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Table of Contents
CLINCAL CASE
Year : 2013  |  Volume : 15  |  Issue : 1  |  Page : 16-18

Parotid deep lobe lipoma in a child: Case report and literature review


Department of Otolaryngology King Abdulaziz Medical City, Riyadh, Saudi Arabia

Date of Web Publication2-Jan-2020

Correspondence Address:
MD Ahmad Alkurdi

Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.274643

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  Abstract 


Lipomas are benign tumors that are considered the most common subcutaneous tumor. It is a tumor of mature fatty cells that can be classified according to its morphology, location and other features. It can affect all age groups. Areas of the head and neck are commonly involved with lipomas. Children are rarely involved and the involvement of parotid gland in children is extremely rare. Here we report a case of a simple lipoma in the deep lobe of the parotid gland in a two-year-old boy. It was managed by total parotidectomy. Follow up for one year shows no recurrence.

Keywords: children; parotid; deep lobe; lipoma


How to cite this article:
Alroqi A, Alkurdi A, Almazrou K. Parotid deep lobe lipoma in a child: Case report and literature review. Saudi J Otorhinolaryngol Head Neck Surg 2013;15:16-8

How to cite this URL:
Alroqi A, Alkurdi A, Almazrou K. Parotid deep lobe lipoma in a child: Case report and literature review. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2013 [cited 2022 Nov 28];15:16-8. Available from: https://www.sjohns.org/text.asp?2013/15/1/16/274643




  Introduction Top


Lipomas are benign tumors composed of mature fat cells and are the most common subcutaneous tumors [1]. Lipomatous masses include simple lipomas, angiolipomas, well-differentiated lipomas, and liposarcomas. Another variant, the “atypical lipoma,‘' is also noted in the literature, with histologic similarities to the well-differentiated liposarcoma and propensity for local recurrence.

Complicated lipomas include masses found on imaging to have multiple septae or involvement of deeper structures and nerve involvement. These are normally found to be well-differentiated lipomas, deep atypical lipomas, or liposarcomas. Lipomas typically occur in the fifth and sixth decades of life, but they can also occur in young children.

Lipomas usually present as slow-growing masses without symptoms of pain or functional impairment [2].

The aim of reporting this case is to draw the attention of the pediatric otolaryngologists to such a very rare pathology involving the deep lobe of parotid gland. Therefore, it is important to consider lipoma in the differential diagnosis of parotid masses in children.


  Case report Top


A two year-old boy presented with right parotid swelling for one year. It was painless and not causing obstructive symptoms. Perinatal history was unremarkable. Examination showed a soft and non tender right parotid swelling. It was around 6 cm x 3 cm with a normal overlying skin color. The rest of head and neck examination was within normal. Computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a lobulated mass involving the deep lobe of the right parotid gland extending to the infratemporal fossa. Fine needle aspiration was suggestive of lipoma. Total parotidectomy with intraoperative facial nerve monitoring was undertaken.

Intraoperatively, the mass was huge, multilobulated, displacing the facial nerve laterally. It extended to the infratemporal fossa and touching the periosteuom of the skull base [Figure 1]. Frozen section and permanent pathology report confirmed the diagnosis of lipoma.
Figure 1: Intraoperative photo showing the lipoma involving the deep lobe.

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Suction drain was inserted and removed at the second day postoperatively. Mild ramus mandibularis paresis was noticed postoperatively which resolved afterwards within two weeks. The patient was followed for one year with no evidence of recurrence.


  Discussion Top


Most benign salivary gland tumors (95%) occur in adults, and the majority of them are pleomorphic adenomas. In children, the most common benign tumor of mesenchymal origin is the hemangioma, and the most common benign epithelial tumor is the pleomorphic adenoma [3]. The majority of malignant salivary gland tumors occur in the fifth and sixth decade, whereas 2% occur in children under 10 years of age, and 16% occur in those less than 30 years of age [4].

The literature is enriched with cases of lipoma involving the head and neck. Furlong et al [5] reported that lipomas of the oral and maxillofacial region occur most commonly in adult males in the parotid region, followed closely by the buccal mucosa. Spindle cell lipomas are common in this region and comprise the majority of parotid and lip tumors.

Lipoma of the parotid gland is a rare lesion in adults and children, and appears most frequently in the fifth and sixth decade of life. Thirty-two lipomatous lesions of the parotid gland and periparotid area were reviewed by Walts et al [6] with one lipoma reported in a 7-year-old boy. The study shows a definite sex preference, with a male to female ratio of 10:1. It shows no laterality preference. Lipoma extending from superficial to deep lobe of parotid gland has been reported by Debnath et al [7] in a 56-year-old male patient that was managed by conservative superficial parotidectomy preserving the facial nerve.

Lipoma of the parotid gland is a rare lesion in children. A case of lipoma in a 7-year-old boy was reported in a review of thirty-two lipomatous lesions of the parotid gland and periparotid area by Walts et al [6] and another case of angiolipoma of the parotid has been reported in an infant girl [8]. Parotid simple lipoma involving the deep lobe in children has never been reported. We believe this is the first reported case that has been managed successfully by total parotidectomy.

The diagnosis of lipoma is mainly based on history and physical examination. In cases of large lipomas (>5 cm), those irregular in shape, and those with symptoms of myofascial involvement, imaging is warranted using ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Imaging should also be obtained if the tissue biopsy indicates the presence of a malignancy. MRI is the most sensitive imaging modality for lipomatous masses and has a high negative predictive value. On MRI, the fatty nature of the lipoma elicits a strong T1 signal; however, a large lipoma could be difficult to differentiate from a well-differentiated liposarcomas [9].

Indications for surgical removal of a lipoma typically include cosmetic concerns, but these tumors can also cause nerve impingement, pain, and consequent functional limitations that necessitate removal (such as with angiolipomas). Other indications for removal of lipomas include increase in size, irregular characteristics (induration), size (>5 cm), samples of core needle biopsy consistent with atypical features, or other features more consistent with a sarcoma (invasion/involvement of deep fascia) [10]. A simple lipoma may be watched clinically or removed in accordance with patient preference. The more invasive and histologic atypical lesions such as “atypical” lipoma, well-differentiated lipomas, and liposarcomas should be removed due to mass effects and, in the case of the liposarcoma, due to the propensity for systemic disease [11]. Surgical treatment of lipomas involves simple excision, minimal-scar segmental extraction of lipomas, that has been described for larger/multiple lipomas. This technique uses segmental dissection of the lipoma to facilitate removal from a small incision [2]. Liposuction has been described but not associated with the best aesthetic outcome [12]. The local recurrence rate of simple lipomas involving subcutaneous tissue is approximately 1% to 2% [13].

Fatty tumors are classified histologically according to their composition. The most immature fatty cell tumors are known as lipoblastomas, whereas tumors composed of brown fat are called hibernomas. A mature white fat tumor is known as a lipoma [14]. Simple lipomas have a thick, well-defined capsule that is distinctly separate from the surrounding tissue. Spindle cell lipomas and pleomorphic lipomas are associated with dorsal, head, and neck distribution and histologically have collagen-forming spindle cells interspersed with adipocytes. Angiolipomas are composed of adipocytes with a vascular infiltration and are more commonly associated with pain and multiplicity, compared with other types of lipomas [13].

In conclusion, parotid lipoma in children is extremely rare. It can be managed safely by parotidectomy with facial nerve preservation. Pediatric otolaryngologists should put in mind the possibility of lipoma when dealing with parotid masses in children.


  Declaration Top


The authors report no conflicts of interest or financial relationship with any organization.



 
  References Top

1.
Hansen SL. Skin and Subcutaneous tissue. In: Brunicardi FC, editor. Schwartz’s principles of surgery. 8th edition. New York: McGraw-Hill Professional; 2004. p. 437.  Back to cited text no. 1
    
2.
Chandawarkar RY, Rodriguez P, Roussalis J, Tantri MD. Minimal-scar segmental extraction of lipomas: study of 122 consecutive procedures. Dermatol Surg. 2005;31(1):59—63 [discussion: 63-4].  Back to cited text no. 2
    
3.
Califano J, Eisele DW. Benign salivary gland neoplasms. Otolaryngol Clin North Am. 1999 Oct;32(5):861-73. Review.  Back to cited text no. 3
    
4.
Rice DH. Malignant salivary gland neoplasms. Otolaryngol Clin North Am. 1999 Oct;32(5):875-86. Review.  Back to cited text no. 4
    
5.
Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 0ct;98(4):441-50.  Back to cited text no. 5
    
6.
Walts AE, Perzik SL. Lipomatous lesions of the parotid area. Arch Otolaryngol. 1976 Apr;102(4):230-2.  Back to cited text no. 6
    
7.
Debnath SC, Saikia A. Lipoma of the parotid gland extending from the superficial to the deep lobe: a rarity. Br J Oral Maxillofac Surg. 2010 Apr;48(3):203-4. Epub 2009 Nov 12.  Back to cited text no. 7
    
8.
Reilly JS, Kelly DR, Royal SA. Angiolipoma of the parotid: case report and review. Laryngoscope. 1988 Aug;98(8 Pt 1):818-21.  Back to cited text no. 8
    
9.
Kransdorf MJ, Bancroft LW, Peterson JJ, Murphey MD, Foster WC, Temple HT. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology. 2002 Jul;224(1):99-104.  Back to cited text no. 9
    
10.
Pandya KA, Radke F. Benign Skin Lesions: Lipomas, Epidermal Inclusion Cysts, Muscle and Nerve Biopsies. Surg Clin N Am. 2009;89:677-687.  Back to cited text no. 10
    
11.
Serpell JW, Chen RY. Review of large deep lipomatous tumours. ANZ J Surg. 2007 Jul;77(7):524-9.  Back to cited text no. 11
    
12.
Dolsky RL. Surgical removal of lipoma by lipo-suction surgery. Am J Cosmet Surg.1986;3:27.  Back to cited text no. 12
    
13.
Brennan M, Singer S. Sarcomas of the Soft Tissue and Bone. In: DeVita VT, editor. DeVita, Hellman, Rosenberg’s cancer: principles & practice of oncology. 8th edition. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1750-2.  Back to cited text no. 13
    
14.
Al-Qattan MM, Al-Lazzam AM, Al Thunayan A, Al Namlah A, Mahmoud S, Hashem F, et al. Classification of benign fatty tumours of the upper limb. Hand Surg. 2005;10(1):43-59.  Back to cited text no. 14
    


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