Bilateral Posterior Pharyngeal Masses in Young Adult with GERD History

Case at a Glance

A 22-year-old female presented with asymptomatic bilateral posterior pharyngeal masses discovered incidentally one month prior, in the setting of known gastroesophageal reflux disease and mild esophagitis.

Patient's Story

The patient, a 22-year-old non-smoking, non-drinking female, reported noticing two raised lesions in her posterior throat approximately four weeks ago. She described minimal discomfort, primarily awareness of the masses during swallowing of solids and liquids. The patient recalled possible mild pain at initial onset but was uncertain of this detail. She denied sore throat, odynophagia, or systemic symptoms. Her medical history was significant for gastroesophageal reflux disease diagnosed one year prior, with endoscopic findings of mild esophagitis.

Initial Assessment

Physical examination revealed two well-demarcated, raised lesions on the posterior pharyngeal wall. The masses appeared to have a smooth surface with possible central clearing or fluid collection. The patient was afebrile with normal vital signs. No cervical lymphadenopathy was detected on palpation.

The Diagnostic Journey

Given the patient's age, benign appearance of the lesions, and absence of concerning symptoms, differential diagnosis included benign lymphoid hyperplasia, retention cysts, or reactive changes secondary to chronic acid reflux. The relationship between her known GERD and these posterior pharyngeal findings required consideration.

Final Diagnosis

Pending further evaluation - likely benign posterior pharyngeal cysts or lymphoid hyperplasia, possibly related to chronic gastroesophageal reflux.

Treatment Plan

ENT consultation recommended for direct laryngoscopy and possible biopsy if lesions persist or enlarge. Continue current GERD management with proton pump inhibitors. Patient counseled on symptoms warranting immediate medical attention including dysphagia, odynophagia, or rapid growth of lesions.

Outcome and Follow-up

Patient advised to return in 4-6 weeks for reassessment if lesions persist, sooner if symptoms develop. ENT referral initiated for specialized evaluation and management recommendations.