Extra-pleural solitary fibrous tumor (ESFT) is an uncommon mesenchymal neoplasm that is anatomically ubiquitous and may be found anywhere in the body, including the head and neck region. It is usually asymptomatic and presents as a slowly growing painless mass. Only three cases of retropharyngeal ESFT have been reported in the literature.A 54-year-old female affected by a cervicomediastinal mass complained of progressive dysphonia, pharyngeal foreign body sensation, and mild dyspnea. CT and MR showed a huge retropharyngoesophageal lesion extending to the upper posterior mediastinum. The tumor, despite its caudal extension, was completely removed with a pure cervicotomic approach; histology was consistent with ESFT.Histopathology and immunohistochemistry are crucial in the diagnosis of solitary fibrous tumor. Radical excision after primary treatment is the most important indicator of prognosis, and long-term clinical follow-up is recommended due to the possibility of recurrence and/or malignant transformation.
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