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| CASE REPORT |
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| Year : 2019 | Volume
: 9
| Issue : 2 | Page : 60-62 |
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Laryngeal lipoma: A review
Rakesh Srivastava1, Devendra Bahadur Singh2, Sunil Kumar3
1 Department of ENT, SIPS, Lucknow, Uttar Pradesh, India
2 Department of ENT, MIMS, Barabanki, Uttar Pradesh, India
3 Department of ENT, KGMU, Lucknow, Uttar Pradesh, India
| Date of Submission | 13-Mar-2018 |
| Date of Acceptance | 02-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Devendra Bahadur Singh
24 “DBS-ENT” Baba Gorakhnath Nagar, Ram Ashrey Purwa, Khargapur, Gomti Nagar Ext., Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jlv.JLV_2_18
 Abstract | | |
Lipoma is a benign mesenchymal tumor. There are about 115 cases of laryngeal lipoma reported in literature, mostly in isolation. This case was a 52-year-old male who presented with hoarseness of voice and feeling of a lump in the throat for the past 18 months. Examination revealed a solitary huge mass over the left aryepiglottic fold. The tumor was excised using cold instruments with the help of endoscopic technique. There was no recurrence after 24 months of follow-up. With reference to this case, we have a review of literature and a brief discussion on various isolated cases of laryngeal and diffuse lipoma.
Keywords: Aryepiglottic fold, benign mesenchymal tumor, lipoma larynx
How to cite this article:
Srivastava R, Singh DB, Kumar S. Laryngeal lipoma: A review. J Laryngol Voice 2019;9:60-2 |
| Introduction | |  |
Lipoma anywhere in the body is a benign mesenchymal tumor.[1],[2] Around 13% of all lipomas are being found in the head-and-neck region, and the most common site is the dorsal aspect of the neck.[3] The other sites are anterior neck, infratemporal fossa, oral cavity, pharynx, and larynx. Intralaryngeal lipoma comprises 0.1% of all benign laryngeal tumors.[4] Sometimes, they are associated with diffuse lipomatosis. Around 115 cases have been reported so far, with most of them in isolation.
Most of the laryngeal lipomas are found over epiglottis and aryepiglottic fold as these areas are rich in subepithelial fat.
| Case Report | | |
A 52-year-old male patient presented with hoarseness of voice and feeling of a lump in the throat for the past 18 months. He had no history of smoking or chewing tobacco.
Videolaryngoscopic examination revealed a huge, smooth, encapsulated solitary mass over the left aryepiglottic fold hanging and covering the left-sided false cord, part of inlet of the larynx, and left side of the pyriform sinus [Figure 1]. The cords were mobile, and the mass occupied the greater side of the laryngeal inlet. There were no signs of congestion and swelling in the neck or any other part of the body.
Computed tomography (CT) scan of the neck showed a well-defined, low-attenuating oval mass with a mean density of 136 HU lesion without any contrast enhancement involving the left aryepiglottic fold and pyriform sinus [Figure 2]. The lesion measured approximately 21 mm × 27 mm in size and showed thin septation. These findings were consistent with laryngeal lipoma. | Figure 2: Preoperative computed tomography scans showing a low-attenuating mass in the left aryepiglottic fold
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Removal of the mass was planned with the help of a endoscopic-assisted cold instrument. Consent of the patient was obtained with full explanation of the procedure and possible outcome. The patient was intubated with a 6-mm internal-bore endotracheal tube. The dissection was done with cold instruments using microlaryngeal sickle knife, elevator, scissors, and cup forceps. Mucosal peeling was done followed by removal of the lesion with the help of cup forceps. Removal of the mass was little difficult due to its large size. After removal, the mucosal covering was reposited [Figure 3].
Macroscopically, it was a well-defined, light-colored, solitary mass, which was sessile and smooth. Microscopically, it was composed of mature, white adipocytes. The fat cells were uniform in shape and size [Figure 4].
The postoperative period was uneventful, and the patient was discharged after 48 h. The histopathology came out to be lipoma.
Videolaryngoscopic examination was done at 1 week, 3 weeks, and 18 months. Postoperative CT scan was done after 18 months of surgery [Figure 5]. There was no evidence of recurrence [Figure 6].
| Discussion | | |
Laryngeal lipomas are very rare. They are mostly solitary; only two case reports of laryngeal lipoma were found associated with diffuse systemic lipomatosis.[5],[6]
Macroscopically, laryngeal lipomas are mostly well delineated; sometimes, they are multilobulated and pedunculated. They are described in two types: myxolipoma and fibrolipoma.[7],[8] The former has a prominent deposition of mucoid substance and the latter is composed of fibrous tissue.[9] The fat cells are usually found in the supraglottic larynx. These masses are believed to develop from multipotential fibroblasts that differentiate into fat cells to form a lipoma.[1]
Surgery is the only treatment option for all histopathological types of lipoma of the larynx and hypopharynx. The approach may differ, depending on the location and size of the tumor. Tumor can be removed through direct laryngoscopy under microscopic vision using cold instruments as it was done in the present case or can be assisted with diode laser. Larger tumors would require an external approach such as lateral pharyngotomy or laryngofissure or subhyoid pharyngotomy.[10] The surgical approach should be wide enough to have a complete excision without any possible recurrence.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Talsania J, Shah VP, Shah AL, Goyal MN, Manjunatha Rao SV. Unusual case of laryngeal lipoma. Indian J Otolaryngol Head Neck Surg 2007;59:85-6.  |
| 2. | Lippert BM, Eggers S, Schlüter E, Rudert H, Werner JA. Lipoma of the larynx. Report of 2 cases and review of the literature. Otolaryngol Pol 2002;56:669-74. |
| 3. | El-Monem MH, Gaafar AH, Magdy EA. Lipomas of the head and neck: Presentation variability and diagnostic work-up. J Laryngol Otol 2006;120:47-55. |
| 4. | Ortiz CL, Weber AL. Laryngeal lipoma. Ann Otol Rhinol Laryngol 1991;100:783-4. |
| 5. | Wenig BM. Lipomas of the larynx and hypopharynx: A review of the literature with the addition of three new cases. J Laryngol Otol 1995;109:353-7. |
| 6. | Durr ML, Agrawal N, Saunders JR, Ha PK. Laryngeal lipoma associated with diffuse lipomatosis: Case report and literature review. Ear Nose Throat J 2010;89:34-7. |
| 7. | Singhal SK, Virk RS, Mohan H, Palta S, Dass A. Myxolipoma of the epiglottis in an adult: A case report. Ear Nose Throat J 2005;84:728, 730, 734. |
| 8. | Mattiola LR, de Sousa CI, Machado RB, Buhler RB, de Brito AJP, da Costa GP. Laryngeal lipoma A case report. Intl Arch Otorhinolaryngol São Paulo 2008;12:133-6. |
| 9. | Majid A, Puri ND, Sawney KL. Lipoma of the larynx. Indian J Otolaryngol 1978;30:177. |
| 10. | Harbert F. Lipoma of the larynx. Ann Otol Rhinol Laryngol 1951;60:982-5. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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