Retropharyngeal Osteolipoma Requiring an Interdisciplinary Approach

Osteolipoma of head and neck - a review

OBJECTIVE

Due to the rarity of osteolipoma, current knowledge and understanding of its' clinical presentation, management, radiological features, histological characteristics, and prognosis are lacking and can present a clinical conundrum to clinicians and histopathologist alike, given wide range of differential diagnoses. This paper aims to compile, analyse and present details to augment the available literature on osteolipoma in the head and neck.

METHODS

A comprehensive literature search on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index, Google scholar and Cochrane database for osteolipoma in head and neck was performed up to the 1st May 2021. Reference lists from the relevant articles were then inspected and cross-referenced and any other pertinent publications were added to the review.

RESULTS

A total of 38 cases were identified from the literature. The commonest sites of involvement within the head and neck region were the oral cavity in 21 (56.8%) patients, followed by the neck in 7 (19.0%) patients. 29 (78.4%) patients presented with soft tissue swelling or mass making it the most common presenting feature. All patients had the tumour excised surgically; of which 18 (48.6%) were excised via transoral approach and 6 (16.2%) via open transcervical approach including 1 lateral pharyngotomy. 12 papers documented long-term follow-ups (median 12 months) with no recurrence. Only 1 regrowth was reported after 5-years.

CONCLUSIONS

Osteolipoma is a rare soft tissue neoplasm which has a wide range differential diagnosis including malignant processes. Recognising this benign tumour through an awareness of presenting sign and symptoms, radiological features and histopathology findings is important for patient reassurance as well as avoiding unnecessary radical treatment.

A Giant Retropharyngeal Lipoma: A Case Report and Review of Literature

Lipoma is a common benign soft tissue lesion that can virtually develop anywhere in the body. However, the retropharyngeal space is an extremely rare location for lipoma. We report the case of a 48-year-old man who presented with progressive dysphagia of 3 months duration. It was associated with a weight loss of 6 kg. There was no history of cough, regurgitation, or heartburn. He was a heavy smoker, but he denied consuming alcohol. On examination, the patient was noted to have a hoarse voice. Examination of the oral cavity revealed a bulge in the posterior pharyngeal wall with intact and smooth overlying mucosa. Examination of the neurological system revealed normal findings. The patient was referred to undergo a computed tomography of the neck, which demonstrated a well-defined homogeneous lesion with fat density in the retropharyngeal space. Subsequently, magnetic resonance imaging revealed a well-encapsulated midline retropharyngeal mass, measuring 4.6 x 10.2 x 13.8 cm, filling the retropharyngeal space and extending from the C2 vertebra superiorly to the inferior border of C7 inferiorly. The mass has a high signal intensity on T1- and T2-weighted images with complete suppression of the signal on the fat-saturated sequences, likely representing a retropharyngeal lipoma. The patient underwent surgical resection of the tumor by the lateral cervical approach. Histopathological examination showed lobules of mature adipose tissue, representing a lipoma. Retropharyngeal space is a very rare location of lipoma. The case highlights the importance of considering retropharyngeal lesions when encountering a patient with progressive dysphagia.