A rare case of a pedunculated lipoma in the pharynx

Spindle cell lipoma of the larynx: A case report

INTRODUCTION

Lipomas are rarely found in primary mesenchymal tumors of the hypopharynx and larynx. When they do appear, they often macroscopically resemble a retention cyst or laryngeal nodule. The laryngeal spindle cell lipoma, a variant, is extremely rare.

PATIENT CONCERNS

A 65-year-old woman presented with a 3-month history of pharyngeal paraesthesia. Laryngoscopy revealed the presence of a well-encapsulated, smooth-surfaced, yellowish, pedicled mass on the left epiglottis. Magnetic resonance imaging confirmed the epiglottic mass.

DIAGNOSIS

Following excision of the mass, the diagnosis of an spindle cell lipoma was established and confirmed by immunohistochemistry.

INTERVENTIONS

Surgical excision of the lesion using a controlled-temperature plasma technique (coblation).

OUTCOMES

At the last (4-year) follow-up evaluation, the patient was asymptomatic and without recurrence.

CONCLUSION

SLC involvement of the epiglottis is rare. Coblation is an effective means to remove it.

Lipoma of Piriform Sinus: A Case Report and Review of the Literature

The lipomas of oropharynx, hypopharynx, and larynx are so rare that up to now approximately there have been 100 cases reported. The lipomas are slow-growing lesions that are capable of reaching considerable dimensions and are often detected at a late stage. The symptoms can vary both in dimension and in location, semiobstructing the aerodigestive tract or exerting compression on adjacent structure. In this case, the lesion, which originated from the piriform sinus, was removed endoscopically urgently due to obvious signs of tissue suffering caused by stretching of the pedicle as a result of displacement of the mass. The two aims of this case report are to expose an interesting and rare case study mainly for an Emergency Room Specialist and an ENT (Ear, Nose, and Throat) Specialist involved in solving the problem and to demonstrate that the choice of an endoscopic approach is useful in order to have an optimal visualization of the lesion and to perform a total eradication. The use of endoscopic devices also allows a rapid postoperative recovery, compared to external access and optimum locoregional control in the follow-up procedures to prevent possible relapses.

Lipoma of vallecula-a case report

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. We present a rare case of a simple lipoma arising from the right vallecula. A 55-year-old male presented with worsening dysphagia for 1 week. CT scan revealed a lesion of fat attenuation in the right vallecula. The patient underwent surgical excision and recovered uneventfully. To our knowledge, there are only two cases of vallecular lipoma that have been reported and they are both of spindle cell subtype and located on the left side. This is the first reported case of a simple lipoma arising from the right vallecula and causing obstructive symptoms. CT scan or MRI is essential in confirming the diagnosis and assessing the extent, thus allowing prompt excision, especially when the patient is symptomatic.

Spindle cell lipoma of the hypopharynx

OBJECTIVE

We report a rare case of a spindle cell lipoma with atypical clinical course.

CASE REPORT

A 51 year old female patient referred to our clinic with feeling of mass in the throat she had had for two years. The patient described difficulty in swallowing. Indirect laryngoscopy did not reveal any masses at bilateral pyriform sinuses, and the mucosa had a natural appearance. However, a mass with a stalk was detected in the side of the mouth when the patient retched. Endoscopic monitoring of the mass revealed its origin to be the left sinus pyriformis. No pathological structures could be detected in the indirect laryngoscopy taken after the patient gulped again. The mass was shown by magnetic resonance imaging to extend into the esophagus. It was removed using suspension microlaryngoscopy. Postoperative control revealed a complete healing at the excision site. Immunohistochemical examination for pathological diagnosis indicated a spindle cell lipoma.

CONCLUSIONS

Laryngeal and hypopharyngeal lipomas are rare forms of benign laryngeal neoplasms. Their asymptomatic course makes diagnosis difficult. The patient is presented here with related clinical and pathological features.

Clinicopathological features of atypical lipomatous tumors of the laryngopharynx

Atypical lipomatous tumor (ALT) of the laryngopharynx is rare. Here we report five cases to demonstrate their clinicopathological features. The patients were four males and one female, aged 41 to 69 years (median 53.6 years). All tumors (two in the hypopharynx and three in the larynx) presented as a slowly growing, painless mass. Symptoms included dysphagia (2/5), dysphonia (3/5), and the feeling of a foreign body in the throat (5/5). Tumors were well circumscribed or focally infiltrative, ranging from 2.0 to 5.0 cm (median, 3.4 cm) in size, and microscopically showed the typical features of lipoma-like ALT. Immunohistochemically, tumor cells were stained with S-100, vimentin, murine double minute 2 (MDM-2), and cyclin-dependent kinase 4 (CDK4). Two patients had local tumor recurrences at 6 and 14 months after initial surgery during follow-up. ALT of laryngopharynx is an indolent tumor. Immunohistochemical staining for MDM-2 and CDK4 is helpful in pathological diagnosis.

Lipoma of the larynx: a case report

Lipoma is a benign tumour of mesenchymal origin with a very rare occurrence in the upper aero-digestive tract. To date, approximately 100 cases have been described in the literature. This lesion has a slow growth and, therefore, can present with various symptoms due to the mass effect with obstruction and compression on neighbouring structures, including dysphagia for liquid and solid food, dyspnoea and hoarseness. For a precise pre-operative diagnosis, indirect or direct laryngoscopy (flexible fibre-optic laryngoscopy) can be employed or, if necessary, also imaging techniques such as computed tomography scan and magnetic resonance imaging scan. These offer more useful information for better treatment planning. Surgery is the treatment of choice and includes endoscopic techniques and an external surgical approach (cervicotomy). It is very important to completely remove these benign neoplasms in order to avoid local recurrence. The present report referring to a case of laryngeal lipoma removed through an external surgical approach, aims to demonstrate that the choice of an external surgical approach is required for complete surgical removal of a large lipoma in order to prevent any possible recurrence. Furthermore, it is useful to keep in mind the possibility of recurrence of lipomas after long free intervals; therefore, it is mandatory to observe these patients at long-term follow-up.

Unusual case of laryngeal lipoma

Lipomas are benign tumors, composed of fat cells of the adult type. While lipomas on the trunk and limbs are common, they are rare in the upper aerodigestive tract. Here we report a case of laryngeal lipoma presented with a complaint of change of voice.

Acute stridor caused by a previously asymptomatic large oropharyngeal spindle cell lipoma

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. Spindle cell lipoma is a rarer histological variant characterised by mature adipocytes mixed with collagen-forming spindle cells. We present an unusual case of a 62-year-old lady who acutely presented to the emergency department with a large spindle cell lipoma arising from the vallecula. This lipoma was causing intermittent stridor unless traction was applied to it. Despite the size of the lesion, she had been completely asymptomatic prior to this single episode. To our knowledge, only one previous case of a spindle cell lipoma has been reported as specifically arising from the vallecula. This case also appears to be the largest reported from the oropharynx (17 cm length, 4 cm width). The tumour was completely removed endoscopically and the patient made an excellent recovery, returning home 3 days post-operatively. The histology, management and follow up of these lipomas are discussed.