Lipoma Surgery in Kolkata
Anterior Neck Lipoma – A Giant Predicament
Hellenic Journal of Surgery on 30 April 2015
Abstract
Though lipomas are one of the commonest mesenchymal tumours in adults, a lipoma of the head and neck region is
relatively rare. Among those lipomas that develop in the neck, the posterior triangle is the most common location;
occurrence in the anterior triangle is very rare. Though most lipomas are <5cm in size, giant lipomas >10cm have
also been reported in different parts of the body. Giant lipomas of the neck, particularly those >20cm, are extremely rare. Most patients of giant lipoma of the neck either present with complaints of cosmetic disfigurement or features of compression on deeper structures. Most lipomas do not pose any diagnostic dilemma. However, when a patient presents with a large, rapidly progressing lipoma of the head and neck region, the possibility of malignancy should be kept in mind. Surgical excision remains the treatment of choice.
Case History
A 45-year-old man presented with a history of a huge mass
in the left anterior part of the neck. Though the mass had been present for the last 15 years, it had increased
rapidly in size over the previous 6 months. Other than cosmetic disfigurement, the patient had no other complaints. On examination, the mass measured 30x35cm from the submandibular region to the suprasternal notch. On ultrasound, the mass was isoechoic with subcutaneous fat. Computerized tomography of the neck showed a homogeneous hypodense mass in the left side of the neck with no contrast enhancement. A needle biopsy showed clusters of mature adipocytes and fibrous stroma, suggestive of a lipoma. There was no evidence of liposarcomatous changes.
Giant lipoma in anterior neck.
CT Scan showing giant anterior neck lipoma.
A complete surgical excision of the lipoma was performed with a good cosmetic result and no functional impairment. The procedure was challenging given the presence of major blood vessels and the vagus nerve in relation to the mass. Finally, the histopathology report confirmed the diagnosis of a lipoma.
Discussion
Lipomas are one of the commonest mesenchymal tumours known to arise from any site where fat cells are present and are therefore referred to as a universal tumour or ubiquitous tumour. Only 13% lipomas arise in the head/neck region. The cheek is the commonest site in the head and neck region, followed by the tongue, floor of the mouth, buccal sulcus, vestibule, lip, palate, gingiva and neck. Lipomas in the neck usually involve the posterior triangle. Anterior neck lipomas are a rare entity.
Peak incidence of lipomas is commonly seen in the 5th
and 6th decade of life. Solitary lipomas are more common in females. Their clinical presentation varies depending on the size, site and rate of growth. They are mostly painless;
the patient seeks the physician’s attention either for cosmetic reasons or pressure symptoms.
Giant lipomas are considered those measuring at least
>10cm in one dimension, or weighing at least 1000gm.
A rapid increase in size should always raise the suspicion of malignancy. A search of the literature failed to reveal reports of giant lipomas as large as that present in our patient (30x35cm).
Surgical excision of the giant anterior neck lipoma.
Ultrasonography acts as the primary imaging modality
for head and neck lipomas. They are usually shown as an elliptical mass that is hyperechoic as compared to surrounding muscles. However, CT is the modality of choice for confirmation of diagnosis. Generally, they are displayed
as homogeneous areas with no contrast enhancement.
MRI is also a good, but expensive modality of imaging for confirming the presence of a head neck lipoma.
Surgical excision remains the treatment of choice for
neck lipomas. Thorough knowledge of the anatomy of the region and meticulous skills are required to operate on giant neck lipomas, given their relationship with important vessels and nerves in the neck. Complete excision with capsule should be performed to prevent recurrence. Smaller lipomas
may be treated with steroid injection or liposuction,
though neither has proved to be very popular.
Histopathological examination showing mature fat cells.
Conclusion
Lipomas in the anterior aspect of the neck are extremely rare. Giant lipomas as big as this rarely present to a physician, since patients generally seek medical attention earlier, fearing malignancy or because of cosmetic reasons. Although lipomas can reach huge dimensions, with proper preoperative imaging and a good operative technique, surgical excision provides good cosmesis and no functional impairment.
Dr. Susenjit Prasad mahato, one of the best surgeon in Kolkata, has done very severe lipoma surgery in Kolkata, Anterior Neck Lipoma – A Giant Predicament.