Hypopharyngeal Venous Malformation Mimicking Malignancy: A Case Report

Hypopharyngeal venous malformations are rare and may mimic malignancy on imaging, creating diagnostic and management challenges, particularly when tissue diagnosis is required. A 61-year-old woman presented with progressive dysphagia and odynophagia. Contrast-enhanced computed tomography (CT) of the neck demonstrated an enhancing lesion involving the left tongue base, aryepiglottic fold, and hypopharynx, with associated coarse calcifications, raising concern for neoplasia. Flexible laryngoscopy revealed a compressible, purplish, vascular-appearing lesion. The patient underwent direct laryngoscopy with biopsy using a Lindholm laryngoscope with rigid telescope assistance, during which bleeding was successfully controlled with epinephrine-soaked pledgets. Histopathological analysis confirmed a venous malformation with phleboliths and features of a chronic low-flow vascular lesion, including positive immunohistochemical staining for CD34, CD31, and smooth muscle actin. Hypopharyngeal venous malformations can closely resemble malignancy on imaging. Recognition of characteristic features, including calcifications and compressibility on endoscopy, is essential to guide diagnosis. This case demonstrates that biopsy can be performed safely in selected patients with appropriate airway planning and hemostatic precautions.