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Table of Contents
CLINICAL CASE
Year : 2015  |  Volume : 17  |  Issue : 2  |  Page : 80-82

Laryngeal spindle cell lipoma with unspecific radiological finding: A case report


Otorhinolaryngology Department, King Abdulaziz University Hospital, College of Medicine, King Saud University, Saudi Arabia

Date of Web Publication2-Jan-2020

Correspondence Address:
MD Manal Bukhari
O.R.L. Department King Abdulaziz University Hospital King Saud University P.O. Box 245, Riyadh 11411
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.274664

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  Abstract 


Laryngeal and hypopharyngeal lipomas are a rare forms of benign laryngeal neoplasm.
Spindle cell lipoma is an uncommon histological variant of benign lipoma .This article present a case of spindle cell lipoma, where the patient presented with symptoms of feeling of a mass like ball in the airway without dysphagia,. Examination showed a pedunculated soft tissue mass coming from posterior wall of left pyriform sinus with unspecific finding on CT scan, The mass was excised completely with microlaryngoscopy cold dissection. Histopathology diagnosis came as spindle cell lipoma .With a review of the literature regarding the pathogenesis and treatment .

Keywords: Lipoma, spindle cell, laryngeal


How to cite this article:
Bukhari M. Laryngeal spindle cell lipoma with unspecific radiological finding: A case report. Saudi J Otorhinolaryngol Head Neck Surg 2015;17:80-2

How to cite this URL:
Bukhari M. Laryngeal spindle cell lipoma with unspecific radiological finding: A case report. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2015 [cited 2022 Dec 9];17:80-2. Available from: https://www.sjohns.org/text.asp?2015/17/2/80/274664




  Introduction Top


Lipoma are most common soft tissue tumor of mesenchymal origin which represent around 15% of the head and neck tumors and less than 1% of all benign tumor in the larynx and hypopharynx [1]. Spindle cell lipoma is an uncommon histological variant of benign lipoma (1.5%), arising mainly in men between 45 to 60 year. The common site of spindle cell lipoma is posterior neck,shoulder and back (80%) while 20% may arise in unusual location. Spindle cell lipoma of the larynx is rare and only few cases have been previously describe in the literature. [2]. Spindle cell lipoma is mostly solitary, well capsulated and slow growing. It is characterized by replacement of mature fat tissue by spindle cell proliferation with variation in the ratio of fat to spindle cell. Exact pathogenesis is still unknown. They should be pathologically differentiated from liposarcoma [2].

Enzinger and Harvey in 1975 were the first to describe spindle cell lipoma as a distinct entity [3].

The aim of this report is to demonstrate a very rare cases of spindle cell lipoma of the pyriform sinuses with unspecific radiological finding.


  Case Presentation Top


A 45-year-old gentleman, who presented to the otolaryngology clinic of King Abdullaziz University Hospital, King Saud University, Riyadh, Saudi Arabia with a 3-month history of attack of apnea during sleep, snoring, difficulty in breathing some time during the day, on off chocking during sleep and foreign body sensation (a ball goes in and out his airway). No history of dysphagia, weight loss or hoarsens. Videostroboscopy revealed a pedunculated soft tissue mass coming from the posterior wall of left the pyriform sinus sucked between the vocal cords during inspiration. The mass was well circumscribed, encapsulated with smooth surfaced measuring 2cm in greatest dimension [Figure 1], [Figure 2].
Figure 1: Vocal cord during phonation.

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Figure 2: Vocal cord during breathing

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CT scan showed non-specific pedunculated well-defined oval polypoidal soft tissue Mass with heterogonous density value [Figure 3]. The mass was excised completely with microlaryngoscopy cold dissection approach and the base was cauterized with diathermy [Figure 4]. Histopathology diagnosis came as spindle cell lipoma of the larynx based on the following feature: bland spindle cells and hyperchromatic round cells with an abundant lipomatous stroma .In the immunohistochemical study the lesional cells were positive with CD34 and bcl2.
Figure 3: CT scan heterogonous mass arise from left pyriform fossa

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Figure 4: Gross view of the lipoma

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Early after surgery the patient’s symptoms resolved. Over a one year follow up the patient has shown no signs of recurrence.


  Discussion Top


Laryngeal lipoma is an extremely rare condition. Laryngeal and hypopharyngeal lipoma first appeared in the literature in 1995 [3]. Laryngeal lipomas originate from adipose tissues such as epiglottis, ventricular fold, and aryepiglottic fold [4]. No cases with laryngeal lipoma at the vocal cords have been reported. Pyriform sinus lipoma has similar symptoms and pathological feature with laryngeal lipogenic tumor [4].

Laryngeal hypopharyngeal lipomas are well-capsulated, smooth-surfaced, yellowish, sessile or pedicled masses. They contain histologically mature, uniform adipose cells. Spindle cell lipomas contain collagen fibers and small, cylindrical spindle cells and mixed mature adipocytes within a matrix containing mucinous material [5].

Spindle cell lipoma was first described by Enzinger and Harvey in 1975 [3]. Spindle cell appears as uniform cells with single elongated nucleus and narrow bipolar cytoplasm, nucleolus is not prominent, mitosis is rare. Misdiagnosis is possible as the histological characteristics of spindle cell lipoma are similar to those of liposarcoma. However, uniformity of spindle cells, lack of lipoblasts and presence of thick mature collagen fibers are typical features of spindle cell lipoma . Immunohistochemically, spindle cell express CD34, bc 1-2 and vimentin, but not S-100. MDM2 and CDK4 are well known regulators of cell progression that are express .Also the distinction between spindle cell lipoma and the sclerosing or myxoid form of liposarcoma is based on the absent of lipoblasts, nuclear pleomorphism, mitotic activity, mucinous material and a diffuse plexiform capillary network in liposarcoma [5].

CT scan showed the lipomata to be typically homogeneous with low attenuation value and a density lower than water. In our case the spindle cell lipoma shown as heterogeneous density value mass [6].

Spindle cell lipoma is usually solitary, slow growing, and becomes symptomatic at advanced stages of life. It usually causes swallowing impairment, phonation problems, the sensation of a lump in the throat, and rarely respiratory problems due to glottic obstructions [3]. In this case, the feeling of a mass moving in and out the airway without dysphagia was the only symptom of large pyriform sinus lipoma. The preferred method of treatment for laryngeal and hypopharyngeal lipogenic tumor is radical endoscopic excision or external surgical procedures.

The choice of external surgical approach is based on several characteristics of lipoma such as site, submucosal growth and size. Large non pedunculated tumors require an external approach using thyrotomy, transhyoid or lateral pharyngotomy for good exposure [5].

Since spindle cell lipomas can relapse even after several years long term follow up mandatory [3].

Summary

Laryngeal and hypopharyngeal lipomas are rare forms of benign laryngeal neoplasms. This article present a case of spindle cell lipoma where the patient presented with symptoms of feeling of a mass like ball in the airway without dysphagia with unspecific finding in CT scan with a review of the literature regarding the pathogenesis and treatment .



 
  References Top

1.
Som Ml,Wolff L. Lipoma of the hypopharynx producing menacing symptoms. AMA Arch Otolaryngol. 1952; 56:524-31.  Back to cited text no. 1
    
2.
Jungehulsing M, Fischbach R, Pototsching C, Eckel HE, Damm M. Rare benign tumors: laryngeal and hypopharyngeal lipomata. Ann Otol Rhinol Laryngol. 2000;109:301-5  Back to cited text no. 2
    
3.
Enzinger FM, Harvey DA. Spindle cell lipoma. Cancer 1975; 36:1852-9.  Back to cited text no. 3
    
4.
Cantarella G, Neglia CB, Civelli E, et al. Spindle cell lipoma of the hypopharynx. Dysphagia. 2001; 16:224-7.  Back to cited text no. 4
    
5.
Fletcher CDM, Martin-Bates E. Spindle cell lipoma: a clinicopathological study with some original observations. Histopathology. 1987; 11:803-17.  Back to cited text no. 5
    
6.
Nonaka S, Enomoto K, Kawabori S, et al. Spindle cell lipoma within the larynx: A case report with correlated light and electron microscopy. ORL J Otorhinolaryngol Relat Spec. 1993; 55:147-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
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