Cervical lipoblastoma: Case report, review of literature, and genetic analysis

Head and neck lipoblastoma in children: A case report and systematic review

BACKGROUND

Lipoblastoma is a rare and benign tumor arising from embryonal fat cells. It develops primarily in infancy and early childhood. We present a case study of a 10-month-old child treated for an extensive tumor of the infratemporal fossa and parapharyngeal space. The systematic review of 60 reports in 80 children with lipoblastoma of the head and neck is also reported.

MATERIAL AND METHODS

Systematic review of all articles included lipoblastomas of the head and neck area in children published from 1964 to 2022 in the PubMed database was conducted. Clinical presentation of extensive lipoblastoma of the head and neck in a child.

RESULTS

On the basis of all inclusion criteria 83 articles were identified concerning pediatric lipoblastoma. There were 36 F (45%) and 39 M (48%), in 6 patients, (7%) gender was not specified. Ages ranged from 0mth (6h) to 15 yo (180mth). The tumor was located in the head in 22 (27%) cases, while the neck area accounted for 53 (65%) cases. General description without precise location was shown in 6 (7%) cases. All patients underwent complete surgical excision. Post surgical recurrence was noted in 6% clinical cases in the analyzed articles.

CONCLUSIONS

Lipoblastoma is characterized by a rapidly growing predominantly adipose mass. The treatment of choice is complete surgical excision. In selected cases when the pathology is hard to reach, as a consequence of the extensive penetration of the mass, we recommend performing the procedure with an interdisciplinary team. Endoscopy assistance and microdebrider significantly facilitated the removal of pathology in the described advanced case of lipoblastoma. This is the only case reported in the pediatric literature of a head and neck lipoblastoma, where due to extensive involvement and location of the disease the cranial nerves V2 and inferior alveolar branch of V3 could not be spared. Long-term follow-up even to 10 years is required because there is a reported tendency for these tumors to recur.

Imaging of head and neck lipoblastoma: case report and systematic review

Lipoblastoma is a rare and benign tumour arising from embryonal fat cells, predominantly diagnosed in children younger than 3 years old. The most frequent locations are the extremities and trunk, while the head and neck areas are more rarely affected (10-15% of total cases). Clinically, the most common presentation is a fast-growing painless mass. Ultrasound is the first-line imaging examination, but Magnetic Resonance Imaging (MRI) allows for better definition of the relationships with the adjacent vascular and muscular structures. It can help to identify the lipomatous components, and it is useful for preoperative planning. However, the definitive diagnosis is provided by histopathological examination. Complete surgical excision is the first-line treatment, with a good prognosis in case of total eradication. We report the case of a 7-month-old male child with a rapidly growing mass that had typical radiological features of lipoblastoma.

Cervical Hibernoma: A Very Rare Tumor of Childhood – Case Report with Review of Literature

Hibernomas are uncommon benign soft-tissue tumors which are composed of brown fat. They are usually seen in adults in the fourth and fifth decades and the common locations are thigh, shoulder, and back. Only few cases in the posterior neck region have been reported in literature. Hibernoma is very uncommon in the pediatric age group and those in the neck region are extremely rare. We present a hibernoma presenting as a swelling on the posterior aspect of base of the neck in a 5-month-old male infant. Considering the rare occurrence in the pediatric age group and difficulty in diagnosis, the clinical features, radiological features, pathological characteristics, differential diagnosis, and management of this rare tumor of childhood are discussed herewith.

A Rare Primary Dumbbell Lipoblastoma

Lipomas and lipoblastomas are benign tumors of mesenchymal origin in contrast to liposarcoma that is a malignant tumor. Atypical lipomatous lesion arising from embryonal fat cells is termed as lipoblastoma. In the present case report 9-month-old male presented to us with painless, rapidly progressing mass over back, power was normal in all four limbs, fine needle aspiration cytology was suggestive of cellular tissue, magnetic resonance imaging suggestive of well-defined enhancing mass in paravertebral location, extending from D3 to D10 vertebrae with intraspinal extension, communicating through neural foramina at level of D7. Intraoperatively, it was dumbbell-shaped, looked like neurofiboma based on the gross findings and it was adherent to dorsal nerve root also. Single level laminectomy with complete surgical excision of lesion done with sacrifice of dorsal nerve root. Histopathology was suggestive of lipoblastoma. Postoperative recovery was uneventful.

Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing

Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (©)RSNA, 2016.

Undifferentiated myxoid lipoblastoma with PLAG1-HAS2 fusion in an infant; morphologically mimicking primitive myxoid mesenchymal tumor of infancy (PMMTI)--diagnostic importance of cytogenetic and molecular testing and literature review

Lipoblastoma is a benign myxoid neoplasm arising in young children that typically demonstrates adipose differentiation. It is often morphologically indistinguishable from primitive myxoid mesenchymal tumor of infancy (PMMTI), which is characterized by a well-circumscribed myxoid mass with a proliferation of primitive mesenchymal cells with mild cytologic atypia. PMMTI occurs in the first year of life and is known to have locally aggressive behavior. No specific genetic rearrangements have been reported to date. In contrast, the presence of PLAG1 (Pleomorphic Adenoma Gene 1) rearrangement is diagnostic for lipoblastoma. We hereby demonstrate the combined application of multiple approaches to tackle the diagnostic challenges of a rapidly growing neck tumor in a 3-month-old female. An incisional tumor biopsy had features of an undifferentiated, myxoid mesenchymal neoplasm mimicking PMMTI. However, tumor cells showed diffuse nuclear expression by immunohistochemical (IHC) stain. Conventional cytogenetic and fluorescence in situ hybridization (FISH) analyses as well as next generation sequencing (NGS) demonstrated evidence of PLAG1 rearrangement, confirming the diagnosis of lipoblastoma. This experience warrants that undifferentiated myxoid lipoblastoma can mimic PMMTI, and the combination of cytogenetic and molecular approaches is essential to distinguish these two myxoid neoplasms. Literature on lipoblastomas with relevant molecular and cytogenetic findings is summarized. Our case is the first lipoblastoma diagnosed with a PLAG1 fusion defined by NGS technology.

Lipoblastoma and lipoblastomatosis of the lower leg

Lipoblastoma is a benign lesion of immature fat cells that is found almost exclusively in pediatric population. This tumor is a rare tumor that occurs in infancy and early childhood, accounting for less than 1% of all childhood neoplasm. It is more common in male than in female and often presents as an asymptomatic, rapidly enlarging, soft lobular mass on the extremity. Although benign, it gives great difficulty in its management, due to its extensions into different facial planes, especially in lipoblastomatosis. Thus, complete surgical excision is the treatment of choice.

Multifocal lipoblastoma of the face

Lipoblastoma is a rare benign neoplasm found exclusively in the pediatric population that can occur anywhere in the body, most commonly seen in the extremities but also found in the face. We report an 8-month-old female subject who presented with multifocal soft tissue masses of the face. The diagnosis of lipoblastoma was made in 2 separate locations after surgical resection. Subsequent surgery was performed at the cheek site in an attempt to remove further mass, resulting in discovery of 2 other discrete tumors found to be lipoblastomas. Although the literature reports recurrence rates ranging from 14% to 27%, to our knowledge, aside from a case of Proteus syndrome, there are no known reports of multiple lipoblastomas in the literature. Presentation of the case, review of pertinent literature, and consideration of congenital infiltrative lipomatosis of the face follow.

Cervical hibernoma and lipoblastomatosis

Lipoblastoma and lipoblastomatosis are rare benign soft-tissue tumoral lesions resembling fetal adipose tissue. A total of 16 cases of lipoblastoma of the neck were reported in the literature, and only 3 were described in the posterior side of the neck. Hibernoma is a rare benign adipose tumor composed of brown fat cells and only about ten cases occurring in the cervical area have been reported. We reported two rare cases of adipose tissue tumors. The first case was a male infant aged 12 months who had a cervical mass on the posterior side of the neck. He underwent a complete resection of the lesion and the pathologic study revealed lipoblastomatosis. The second case was a 36-year-old man with an anterior cervical mass, which moved with swallowing. A resection was made and the histological analysis showed hibernoma.

Cytogenetic analysis in the diagnosis and management of lipoblastomas: results from a single institution

BACKGROUND

Lipoblastomas are rare, benign, soft tissue tumors that occur primarily in young children. Treatment includes complete excision and surveillance for recurrence. Lipoblastomas can be indistinguishable from other benign lipomatous tumors and liposarcomas. Cytogenetic analysis can provide the definitive diagnosis in questionable cases, because benign and malignant lipomatous tumors exhibit specific nonrandom cytogenetic abnormalities. The purpose of the present study was to discuss the disease management and outcomes in a large contemporary group of patients with lipoblastoma.

MATERIALS AND METHODS

A retrospective chart review of patients diagnosed with lipoblastoma presenting from 2000-2011 was conducted. The data from these patients were compared with data from a previously published historical group of patients (1985-1999) from the same children's hospital.

RESULTS

We identified 37 patients in the contemporary cohort group and compared them with 25 patients from the historical group. The tumor involvement sites were similar. The current cohort group had a lower recurrence rate, although this might have been underestimated owing to a shorter follow-up period (median 1.4 y, range 2 wk to 11.0 y). Preoperative imaging findings led to an incorrect diagnosis in 62% of the patients. Cytogenetic analysis was used to help determine the final diagnosis in 50% of the cases. In 39% of cases, translocations involved the long arm of chromosome 8, the most common anomaly in lipoblastoma.

CONCLUSIONS

Lipoblastomas are rare tumors in young children that can be misclassified as other malignant or benign lipomatous tumors with markedly different outcomes and treatments. We recommend that cytogenetic analysis be routinely used for all pediatric lipomatous tumors to provide an accurate diagnosis and guide appropriate therapy and follow-up.

Lipoblastoma with unique localization requiring tracheal and esophageal resection

Lipoblastoma and lipoblastomatosis are rare tumors of infancy. They originate from embryonic fat and localize in soft tissues. We present the case of a lipoblastoma of the neck with localization in tracheal and esophageal walls that required an extended laryngotracheal and esophageal resection. To our knowledge, this is the first report of such localization of this tumor.

Pediatric lipoblastoma in the head and neck: a systematic review of 48 reported cases

BACKGROUND

Lipoblastoma is an exceedingly rare cause of pediatric head and neck masses. There have been 47 cases previously reported in the English literature. We present an additional case and review of the available literature on this rare neoplasm.

OBJECTIVE

To review and assess the current published literature regarding the efficacy of preserving neurovascular structures in the surgical management of pediatric lipoblastoma.

METHODS

Literature analysis of case reports was performed. MEDLINE was searched for the terms "neonatal lipoblastoma", "lipoblastomatosis", and "benign lipoblastoma". Results in the English literature were mined for relevant clinical data when available. The citations of case reviews found were searched to find additional cases.

RESULTS

Including our new case, a total of 48 cases of head and neck lipoblastoma have been reported in the English literature within 23 manuscripts. Four manuscripts presented cases series (Evidence Based Medicine Level 4) and 19 were case reports (Level 5). The median sample size was 1 (range 1-4). For those 14 articles (N=23 cases) reporting follow-up, the median follow-up duration was 22 months. Male to female ratio was 2.1:1 with an average age at presentation of 2.1 years (range: newborn to 12 years). Lesions ranged from 3 to 12 cm in longest diameter. Recurrence was seen in 27% of patients in which there was at least 1-year follow-up. The most common presenting symptoms were painless enlarging neck mass (53%, 17/32) and respiratory distress (12%, 4/32). An exact binomial sign test indicated that most authors recommend conservative complete excision with preservation of vital structures with 10 of 11 authors giving a stance supporting conservative surgical resection, p=.012.

CONCLUSIONS

Our findings suggest that although total excision is ideal and curative, subtotal resection may be a viable treatment alternative for lipoblastoma of the head and neck. This tumor presents a clinical challenge and should be considered in infants presenting with a cervical mass. It is difficult to differentiate from the much more common lymphangioma on clinical and radiological examination. Additionally, the potential for rapid growth and adhesion to neurovascular tissue makes surgical resection arduous. Nonetheless, recurrence rates for head and neck lipoblastomas are similar to those rates observed elsewhere in the body.

Congenital Infiltrative Lipomas in a Calf

The current report describes a case of congenital subcutaneous and intramuscular tumors of the neck and tail base in a 4-week-old female Angus-Charolais crossbred calf. Results of clinical and ultrasound examination are summarized. Biopsy and necropsy findings indicated an infiltrative lipoma. Congenital lipomas are uncommon tumors in bovids. Clinical and morphologic differentials, as well as classification and the possible pathogenesis of congenital neoplasms, are discussed.