Sudden death due to a hypopharyngeal mass during sleep: a case report

It is not frequent to find during the autopsy a lymphoid hyperplasia located in the hypopharynx. The literature reports numerous cases characterized by the presence of a mass, non-malignant too, in this particular anatomical district; in these cases the neoformation plays an important role in explaining the cause of death through different asphyxial mechanisms. We present a case of a 44-year-old man, in apparent good health, who suddenly died during sleep. The autopsy revealed an hypopharyngeal lymphoid hyperplasia that can provide the asphyxial mechanisms as cause of death. Furthermore, the anatomical finding could be integrated by a circumstantial piece of evidence: the death occurring during sleep. Some studies, in fact, have highlighted the physio-pathological mechanisms to explain sleep-disordered breathing, particularly the muscular and neural changes involving the pharynx. The asphyxial mechanism was also studied by an immunoistochemical analysis with the anti-Human Surfactant Apoprotein-A (SP-A) antibody.