Lipoma of the larynx: a case report

Abstract

Lipoma is a benign tumour of mesenchymal origin with a very rare occurrence in the upper aero-digestive tract. To date, approximately 100 cases have been described in the literature. This lesion has a slow growth and, therefore, can present with various symptoms due to the mass effect with obstruction and compression on neighbouring structures, including dysphagia for liquid and solid food, dyspnoea and hoarseness. For a precise pre-operative diagnosis, indirect or direct laryngoscopy (flexible fibre-optic laryngoscopy) can be employed or, if necessary, also imaging techniques such as computed tomography scan and magnetic resonance imaging scan. These offer more useful information for better treatment planning. Surgery is the treatment of choice and includes endoscopic techniques and an external surgical approach (cervicotomy). It is very important to completely remove these benign neoplasms in order to avoid local recurrence. The present report referring to a case of laryngeal lipoma removed through an external surgical approach, aims to demonstrate that the choice of an external surgical approach is required for complete surgical removal of a large lipoma in order to prevent any possible recurrence. Furthermore, it is useful to keep in mind the possibility of recurrence of lipomas after long free intervals; therefore, it is mandatory to observe these patients at long-term follow-up.

Keywords: Imaging; Larynx; Lipoma; Surgical techniques.

Fig. 1a, b, c, d.

Sagittal reconstruction of axial CT scan without contrast-enhancement shows a bulky, expansive, oval mass (white arrows) with maximum dimension 4 cm, well-defined and regular margins, encapsulated, with frankly lipomatous density involving hypopharynx, at level of hyoid bone, and exerting compression on larynx with a markedly narrowed lumen.

Fig. 1a, b, c, d.

Sagittal reconstruction of axial CT scan without contrast-enhancement shows a bulky, expansive, oval mass (white arrows) with maximum dimension 4 cm, well-defined and regular margins, encapsulated, with frankly lipomatous density involving hypopharynx, at level of hyoid bone, and exerting compression on larynx with a markedly narrowed lumen.

Fig. 2a, b.

Coronal reconstruction of axial contrast-enhanced CT scan (arterial phase) shows that lesion (white arrows) arises from right para-laryngeal space and with an intra-luminal projecting portion extending superiorly with involvement of hypopharynx, covering the ipsilateral pyriform sinus. Lesion exerts compression on larynx that is deviated to left with a markedly narrowed lumen.

Fig. 3

Axial contrast-enhanced CT scan (arterial phase) shows an encapsulated lesion, originating in right para-laryngeal space with narrowing of homo-lateral pyriform sinus, that exerts compression on right infra-hyoid muscles and is well-circumscribed with respect to neck vessels. No evidence of involvement of the cervical or jugo-digastric lymph nodes.