Surgical Management of Large Symptomatic Retropharyngeal Lipoma

We report a rare case of a giant retropharyngeal lipoma presenting with progressive neck swelling and compressive symptoms in a 41-year-old man with obesity, obstructive sleep apnea, and hypertension. Computed tomography imaging revealed a well-circumscribed, homogenous fat-density mass measuring 12×9×18 cm extending from the retropharyngeal space into the superior mediastinum. Transcervical excision was performed followed by dissection out adjacent structures and removing en bloc. Histopathology confirmed benign lipomatous mass. Postoperatively, the patient experienced rapid improvement in airway patency and dysphagia with no recurrence at follow-up. This case underscores the importance of including deep cervical lipoma in the differential diagnosis of a large anterior neck mass, the role of advanced imaging in excluding malignancy, and complete excision in treating symptomatic neck lipomas.