Central PMCID: PMC12374110.
8. Petrelli F, Cin ED, Ghidini A, Carioli D, Falasca V, De Stefani A, et al. Human papillomavirus infection and non-oropharyngeal head and neck cancers: an umbrella review of meta-analysis. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2023 Sep;280(9):3921–30. doi:10.1007/s00405-023-08027-4 PubMed PMID: 37212863.
9. Kim Y, Joo YH, Kim MS, Lee YS. Prevalence of high-risk human papillomavirus and its genotype distribution in head and neck squamous cell carcinomas. J Pathol Transl Med. 2020 Sep;54(5):411–8. doi:10.4132/jptm.2020.06.22 PubMed PMID: 32683856; PubMed Central PMCID: PMC7483023.
Downloads
Published
How to Cite
License
Copyright (c) 2026 Muhammad Suliman Sajid, Dr Sheeza Afzal, Dr Shayan Asmat, Muhammad Haris, Dr Ameena Nasir, Dr Muhammad Amir Sohail, Dr Muhammad Osama Afzal, Dr Uzair Asad
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
