Myxolipoma of the epiglottis in an adult: a case report

Ear, Nose & Throat Journal, Nov, 2005 by Surinder K. Singhal, Ramandeep S. Virk, Harsh Mohan, Sanjeev Palta, Arjun Dass

Abstract

Lipomas of the larynx are rare. When they do occur, they are important because some require that the surgeon perform a tracheotomy to prevent a fatal airway obstruction. We report a case of myxolipoma--that is, a lipoma with foci of myxomatous degeneration--of the epiglottis in a 56-year-old woman. We successfully treated the tumor with intubation and surgery; tracheotomy was not necessary. To the best of our knowledge, myxolipoma of the epiglottis in an adult has not been previously reported in the English-language literature.

Introduction

Laryngeal lipomas are rare, as fewer than 100 cases have been reported in the English-language literature. Most of these cases were isolated occurrences and were not associated with systemic lipomatosis. When lipomas do occur, they are important because, even though they are benign, they can cause a fatal airway obstruction, particularly during the induction of general anesthesia. (1)

A myxolipoma is a lipoma that contains foci of myxomatous degeneration. In this article, we report our successful management of a case of myxolipoma of the epiglottis in a middle-aged woman. To the best of our knowledge, this case represents the first reported instance of an epiglottal myxolipoma in an adult.

Case report

A 56-year-old woman presented to our clinic with a 5-month history of dysphagia with solid foods. The onset of the dysphagia had been insidious, and its course had been gradually progressive. The patient had also noticed a discrete, insidious, and gradually progressive change in her voice during the previous month. She reported no pain or dyspnea. She had no history of trauma or weight loss, but she was a known diabetic whose disease was controlled with regular treatment.

Oral examination revealed that the mouth opening was adequate and that the patient was edentulous. The tongue, floor of the mouth, buccal mucosa, palate, bilateral tonsillar fossae, and posterior wall of the oropharynx were normal. Indirect laryngoscopy identified a single, round, cystic swelling that involved the valleculae and the anterior surface of the epiglottis. Both vocal folds were normal and mobile. Laryngeal crepitus was present. Findings on routine hematologic testing and systemic evaluation were within normal limits. Based on these findings, we reached a presumptive diagnosis of a vallecular/epiglottic cyst.

A lateral x-ray of the soft tissue of the neck revealed that a mass had arisen from the anterior surface of the epiglottis. The aryepiglottic folds and the arytenoids were normal on x-ray. Computed tomography (CT) confirmed that the irregular soft-tissue mass had arisen in the area of the valleculae from the right side (figure 1). The dense mass--which measured 24 x 18 x 30 mm--extended into the pre-epiglottic space. The pharyngeal lumen was partially eroded. The major vascular structures were normal, and no clearly enlarged cervical lymph nodes were detected. The patient could not afford to undergo magnetic resonance imaging (MRI), and it was not performed.

[FIGURE 1 OMITTED]

Excision of the cyst under general anesthesia was planned. The patient was counseled that she might require a tracheotomy just prior to the procedure in case we encountered difficulty intubating her; the tracheotomy would be performed in order to prevent the cyst from rupturing. When the patient was taken to the operating room, the anesthesiologist was able to successfully intubate her, thereby obviating the need for the tracheotomy.

A wide-mouth direct laryngoscope was introduced and fixed with a chest support. The swelling was visualized arising from the anterior surface of the epiglottis on the right side. It was dissected free from the surrounding structures with cold instruments. Part of the epiglottis on the right side where swelling was present was also resected. The mass was delivered en toto without any rupture or leakage. The patient's postoperative course was uneventful, and she was discharged 2 days later.

Naked-eye examination of the excised specimen revealed that it was a gray-white and gray-brown, externally encapsulated, nodular soft-tissue mass measuring 3.5 x 2.5 x 1.0 cm. Cut section was lobulated and gray-brown, gray-yellow, and gray-white. Histopathologic examination identified the mass as a benign encapsulated mesenchymal tumor. The tumor was made up of lobules of mature fat separated by oval to spindle-shaped cell septae that exhibited abundant myxoid change and mild lymphocytic infiltration (figure 2). These findings established a diagnosis of myxolipoma.

[FIGURE 2 OMITTED]

At a regular follow-up visit 2 years later, no sign of recurrence was evident (figure 3).

[FIGURE 3 OMITTED]

Discussion

Lipomas of the larynx are rare benign neoplasms derived from adipose tissue. On gross examination, they are encapsulated, smooth, and usually pedunculated. (2) Histologically, they are made up of mature adipocytes. (3) A myxolipoma is a variant of a lipoma in which myxoid change has taken place. Malignant transformation of solitary lipomas has not been reported, but it has occurred in cases of multiple lipomas of the larynx.