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.
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Copyright (c) 2026 Muhammad Suliman Sajid, Dr Sheeza Ahmed, Dr Shayan Asmat, Muhammad Haris, Dr Ameena Nasir, Dr Muhammad Amir Sohail, Dr Muhammad Osama Afzal, Dr Uzair Asad
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