Hypopharyngeal lipoma (HL) is one of the most frequent benign tumors of soft tissue, about 4-5% of the total benign tumors and can reach considerable size. Lipomas are found, usually in the soft tissue of the neck, trunk, spine extremities, but quite rare in the upper airway tract. We present a clinical case of a 65 year old man, with HL of considerable size, slow evolution and serious complications, emergency hospitalized an otolaryngologist (ENT) clinic. The patient is a smoker, married, with satisfactory living conditions, he contends himself ill for 3 years when slight dysphagia first appeared. He addressed the doctor many time and following the symptomatic treatment. After several months the patient feels discomfort in the throat (foreign body), intense discomfort at the swallowing, the irritating cough until dyspnea, intensification of the snore, and excessive secretion in the throat. Because of the intense symptoms the patient is hospitalized to the special ENT clinic. At the oropharyngoscopic examination we see: the mucosa of the oral cavity is pale pink, the tongue moist, clean. At the indirect laryngoscopy it is detected an smooth formation, pale pink, which occupies around 2/3 of the hypopharyngeal space, predominantly on the left upper part above the epiglottis, around 4x3 cm, the glottic cleft and the vocal cords are partially visualized, the mucosa is pale pink in the region of the epiglottis, rhinoscopic and otoscopic examination without pathological features. Blood test without changes. After patient examination the specialists decided and practiced ablation of the formation by suspended microlaryngoscopy with general anesthesia, orotracheal intubation. Intraoperative is determined a polypoid formation, smooth, pale pink, elastic, located with the wide pedicle in the left part of the hypopharynx. At the histological examination of the anatomical part, it is determined uniformly mature adipocytes, univacuolate, separated by dense bands of fibrosis, characteristic for fibrolipoma. The particularity of this case is based on the slow evolution of HL can take years, with considerable sizes which endangers life. Specific characteristics of HL explaine late presentation to the ENT specialist. To treat the patient with HL it isnecessary to involve a multidisciplinary team ENT, Anesthesiology and intensive care, Oral and maxillofacial surgery.