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Fernández-Alvarez V, Linares-Sánchez M, Mäkitie AA, Suárez C, de Bree E, Karatzanis A, Takes RP, Strojan P, Rinaldo A, Ferlito A. Intravenous lipomas of head and neck: an exceptional entity and its clinical implications. Front Neurol 2024; 15:1447960. [PMID: 39224883 PMCID: PMC11366592 DOI: 10.3389/fneur.2024.1447960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Intravenous lipomas (IVLs) of the head and neck are uncommon benign tumors that develop within the venous walls, often detected incidentally during imaging for unrelated issues. While usually asymptomatic, these IVLs can cause congestive venous symptoms like swelling, paresthesia or pain in the head and neck and upper limbs, or even venous thromboembolism. The precise diagnosis of IVLs is predominantly achieved through computed tomography (CT) and magnetic resonance imaging (MRI), with CT being the most frequently used method. Symptomatic patients generally undergo open surgery with excision of the IVL followed by venous reconstruction, which has shown safe and effective outcomes. However, the management of asymptomatic IVLs remains controversial due to the limited number of reported cases. Despite this, there is a notable trend toward recommending surgical removal of IVLs to prevent complications and rule out malignancy, driven by the challenges of differentiating IVLs from malignant tumors using imaging alone. This review highlights the key differential imaging characteristics of IVLs and the main surgical techniques to remove the tumor and repair the vascular defect. Further research is necessary to establish a robust, evidence-based approach for treating asymptomatic IVLs, balancing the risks of surgery against the potential for future complications.
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Affiliation(s)
| | - Miriam Linares-Sánchez
- Department of Vascular and Endovascular Surgery, Cabueñes University Hospital, Gijon, Spain
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Carlos Suárez
- Department of Otorhinolaryngology, University of Oviedo, Oviedo, Spain
| | - Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Alexander Karatzanis
- Department of Otorhinolaryngology, Medical School of Crete University Hospital, Heraklion, Greece
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Primoz Strojan
- Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Schranz AL, Riordan F, Dolan R, Lawlor C, Morrison C, O'Toole G, Killeen R, McNeill G, O'Donohoe R, Moran T, O'Duffy F. Retrospective analysis of radiological investigation of surgically excised head and neck lipomas. Eur Arch Otorhinolaryngol 2024; 281:4333-4339. [PMID: 38740577 PMCID: PMC11266480 DOI: 10.1007/s00405-024-08672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Differentiating benign lipomas from malignant causes is challenging and preoperative investigative guidelines are not well-defined. The purpose of this study was to retrospectively identify cases of head and neck lipomas that were surgically resected over a 5-year period and to identify the radiological modality chosen and features discussed in the final report. Multidisciplinary outcomes and pathology reports were examined with a view to identifying high risk features of a lipoma to aid in future risk stratification. METHODS Retrospective chart review of pathology characteristics, radiological features (modality, size, calcifications, septations, globular/nodular foci), multidisciplinary discussion and history of presenting complaint was performed. RESULTS Two liposarcomas and 138 lipomas were identified. Twenty-two percent of all lipomas received radiological investigation. Twenty-two percent of imaging referrals were possibly inappropriate. Furthermore, radiological features suggestive of malignancy were not present in the final radiology report, X2 = 28.8, p < 0.0001. CONCLUSION As expected, the incidence of liposarcoma is low. There is limited awareness of radiology referral guidelines superimposed with a tendency to over-investigate lipomas. Furthermore, radiological features suggestive of malignancy were inconsistently reported on and not documented in multidisciplinary discussions. Therefore, we propose a multidisciplinary checklist for referring physicians and radiologists to aid in diagnostic work-up.
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Affiliation(s)
- Amy L Schranz
- Graduate Entry Medicine, University College Dublin, Dublin, Ireland
| | - Fiona Riordan
- Otorhinolaryngology/Head and Neck Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Roisin Dolan
- Plastic, Reconstructive and Aesthetic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Catriona Lawlor
- Plastic, Reconstructive and Aesthetic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Colin Morrison
- Plastic, Reconstructive and Aesthetic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Gary O'Toole
- Orthopaedics Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Ronan Killeen
- Radiology Department, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Graeme McNeill
- Radiology Department, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rory O'Donohoe
- Radiology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Tom Moran
- Otorhinolaryngology/Head and Neck Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Otorhinolaryngology/Head and Neck Surgery, St. Vincent's University Hospital, Dublin, Ireland.
- School of Medicine, University College Dublin, Dublin, Ireland.
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Hosri J, Yammine Y, Hadi NE, Aoun J, Mourad M, Hadi U. Intramuscular Lipoma of the Sternocleidomastoid Muscle: A Rare Entity Revisited. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2024; 17:2632010X241260200. [PMID: 38864025 PMCID: PMC11165958 DOI: 10.1177/2632010x241260200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/19/2024] [Indexed: 06/13/2024]
Abstract
Intramuscular lipomas, typically found in subcutaneous tissue, rarely affect deeper muscular planes, especially those of the head and neck region. The following are 3 cases of intramuscular lipomas involving the sternocleidomastoid muscle. The first 2 patients presented with painless, palpable masses confirmed by diagnostic imaging as well-circumscribed intramuscular lipomas. One was treated surgically, while the other was managed conservatively with monitoring and close follow-up. The third patient reported dysphagia associated with occasional dyspnea and mild pain. The mass was identified as infiltrative lipoma and was resected surgically. Complete tumor removal with no recurrence at 6 months was observed for the first and last cases. The second case was serially followed at 3 and 6 months with no interval changes. We report the largest case series on intramuscular lipomas of the sternocleidomastoid muscle to enhance our understanding of this rare entity.
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Affiliation(s)
- Jad Hosri
- Department of Otolaryngology—Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yara Yammine
- Department of Otolaryngology—Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine El Hadi
- Department of Otolaryngology—Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Aoun
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marc Mourad
- Department of Otolaryngology—Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Usamah Hadi
- Department of Otolaryngology—Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Akhmedov AD, Poluektov YM, Bychkovskii NI, Kondratev VP, Zakirov BA, Usachev DY, Konovalov NA. [Giant cervical lipoma adjacent to carotid artery: a case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:78-84. [PMID: 39169585 DOI: 10.17116/neiro20248804178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection. MATERIAL AND METHODS We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. RESULTS AND DISCUSSION Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner's syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle. CONCLUSION Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.
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Affiliation(s)
| | | | - N I Bychkovskii
- Burdenko Neurosurgical Center, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - B A Zakirov
- Burdenko Neurosurgical Center, Moscow, Russia
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Large Lipoma of the Lateral Space of the Neck. J Craniofac Surg 2023:00001665-990000000-00606. [PMID: 36913618 DOI: 10.1097/scs.0000000000009280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 03/15/2023] Open
Abstract
Giant lipoma is characterized by asymptomatic growth and compared with other parts of the body rarely occurs on the neck. If the tumor is localized in the lateral segment of the neck, it can show symptoms in the form of dysphagia and dyspnea. Preoperatively, it is important to perform computed tomography (CT) diagnostic to determine the size of the lesion and makes the plan for operative treatment. The paper presents the case of a 66-year-old patient with a tumor in the neck area as well as swallowing disorders and suffocation during sleep. Palpation revealed a tumor of soft consistency, and based on a CT scan of the neck, the differential diagnosis confirmed giant lipoma. Clinical picture and CT findings of giant neck lipoma are clear in most cases. Due to the atypical localization and size, the tumor should be removed to prevent possible functional disturbances. The treatment is operative, and a histopathological examination should exclude malignancy.
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6
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Lee J, Lee J, Hong HS, Park KN. A Rare Case of Well-Differentiated Parapharyngeal Liposarcoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221119069. [PMID: 35949063 DOI: 10.1177/01455613221119069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parapharyngeal liposarcoma is a rare malignant tumor, the pathogenesis of which is uncertain. Parapharyngeal liposarcoma often causes nonspecific clinical features, including dysphagia, globus sensation, and/or respiratory disturbances. The parapharyngeal space is a rare location for head and neck liposarcoma, and these lesions may therefore be confused with a variety of other tumors that can originate in this area. Here, we report a case of liposarcoma originating from the prestyloid parapharyngeal space and discuss the possible differential diagnosis on radiographic findings.
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Affiliation(s)
- Jeonghyun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
| | - Jaeha Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang Universityy, Bucheon, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
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Lipoblastoma of the extremities. J Plast Reconstr Aesthet Surg 2022; 75:3761-3767. [DOI: 10.1016/j.bjps.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/26/2022] [Accepted: 06/05/2022] [Indexed: 11/21/2022]
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Yaro JP, Ibrahim Y, Mann A, Chan JY, Mansuri MS. A Challenging "Achy" Neck. Cureus 2022; 14:e24544. [PMID: 35651440 PMCID: PMC9138194 DOI: 10.7759/cureus.24544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/11/2022] Open
Abstract
Lipomas are common benign mesenchymal tumours that may occur in many regions of the body. Giant neck lipomas are uncommon, especially when they arise from the neck and extend into the thorax. In this case report, we present a unique case of a giant submuscular lipoma involving the posterior neck triangle extending down to the scapular tip. A 43-year-old male presented with a six-month history of two slow-growing masses involving the left neck and scapular region. MRI demonstrated a single large fat suppressing lesion underlying the left trapezius muscle extending down to the scapula with homogenous signal return and smooth outline measuring 4.5x7.5 cm by 16 cm. Histology showed features consistent with lipoma. Giant lipomas in the neck post a significant diagnostic and surgical challenge. The importance of pre-operative planning and patient involvement in decision-making are essential.
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Affiliation(s)
- John P Yaro
- Otolaryngology, University Hospitals of Derby and Burton, Derby, GBR
| | - Yousef Ibrahim
- Otolaryngology, University Hospitals of Derby and Burton, Derby, GBR
| | - Amandeep Mann
- Pathology, University Hospitals of Derby and Burton, Derby, GBR
| | - Jo-Yen Chan
- Radiology, University Hospitals of Derby and Burton, Derby, GBR
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Tarifi AA, Al-Qutiesh BH, Badran KH, Al-Mallah HH, Medina JE. Transoral Endoscopic Resection of Oropharyngeal Pedunculated Giant Fibrolipoma Using Harmonic Scalpel: A Case Report. EAR, NOSE & THROAT JOURNAL 2022:1455613221086036. [PMID: 35324367 DOI: 10.1177/01455613221086036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lipoma is the most common soft tissue benign tumor in the body. It can occur in the head and neck area as well. Fibrolipoma is a variant of lipoma that contains fibrous tissue. Fibrolipomas of the head and neck are relatively rare, and their presentation depends largely on their size and location; some slowly growing tumors might go unnoticed until they reach significant size and become symptomatic. Here, we report a case of 64-year-old male who presented with large pedunculated oropharyngeal fibrolipoma that originated from the posterior oropharyngeal wall and extended downward into the postcricoid area and cervical esophagus. It was excised transorally using rigid endoscope, and ACE Harmonic scalpel was utilized to excise this 16.7 cm long mass. The postoperative pain was minimal, the surgical site showed complete healing, and oral diet was resumed easily in 5 days.
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Affiliation(s)
- Amjed A Tarifi
- Department of General and Special Surgery, Faculty of Medicine, 34419The Hashemite University, Zarka, Jordan
| | - Bara' H Al-Qutiesh
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince Hamza Hospital, Amman, Jordan
| | - Khaled H Badran
- Department of General and Special Surgery, Faculty of Medicine, 34419The Hashemite University, Zarka, Jordan
| | | | - Jesus E Medina
- Department of Otorhinolaryngology, Head and Neck Surgery, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Wannapanich T, Pratipanawat P. Primary orbital pleomorphic liposarcoma in a child: A case report. Am J Ophthalmol Case Rep 2022; 25:101285. [PMID: 35146183 PMCID: PMC8818483 DOI: 10.1016/j.ajoc.2022.101285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a rare case of primary orbital pleomorphic liposarcoma and present a relevant literature review. Observations An 11-year-old boy presented with an enlarging, painless lower right eyelid mass that was noted 4 months ago. Imaging revealed a 3.2 × 2.1 × 3.7-cm-sized well-circumscribed lobulated mass. Biopsy revealed a pleomorphic spindle cell neoplasm that was consistent with a pleomorphic liposarcoma. A systemic evaluation found no evidence of distant metastasis. Despite four chemotherapy cycles, the mass size increased at follow-up. Total orbital exenteration was performed 1 year after confirming a diagnosis of pleomorphic liposarcoma. At the 6-month follow-up, the patient was alive with no signs of recurrence. Conclusions Pediatric pleomorphic liposarcoma is a very rare entity. Its definite diagnosis relies on histopathological results. In the absence of systemic metastasis, total orbital exenteration is the optimal approach for local control.
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Gennaro P, Benedetti S, Cascino F, Gabriele G. Intramuscular lipoma of the temporalis muscle extending to the infratemporal fossa: surgical pitfalls and short literature review. BMJ Case Rep 2022; 15:e245465. [PMID: 35131776 PMCID: PMC8823042 DOI: 10.1136/bcr-2021-245465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/03/2022] Open
Abstract
Lipomas are benign tumours of mesenchymal origin, representing one of the most common tumours of the body. They are often observed between the fourth and the sixth decade of life and in 13% of the cases they occur in the head and neck region. In case of symptoms, surgical removal is the treatment of choice; when the formation involves the temporal region, the surgical approach is often challenging due to the presence of the neurovascular structures, such as the temporalis branch of the facial nerve and their potential extension to the nearby structures under the zygomatic arch to either the infratemporal fossa or the buccal region. Recurrence can occur frequently only if there is incomplete removal of lipoma. In this paper, the authors discuss surgical pitfalls of a very rare case of a large-sized symptomatic lipoma extended to the infratemporal and pterygomaxillary fossa, surgically removed via trans-zygomatic hemicoronal approach.
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Affiliation(s)
- Paolo Gennaro
- Department of Maxillo-Facial Surgery, University of Siena Faculty of Medicine and Surgery, Siena, Italy
| | - Simone Benedetti
- Department of Maxillo-Facial Surgery, University of Siena Faculty of Medicine and Surgery, Siena, Italy
| | - Flavia Cascino
- Department of Maxillo-Facial Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Toscana, Italy
| | - Guido Gabriele
- Department of Maxillo-Facial Surgery, University of Siena Faculty of Medicine and Surgery, Siena, Italy
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Lee YJ, Cha WJ, Kim Y, Oh DY. The recurrence of well-differentiated liposarcoma from benign giant intramuscular lipoma: A case (CARE-compliant) report. Medicine (Baltimore) 2021; 100:e24711. [PMID: 33578611 PMCID: PMC10545130 DOI: 10.1097/md.0000000000024711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Recurrent liposarcoma, previously confirmed as lipoma, has rarely been reported. However, the risk factors for recurrence and the correlation between benign lipoma and malignant liposarcoma remain unclear. In this case study, we suggest a precise diagnostic strategy to minimize recurrence and malignant transformation. PATIENT CONCERNS A 60-year-old male patient with a history of left chest wall swelling without any symptoms underwent excisional surgery, and the mass was confirmed as a benign lipoma in 2015. In 2019, the patient returned to the hospital with symptoms of a palpable mass on the left chest wall. DIAGNOSIS The mass was considered a recurrent lipomatous tumor with the possibility of malignant transformation. Magnetic resonance imaging (MRI) revealed a deep-seated, septate, intramuscular, irregular margin, and large lipomatous tumor invading the ribs, pleura, and adjacent muscle, suggestive of malignancy. The MRI findings were similar to those 4 years ago, except for margin irregularity and invasion to adjacent tissue. INTERVENTIONS Wide en bloc excisions encompassing the 5th to 7th ribs, pleura, and adjacent muscle were followed by reconstruction with a pedicled latissimus dorsi muscle flap. OUTCOMES The recurrent large lipomatous tumor was confirmed as well-differentiated liposarcomas through histological and MDM2-FISH immunohistochemical staining. Postoperatively, follow-up visits continued for 1.5 years without recurrence. LESSONS We suggest that deep-seated, septate, and giant lipomatous tumors should be considered as risk factors for recurrence with the possibility of malignancy and misdiagnosis. It is important to inform patients of all these possibilities and plan close and long-term follow-up.
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Affiliation(s)
- Yeon Ji Lee
- Department of Plastic and Reconstructive Surgery, St. Vincent hospital, College of Medicine, The Catholic University of Korea
| | - Won Jin Cha
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yesol Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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From head and neck lipoma to liposarcoma: a wide spectrum of differential diagnoses and their therapeutic implications. Curr Opin Otolaryngol Head Neck Surg 2020; 28:136-143. [PMID: 32011399 DOI: 10.1097/moo.0000000000000608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To overview the array of differential diagnoses among lipomatous tumours of the head and neck with special focus on their evaluation, three-dimensional assessment, and their available treatments. RECENT FINDINGS The head and neck is an infrequent localization for lipomatous tumours, even though they represent the most common mesenchymal lesions. Lipoma, spindle cell/pleomorphic lipoma (SC/PL), atypical lipomatous tumour/well differentiated liposarcoma (ALT/WDLPS), de-differentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), and pleomorphic liposarcoma (PLPS) are the most distinctive histotypes. Lipoma and SC/PL present alterations of chromosomes 12 and 13, ALT/WDLPS and DDLPS both show the Mouse Double Minute 2 amplification, whereas MLPS presents a CHOP gene fusion. Diagnosis of PLPS is purely morphological as there is no pathognomonic genetic alteration identified to date. Radiological assessment can be challenging for the presence of nonadipose components within the lesion. Surgery is the mainstay of treatment, even though achieving true radicality in terms of a large cuff of healthy tissue surrounding the tumour is not always realistic in the head and neck. Adjuvant radiation, eventually in combination with systemic chemotherapy, has been shown to improve overall survival in patients with positive margins, high-grade, deep, and more than 5 cm lesions. Further studies should be aimed at the evaluation of the role of hadron therapy, as well as targeted drugs against overexpressed proteins. SUMMARY Adequate differential diagnosis of the histotypes collected under the umbrella term of head and neck lipomatous tumours plays a fundamental role in treatment and follow-up of these lesions and requires specific expertise with referral to high-volume centres.
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Abstract
Lipomas are the most common benign mesenchymal tumors, composed of mature adipocytes, and may occur anywhere in the body where fatty tissue is present. Neck lipomas are rare and usually appear as solitary, small (<5 cm), and asymptomatic lesions located in the subcutis of posterior neck. Giant anterior neck lipomas are exceptionally rare and, other than cosmetic concerns, seldom present with respiratory symptoms. A 37-year-old female patient was referred for a long-standing anterior and right-sided neck swelling, which had markedly increased in size causing cosmetic disfigurement, neck discomfort, and transient episodes of dyspnea when lying on the side opposite the neck mass. Under general anesthesia, the lesion was completely dissected and removed through the elliptical cervical incision over the right supraclavicular fossa, while carefully preserving the surrounding neck structures. The postoperative recovery was uneventful and the patient was satisfied with the cosmetic outcome and relief of her respiratory symptoms.
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Affiliation(s)
- Ognjen Cukic
- Department of Otorhinolaryngology With Maxillofacial Surgery, Clinical Hospital Center Zemun, Belgrade, Serbia
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15
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Endoscope-assisted resection of residual parapharyngeal liposarcoma: A case report. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lipoma Rarely Involving Multiple Suprahyoid Fascial Spaces: A Large Lesion Removed With Bimanual Transcervical Finger Dissection Using a "Push-Pull Down" Maneuver. J Craniofac Surg 2019; 30:e717-e719. [PMID: 31261336 DOI: 10.1097/scs.0000000000005703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lipoma involving multiple fascial spaces is extremely rare and poses a challenge to surgeons using less invasive procedures. Although blunt dissection using a finger is often used in excisional surgeries as a supplementary maneuver, few cases have been described using the bimanual technique for the removal of these extensive lesions.Herein, the authors present a large lipoma of the oral floor extending to the unilateral submandibular and parapharyngeal spaces, which was excised only via a submandibular approach using the "push-pull down" maneuver, blunt finger dissection of the tumor with counter-pushing on the overlying mucosa to the submandibular direction facilitated tumor separation. The tumor was consequently pulled down and removed without an additional intraoral incision.Based on accurate preoperative examinations, this maneuver, provides a less invasive surgery for well-encapsulated benign tumors involving multiple fascial spaces.
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Košec A, Zurak K, Čupić H, Bedeković V. Primary parotid liposarcoma. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:405-408. [PMID: 30876853 DOI: 10.1016/j.anorl.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 12/05/2017] [Accepted: 01/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Primary liposarcoma is very rare in the parotid gland. To date, only 8 cases of primary parotid liposarcoma have been reported. The aim of this study is to report on a case of primary parotid liposarcoma highlighting the complexity of its treatment and analyze treatment outcomes of other reported cases. CASE SUMMARY We report a case of parotid liposarcoma arising in the left parotid gland of a 66 year-old man, causing local morbidity, recurrence, repeated surgical treatment and death 5 months after initial treatment. DISCUSSION Parotid liposarcoma is marked by a high probability of local recurrence of up to 70% and is prone to distant metastatic spread, as was the case in our patient. Based on limited experience from published literature, optimal treatment entails radical surgery with negative margins. Postoperative radiotherapy is an option for patients with large high-grade tumors, positive margins and involvement of complex anatomic subsites. High-grade tumors have a worse outcome despite the addition of surgery and postoperative radiotherapy.
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Affiliation(s)
- A Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia.
| | - K Zurak
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia
| | - H Čupić
- Department of Pathology Ljudevit Jurak, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia
| | - V Bedeković
- School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
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18
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Andrea T, Giulio G, Giuliana L, Sandro P. Primary dedifferentiated liposarcoma of the orbit, a rare entity: Case report and review of literature. Saudi J Ophthalmol 2019; 33:312-315. [PMID: 31686978 PMCID: PMC6819729 DOI: 10.1016/j.sjopt.2019.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/09/2019] [Indexed: 12/26/2022] Open
Abstract
Head and neck liposarcomas are rare entities accounting for less than 5% of all liposarcomas. The primary orbital location is even rarer, with about 40 cases described in the English literature. According with the widely accepted classification of Enzinger and Weis there are 5 histologic variants of liposarcomas: well differentiated, myxoid, dedifferentiated, round cell and pleomorphic. The first two are considered low-grade and display a favourable prognosis (>90% 5-year DSS and OS), whereas the dedifferentiated, round cell, and pleomorphic are defined high-grade and burdened with poorer prognosis (5-year DSS ranging 45-73%). Dedifferentiated liposarcomas (DDL) of the head and neck region are exceedingly rare, therefore there are scattered and contrasting data regarding their clinical history, treatment modality, and prognosis. We presented a case of DDL arising in the the left orbit (fourth case of primary orbital DDL described), free from disease after 5-year follow-up. Clinical history, treatment, and characteristics of the presented case were described and discussed in the light of how reported in the literature, in the attempt to bring further insight in the nature and management of this rare pathological entity.
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Affiliation(s)
- Torroni Andrea
- Department of Plastic Surgery, Division of Oral and Maxillofacial Surgery, New York University, USA
| | - Gasparini Giulio
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
| | - Longo Giuliana
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
| | - Pelo Sandro
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
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19
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20
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Ralli M, de Vincentiis M, Greco A. First, Rule Out Cancer: Giant Lipoma. Am J Med 2018; 131:146-147. [PMID: 28982584 DOI: 10.1016/j.amjmed.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy.
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
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21
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Management of a Nasal Spindle Cell Lipoma: Diagnostic and Therapeutic Considerations. Dermatol Surg 2016; 41:1424-6. [PMID: 26517318 DOI: 10.1097/dss.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Langhans L, Frevert SC, Andersen M. Lipomatous tumours of the face in infants: diagnosis and treatment. J Plast Surg Hand Surg 2015; 49:260-264. [DOI: 10.3109/2000656x.2015.1034725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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