The Laryngoscope

C 2012 The American Laryngological,

V
Rhinological and Otological Society, Inc.

Lipomatous Lesions of the Parotid Gland: Analysis of 70 Cases

Sidney J. Starkman, BS; Steven M. Olsen, MD; Jean E. Lewis, MD; Kerry D. Olsen, MD; Alain Sabri, MD

Objectives/Hypothesis: To investigate presenting signs and symptoms, preoperative workup, operative therapy, and
morbidity of benign and malignant lipomatous lesions of the parotid gland.
Study Design: Medical literature review and retrospective chart review for all patients who underwent surgery for lip-
omatous lesions of the parotid gland at our institution from 1959 to 2009.
Methods: Seventy patients underwent surgery for such lesions. Histologic sections were stained with hematoxylin-eosin
and reviewed, and clinical information was obtained from hospital medical records for each case.
Results: Forty-nine patients (70.0%) were male and 21 (30.0%) female (mean age, 49.9 years). Of the lesions, 43
(63.2%) were intraparotid, 25 (36.8%) periparotid, 69 (98.6%) unilateral, and 1 (1.4%) bilateral (average size, 3.7 cm). Fifty-
nine patients were treated with superficial or partial superficial parotidectomy, 10 were treated with total parotidectomy, and
one was treated with parapharyngeal space dissection. Complications included six cases (8.6%) of facial paresis or paralysis
and two cases of hematoma. No lesions recurred.
Conclusions: We present the largest series, to our knowledge, of lipomatous lesions of the parotid gland. These masses,
although rare, should be considered in the evaluation of a parotid mass. This series provides insight into the clinical presenta-
tion, diagnostic evaluation, and surgical treatment of parotid lipomatous lesions. Surgical extent depends on lesion location in
the gland. Lipomatous masses can be effectively treated surgically with low morbidity and high cure rates.
Key Words: Fatty tumor, lipoma, neoplasms, parotid gland, tumors..
Level of Evidence: 4
Laryngoscope, 123:651–656, 2013

INTRODUCTION report our institution’s experience with 70 lipomatous

Lipomatous tumors are the most common neo- lesions of the parotid gland from 1959 until 2009.
plasms of mesenchymal origin. Of lipomas, 13% arise in
the head and neck, with the posterior neck being the MATERIALS AND METHODS
most common subsite.1,2 Lipomas are composed of a be- This study was approved by the institutional review board
nign collection of adipose tissue that may be surrounded and was conducted in compliance with board guidelines. A ret-
by a fibrous capsule. Diagnosis is based on clinical and rospective chart review of 70 cases was performed. Inclusion
radiographic evidence and is confirmed with histopatho- criteria required that patients had undergone parotid surgery
logic analysis. Lipomas tend to exhibit slow growth, are at our institution for removal of a lipomatous lesion of the pa-
often asymptomatic, and on examination are generally rotid between 1959 and 2009. Patient data included age at
well-circumscribed soft lesions. Radiographic imaging— diagnosis, sex, and clinical signs and symptoms, including size,
laterality, facial nerve status, treatment extent, intraoperative
particularly computed tomography (CT) and magnetic
finding, histopathologic findings, and treatment morbidity and
resonance imaging (MRI)—can be suggestive of this
efficacy. Follow-up was obtained either by subsequent visit at
diagnosis. our institution or through correspondence of medical records
Lipomas of the parotid gland are rare. The medical with the patient’s home hospitals. Among 70 patients who
literature reports that they comprise 0.5% to 4.4% of all underwent treatment of parotid lesions, 16 patients were lost to
parotid masses. Most cases reported in the literature are long-term follow-up. The other 54 patients had a median follow-
single cases, with the largest series to date reporting 32 up period of 68.0 months (range, 1 month–23.2 years).
cases of lipomatous tumors in the parotid region. We
RESULTS
From the Department of Otolaryngology–Head and Neck Surgery Patient Demographic Characteristics
(S.M.O., K.D.O.), Division of Anatomic Pathology (J.E.L.), and Mayo Medical The male to female ratio was 2.5:1. Age range at
School, College of Medicine (S.J.S.), Mayo Clinic, Rochester, Minnesota; and
Department of Otolaryngology–Head and Neck Surgery (A.S.), American lesion diagnosis was 7.4 through 89.5 years (mean age
University of Beirut, Beirut, Lebanon. at symptom onset, 49.9 years) (Table I). Patients
Editor’s Note: This Manuscript was accepted for publication included three children younger than 16 years. Across
August 13, 2012.
the cohort, most patients were white. No patient had a
The authors have no funding, financial relationships, or conflicts
of interest to disclose. family history positive for lipomas. However, 18 patients
Send correspondence to Alain Sabri, MD, Department of Otolar- (25.7%) had at least one medical comorbidity, and eight
yngology–Head and Neck Surgery, American Academy of Beirut Medical (11.4%) had a history of diabetes mellitus, 10 (14.3%)
Center, Cairo Street, Beirut, Lebanon. E-mail: [email protected]
had hypercholesterolemia, and one (1.4%) had polycythe-
DOI: 10.1002/lary.23723 mia vera. Eleven patients were current smokers, 26

Laryngoscope 123: March 2013 Starkman et al.: Lipomatous Lesions of the Parotid Gland
651
 TABLE I. TABLE III.
Demographic Characteristics of 70 Patients Lesion Characteristics (N 5 70).
With Lipomatous Masses.
Location Patients, No. (%)
Characteristic Patients, No. (%)
Intraparotid* 43 (63.2)
Ethnicity (n ¼ 68)*
Periparotid* 25 (36.8)
White 67 (98.5)
Superficial lobe† 62 (92.5)
Asian 1 (1.5) Deep lobe† 3 (4.5)
Age range, yr
Superficial and deep lobe† 2 (3.0)
Children, 16 3 (4.3)
Right parotid gland 35 (50.0)
Adults, >16 67 (95.7) Left parotid gland 34 (48.6)
Sex
Bilateral parotid glands 1 (1.4)
Male 49 (70.0)
*Two patients had indeterminate intra- or periparotid location (n ¼
Female 21 (30.0) 68).
†
Three patients had unrecorded superficial or deep lobe involvement
*Two patients had no ethnicity recorded.
(n ¼ 67).

were past smokers, and 33 were never smokers. Patients Treatment

with a history of smoking had an average pack-year his- Eighteen patients underwent preoperative imaging
tory of 24.8 (range, 2–80 pack-years). Among the 67 (11 had CT and seven had MRI). Among the 52 patients
patients who reported their drinking history, 20 were without preoperative imaging, only 19.2% had the appro-
nondrinkers, 13 reported one drink per month, 13 priate preoperative diagnosis of lipoma. Among those
reported several drinks per month, 12 reported several who had CT, a statistically significant improved rate of
drinks per week, and nine reported more than several preoperative diagnosis was achieved, with 63.6% of
drinks per week. patients receiving an accurate diagnosis (P ¼ .003). Of
patients with MRI preoperatively, an improved rate of
diagnosis was seen, but results did not achieve statisti-
Presentation of Neck Mass cal significance, with 42.9% of lipomas correctly
Table II summarizes the presenting symptoms of identified (P ¼ .42). Ten patients had fine-needle aspira-
the patients. Sixty-six patients (94.3%) presented with tion (FNA) of the parotid mass; five results were
neck mass as their chief concern. One patient had facial indeterminate, three were suggestive of another benign
nerve symptoms, which included facial twitching with- mass, one was correctly suggestive of lipoma, and one
out clinically evident facial nerve weakness. The mean was correctly suggestive of liposarcoma.
duration of symptoms before presentation was 3.3 years The performed surgical procedures were superficial
(range, 1 month–30 years). parotidectomy (n ¼ 51), total parotidectomy (n ¼ 10),
partial superficial parotidectomy (n ¼ 8), and paraphar-
yngeal space dissection (n ¼ 1). Ages at surgery ranged
Lesion Characteristics from 14.7 to 89.6 years (mean, 56.5 years). At the time
Among all patients, 50.0% had right parotid of the surgical operations, 100% of patients had the pa-
involvement, 48.6% had left parotid involvement, and rotid masses completely removed.
one patient (1.4%) had bilateral involvement (Table III).
Lipomatous masses involved only the superficial lobe in
92.5% of cases; the involved area was unrecorded in Pathologic Findings
three cases. In 36.8% of cases, the mass was extraparo- Pathologic examination showed standard lipoma
tid, arising from periparotid subcutaneous fat tissue but histologic features in 63 cases (Table IV). Variations
adjacent to or involving parotid tissue. Average dimen- included sialadenosis, fibrolipoma, sialolipoma, angioli-
sions of the lipomas were 3.7
2.8
1.6 cm (smallest, poma, and liposarcoma. Of the lipomatous lesions, 54
0.8
0.8
0.8 cm; largest, 16.5
7.5
2.5 cm) (Fig. 1). were without a completely enveloping capsule and 16
Six patients also had a lipoma at other sites (the back [n were fully encapsulated. Pathologic investigation showed
¼ 3], the trunk [n ¼ 2], and the neck [n ¼ 1]). that the locations were intraparotid in 43 cases, extrap-
arotid in 25 cases, and indeterminate in two cases.
TABLE II.
Presenting Symptoms of Patients With Lipomatous Follow-up
Masses (N 5 70).
Short-term treatment morbidities included two
Presenting Symptom Patients, No. (%) cases of hematoma, four cases of transient facial paresis,
Neck mass 66 (94.3) and two cases of transient facial paralysis, with full
Lesion size progression 43 (61.4) recovery of facial nerve function in all cases at last
Pain 3 (4.3) follow-up (Table V). Eight of 61 patients who underwent
Facial nerve signs 1 (1.4)
superficial or total parotidectomy had some immediate
postoperative sequelae, although none of the nine

Laryngoscope 123: March 2013 Starkman et al.: Lipomatous Lesions of the Parotid Gland
652
Fig. 1. Intraoperative image of intra-
parotid lipoma. [Color figure can be
viewed in the online issue, which is
available at wileyonlinelibrary.com.]

patients who underwent partial superficial parotidec- Another theory on the cause of lipoma is proliferation of
tomy or parapharyngeal space dissection had misplaced islands of lipoblasts or a metaplastic transfor-
postoperative sequelae. In addition, two (10.0%) of 20 mation of connective tissue into fatty tissue.5 These
patients with a correct preoperative diagnosis had short- lesions rarely undergo lipolysis in cases of severe malnu-
term postoperative complications, and six (12.2%) of 49 trition or cachexia.4,6,7
patients with unspecific preoperative diagnoses had
complications.
Among the 54 cases with follow-up for more than
one month, there were no recurrences for patients
Lesion Presentation
Only rarely do lipomatous masses present in the pa-
treated at our institution (median follow-up, 68.0
rotid area. Our experience represents, to our knowledge,
months; range, 1 month–23.2 years). One patient had a
the largest report of parotid lipomas to date. A previous
tumor incompletely resected at an outside institution
review of 14 studies reported 76 cases of lipomas identi-
and presented to our institution for surgical manage-
fied from a total of 6,101 parotid tumors (a prevalence
ment after tumor persistence. After complete removal,
rate of 1.2%).8 The largest individual series focusing on
the tumor did not recur. Among the three pediatric
lipomas from the parotid gland reported 32 cases.9
patients, there were no cases of postoperative morbidity
Parotid lipomas are more common in males than
or recurrence.
females. The male to female ratio in our series was
2.5:1, a lower ratio than in the previous largest series of
parotid lipomas, which reported a ratio of 10:1.9. Lipom-
DISCUSSION
atous tumors are generally found in adults, with a small
Lipoma is the most common soft tissue tumor in the
percentage occurring in the pediatric population (4.3%
body. It has been reported in virtually every organ,1
with 13% of cases presenting in the head and neck area2
and mainly in the posterior neck.3 Lipomas are believed TABLE V.
to develop as a result of hypertrophy from increased Morbidity Incidence Rates in Various Surgical Events.
uptake of acetate and increased fatty synthesis.4 Transient Facial Total
Nerve Paresis/ Hematoma, Morbidity
Surgical Event Paralysis, % % Incidence, %
TABLE IV.
Lesion Variants (N 5 70). Superficial 9.8 (n ¼ 5) 3.9 (n ¼ 2) 13.7 (n ¼ 7)
parotidectomy
Variant Patients, No. (%) (n ¼ 51)
Total parotidectomy 10.0 (n ¼ 1) 0 10.0 (n ¼ 1)
Lipoma 63 (90.0) (n ¼ 10)
Sialadenosis 2 (2.9) Partial superficial 0 0 0
Fibrolipoma 2 (2.9) parotidectomy
(n ¼ 8)
Sialolipoma 1 (1.4)
Parapharyngeal 0 0 0
Angiolipoma 1 (1.4) space
Liposarcoma 1 (1.4) dissection (n ¼ 1)

Laryngoscope 123: March 2013 Starkman et al.: Lipomatous Lesions of the Parotid Gland
653
in our study). They occur with equal frequency on the location without exposing the patient to the ionizing
right and left sides of the body and rarely are identified radiation of a CT scan.19,20 MRI also can identify the tu-
bilaterally. Our study did not find a significant correla- mor capsule, enabling the clinician to distinguish tumor
tion between the incidence of lipomatous tumor and a from surrounding fatty tissue.21
history of smoking or alcohol use. Likewise, this rela- Although ultrasonography was not used in this
tionship has not been reported in the literature. study, the literature has demonstrated the effectiveness
Clinically, lipomatous masses generally manifest as of this modality in preoperative evaluation of lipomatous
relatively asymptomatic masses. In this series, the most masses. A recent study determined that sensitivity for
common presenting symptom was a parotid mass, with the diagnosis of lipoma increased from 54.8% after pal-
more than half having progressed in size. Fewer than pation to 88.1% after ultrasonography.22 An elongated
5% of patients noticed pain or facial nerve symptoms. echogenic mass in the subcutaneous tissues should sug-
On examination, lipomas are soft compressible gest the diagnosis of lipoma. This echogenic pattern is
masses with normal overlying skin. They often display a very similar to the pattern of subcutaneous adipose tis-
positive ‘‘slippage sign’’ when the fingers are slid gently sue. Striated echoes in the tumor, which correspond to
over the edge of the tumor.1 Lipomas will be felt to slip the septa, increase the possibility of lipoma.
aside when under pressure, rather than a sebaceous cyst This study showed that FNA is an inaccurate
or abscess that is tethered to surrounding tissues. Neu- means of identifying parotid lipomas. Among 10 parotid
rologic findings, including hypoesthesia and paresis, are lipomatous lesions that underwent FNA, an accurate di-
rare,10,11 with only one case of facial paresis reported.12 agnosis was obtained in only 22% (2/9) of cases.
These tumors are rarely considered in the differential di- Previously, FNA has been described as inaccurate for di-
agnosis of parotid tumors when diagnosis is based on agnosis of parotid lipomas, largely because fat cells from
clinical findings only. Before any imaging is performed, lipomas are histologically indistinguishable from normal
the most commonly reported preoperative clinical diag- subcutaneous fat, which is expected in the FNA of a pa-
noses are pleomorphic adenoma and Warthin tumor.8,9,13 rotid mass.23 In another study, only five of nine parotid
lipomatous lesions yielded an accurate diagnosis on
FNA.13
Preoperative Workup
Preoperative imaging and FNA of parotid masses
are selectively used at our institution. We generally Histologic Features
reserve imaging for cases of suspected malignancy or Of lipomatous tumors in the parotid gland, 90%
cases with suspected deep lobe or parapharyngeal were pathologically determined to be standard lipomas;
involvement. In addition, FNA is generally used when the others were classified as different variants. Histolog-
malignancy is suspected or when either parotid surgery ically, parotid lipomas consist of circumscribed masses of
is contraindicated or the patient elects for observation. mature adipose tissue, often with a thin fibrous capsule
Thus, the majority of patients in this series did not at the margin, differentiating them from simple aggrega-
undergo preoperative imaging or FNA. tions of adipose tissue.8,24,25 We found that 22.9% (16/70)
Preoperative use of CT in the present study showed of lesions were well encapsulated, a finding determined
a significantly higher rate of accurate preoperative diag- histologically.
nosis of parotid lipoma (P ¼ .003). MRI also improved Several unusual variants of lipomatous masses
the rate of accurate preoperative diagnosis over baseline were found. Our series included two cases of sialadeno-
(preoperative rate vs. baseline, 42.9% vs. 19.2%), sis—one case in an adult with diabetes mellitus and the
although the results did not reach statistical signifi- other case in an otherwise-healthy 15-year-old child. In
cance. The lack of significance is likely due to the small each case, the patient underwent complete lesion exci-
sample (n ¼ 7); a larger sample may yield a more signifi- sion and had no complications or recurrence.
cant result. Sialadenosis is defined by characteristic swelling of the
CT imaging of lipomas reveals a hypodense mass acini, together with changes in the cytoplasm of the aci-
(between 150 and 50 Hounsfield units), which is con- nar cells. In cases of longer duration, fatty infiltration
sidered diagnostic by most investigators.3,14,15 The becomes predominant.26 Sialadenosis can occur second-
exception is fibrolipoma, which may show a contradic- ary to a metabolic disease (e.g., diabetes, alcoholism,
tory high density on CT scan, secondary to the increased malnutrition, drug adverse effect)3,13 but has also been
amount of fibrotic tissue in the tumor.16 Lipomas do not reported as a congenital condition.27
enhance with injection of contrast medium except in Other uncommon variants of lipomatous tumors
cases of angiolipomas.17 In addition to aiding in diagno- that our series included were two cases of fibrolipoma,
sis, CT scan helps in defining the location and extent of one case of angiolipoma, and one case of sialolipoma.
the tumor.18 Sialolipomas are rare salivary gland tumors defined his-
On MRI, lipomas show a high T1 and low T2 signal tologically by mature adipocytes encasing normal
characteristic of fatty tissue that is comparable in signal salivary glandular components.28 They most commonly
intensity to subcutaneous fat. The fat suppression affect the parotid gland and present in adults as a slow-
sequence of lipomatous lesions demonstrated on MRI growing, asymptomatic swelling. Angiolipomas have
clearly distinguishes these masses from other types of been reported as a congenital mass.17 Chondrolipoma
tumors. MRI provides information about tumor size and and myelolipoma are lipoma variants that have not been

Laryngoscope 123: March 2013 Starkman et al.: Lipomatous Lesions of the Parotid Gland
654
reported in the parotid gland. Multiple rare parotid lip- complete mass resection (when possible, with a cuff of
oma variants have been described in the literature, normal parotid tissue around the mass) and facial nerve
including fibrolipoma, angiolipoma,29 spindle cell lip- preservation. The amount of parotid gland removed is
oma,30 pleomorphic lipoma (believed to be a variant of dictated by lesion size and location and the prior two op-
spindle cell lipoma),31,32 lipoblastoma (an immature fatty erative factors. We do not advocate intraparotid
tumor),14,33 and osteolipoma.34 Molecular biological anal- lumpectomy alone. Most investigators recommend super-
ysis has been useful in evaluation and diagnosis of these ficial parotidectomy for tumors located within the
tumor subtypes. For example, lipoblastomas are pediat- superficial lobe, with dissection and preservation of the
ric neoplasms resulting from transformation of facial nerve 8,15,45 and total parotidectomy for deep lobe
adipocytes, originating with PLAG1 activation (presum- tumors. We and other investigators also recommend par-
ably resulting from transcriptional upregulation).35 tial parotidectomy for select masses (e.g., parotid tail
One case of liposarcoma was found in the present lesions) in the superficial lobe and the deep lobe.45 For
study, occurring in an 89-year-old woman and presenting certain tumors, the superficial lobe can also be reposi-
as a progressive mass over 6 months. This patient tioned over the nerve after resection of a deep lobe
underwent complete surgical tumor excision and did not tumor, to prevent facial depression.46 Management of
show any signs of subsequent recurrence. Liposarcomas periparotid lesions is less debatable, with complete exci-
are believed to develop de novo, rather than as malig- sion cited as an effective treatment.15
nant transformation of benign fatty tissue.5 Few cases of Postoperative complications in the present study
liposarcoma have been reported in the literature. Stew- were uncommon. The nine patients who had postopera-
art et al.36 found three cases reported in the literature. tive morbidity had received parotidectomy procedures
The literature identified 12 cases of salivary gland lipo- for intraparotid lipomas rather than simple excision of
sarcomas. Nine of these cases were in the parotid gland periparotid tumors. Postoperative complications were
and three were in the submaxillary gland.37–41 Radio- similar to other studies of parotidectomies for benign
logic studies may demonstrate features suggestive of a tumors, including transient facial nerve weakness and
malignancy by exhibiting areas of heterogeneous density Frey syndrome.47 Of note, the prevalence of Frey syn-
in the lipomatous mass. Histologic subtype is the most drome in our study was lower than would be expected.
important prognostic factor for malignant lipomatous The medical literature has found the incidence of Frey
tumors. syndrome after parotidectomy to be about 23.5%.48 This
The five liposarcoma subtypes are atypical lipoma- lower rate could be due to the referral basis of our insti-
tous tumor/well-differentiated, dedifferentiated, myxoid, tution with follow-up performed at other centers.
pleomorphic, and mixed-type liposarcomas. More favor- Additionally, approximately half of Frey syndrome cases
able prognoses were found with well-differentiated, can be subclinical and may not have been reported. Fa-
dedifferentiated, and myxoid liposarcomas. Pleomorphic cial nerve weakness has been shown to be more common
and mixed-type liposarcomas, which make up <10% of after resection of deep lobe tumors.21
all liposarcomas, carried the worst prognoses, with 5-
year survival rates of <25%.37
A rare lipomatous disorder that we did not encoun- CONCLUSION
ter in our study was Madelung deformity (benign We present, to our knowledge, the largest series of
symmetrical lipomatosis). This condition is characterized lipomatous lesions of the parotid gland. The most com-
by large, subcutaneous, fatty masses distributed around mon presentations of these lesions were painless masses,
the neck, shoulders, upper extremities, and upper dorsal with progression in size over time. FNA was noticeably
regions, mainly affecting middle-aged men (male to inaccurate in preoperative diagnosis. However, CT and
female ratio, 15:1) with a history of alcoholism.42 It has MRI can be useful for diagnosis. Preoperative imaging
been found to present bilaterally in the parotid can be particularly useful in identifying size, location,
regions.43 The pathogenesis of Madelung deformity is and even the histologic characteristics of lipomatous
unclear. lesions. Imaging can assist in planning the extent of the
surgery, particularly in periparotid lesions that require
extracapsular dissection. Treatment of benign lipoma-
Treatment tous lesions is indicated to correct cosmetic reports due
This study showed the efficacy of surgical treatment to unpleasant physical appearance or when preoperative
of lipomatous masses. Every lesion was treated with diagnosis is inconclusive. Intraparotid lipomas require
complete surgical excision through parotidectomy, par- standard parotidectomy procedures. Complications are
tial superficial parotidectomy, or parapharyngeal space rare and recurrences even more so.
dissection. No cases of recurrence were found among the
70 lipomatous lesions. The sole case of liposarcoma was
treated with total parotidectomy and had no recurrence. BIBLIOGRAPHY
Prior cases of parotid liposarcoma have been treated 1. Adebamowo CA, Ladipo JK, Ajao OG. Parotid lipoma: a report of two
cases. East Afr Med J 1994;71:210–211.
with complete surgical excision successfully and without 2. de Jong AL, Park A, Taylor G, Forte V. Lipomas of the head and neck in
recurrence.40,44 children. Int J Pediatr Otorhinolaryngol 1998;43:53–60.
3. Som PM, Scherl MP, Rao VM, Biller HF. Rare presentations of ordinary
We believe that the extent of surgery should be lipomas of the head and neck: a review. AJNR Am J Neuroradiol 1986;
determined at the time of operation with dual goals of 7:657–664.

Laryngoscope 123: March 2013 Starkman et al.: Lipomatous Lesions of the Parotid Gland
655
 4. Das Gupta TK. Tumors and tumor-like conditions of the adipose tissue. 28. Bansal B, Ramavat AS, Gupta S, et al. Congenital sialolipoma of parotid
Curr Probl Surg 1970;7:1–60. gland: a report of rare and recently described entity with review of liter-
5. Ashley DJB. Evan’s Histological Appearances of Tumours. 3rd ed. Edin- ature. Pediatr Dev Pathol 2007;10:244–246.
burgh, UK: Churchill Livingstone; 1978:54–57. 29. Gallagher DM, Goldman E, Schaffer SD. Fibrolipoma of the cheek in a
6. Barnes L. Surgical Pathology of the Head and Neck. Vol. 1. New York, NY: child. J Oral Maxillofac Surg 1982;40:824–827.
Dekker; 1985:747–785. 30. Rosenthal LS, Garzon S, Setty S, Yao M. Left-sided facial mass: spindle cell
7. Vindenes H. Lipomas of the oral cavity. Int J Oral Surg 1978;7:162–166. lipoma of the parotid gland. Arch Pathol Lab Med 2006;130:875–876.
8. Baker SE, Jensen JL, Correll RW. Lipomas of the parotid gland. Oral 31. Graham CT, Roberts AH, Padel AF. Pleomorphic lipoma of the parotid
Surg Oral Med Oral Pathol 1981;52:167–171. gland. J Laryngol Otol 1998;112:202–203.
9. Walts AE, Perzik SL. Lipomatous lesions of the parotid area. Arch Otolar- 32. Enzinger FM, Weiss SW. Soft Tissue Tumors. 3rd ed. St. Louis, MO:
yngol 1976;102:230–232. Mosby; 1995:395–401.
10. Batsakis JG. Tumors of the Head and Neck: Clinical and Pathological 33. Krempl GA, McGuff HS, Pulitzer DR, Otto RA. Lipoblastoma in the pa-
Considerations. 2nd ed. Baltimore, MD: Williams and Wilkins; rotid gland of an infant. Otolaryngol Head Neck Surg 1997;117:
1979:360–364. S234–S237.
11. Phalen GS, Kendrick JI, Rodriguez JM. Lipomas of the upper extremity: a 34. Diom ES, Ndiaye IC, Ndiaye M, et al. Osteolipoma: an unusual tumor of
series of fifteen tumors in the hand and wrist and six tumors causing the parotid region. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:
nerve compression. Am J Surg 1971;121:298–306. 34–36.
12. Srinivasan V, Ganesan S, Premachandra DJ. Lipoma of the parotid gland 35. Hibbard MK, Kozakewich HP, Dal Cin P, et al. PLAG1 fusion oncogenes in
presenting with facial palsy. J Laryngol Otol 1996;110:93–95. lipoblastoma. Cancer Res 2000;60:4869–4872.
13. Layfield LJ, Glasgow BJ, Goldstein N, Lufkin R. Lipomatous lesions of the 36. Stewart MG, Schwartz MR, Alford BR. Atypical and malignant lipomatous
parotid gland: potential pitfalls in fine needle aspiration biopsy diagno- lesions of the head and neck. Arch Otolaryngol Head Neck Surg 1994;
sis. Acta Cytol 1991;35:553–556. 120:1151–1155.
14. Calhoun KH, Clark WD, Jones JD. Parotid lipoblastoma in an infant. Int 37. Chandan VS, Fung EK, Woods CI, de la Roza G. Primary pleomorphic lip-
J Pediatr Otorhinolaryngol 1987;14:41–44. osarcoma of the parotid gland: a case report and review of the litera-
15. Malave DA, Ziccardi VB, Greco R, Patterson GT. Lipoma of the parotid ture. Am J Otolaryngol 2004;25:432–437.
gland: report of a case. J Oral Maxillofac Surg 1994;52:408–411. 38. Jones JK, Baker HW. Liposarcoma of the parotid gland: report of a case.
16. Saitoh Y, Hama T, Ishizaka S, et al. Fibrolipoma of the parotid in a child. Arch Otolaryngol 1980;106:497–499.
Am J Otolaryngol 1995;16:433–435. 39. Korentager R, Noyek AM, Chapnik JS, Steinhardt M, Luk SC, Cooter N.
17. Zeit RM. Hypertrophy of the parotid gland: computed tomographic find- Lipoma and liposarcoma of the parotid gland: high-resolution preopera-
ings. AJR Am J Roentgenol 1981;136:199–200. tive imaging diagnosis. Laryngoscope 1988;98:967–971.
18. Reilly JS, Kelly DR, Royal SA. Angiolipoma of the parotid: case report and 40. Zheng JW, Wang Y. Liposarcoma in the oral and maxillofacial region: an
review. Laryngoscope 1988;98(8 pt 1):818–821. analysis of 10 consecutive patients. J Oral Maxillofac Surg 1994;52:
19. Eckel HE, Jungehulsing M. Lipoma of the hypopharynx: pre-operative 595–598.
diagnosis and transoral resection. J Laryngol Otol 1994;108: 41. Minic AJ. Liposarcomas of the oral tissues: a clinicopathologic study of
174–177. four tumors. J Oral Pathol Med 1995;24:180–184.
20. Tsunoda A. Lipoma in the peri-tonsillar space. J Laryngol Otol 1994;108: 42. Meningaud JP, Pitak-Arnnop P, Bertrand JC. Multiple symmetric lipoma-
693–695. tosis: case report and review of the literature. J Oral Maxillofac Surg
21. Kimura Y, Ishikawa N, Goutsu K, Kitamura K, Kishimoto S. Lipoma in 2007;65:1365–1369.
the deep lobe of the parotid gland: a case report. Auris Nasus Larynx 43. Kohan D, Miller PJ, Rothstein SG, Kaufman D. Madelung’s disease: case
2002;29:391–393. reports and literature review. Otolaryngol Head Neck Surg 1993;108:
22. Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultra- 156–159.
sonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol 44. Fanburg-Smith JC, Furlong MA, Childers EL. Liposarcoma of the oral and
2009;145:761–764. salivary gland region: a clinicopathologic study of 18 cases with empha-
23. Ulku CH, Uyar Y, Unaldi D. Management of lipomas arising from deep sis on specific sites, morphologic subtypes, and clinical outcome. Mod
lobe of the parotid gland. Auris Nasus Larynx 2005;32:49–53. Pathol 2002;15:1020–1031.
24. Houston GD, Brannon RB. Lipoma of the parotid gland. Oral Surg Oral 45. Weiner GM, Pahor AL. Deep lobe parotid lipoma: a case report. J Laryngol
Med Oral Pathol 1985;60:72–74. Otol 1995;109:772–773.
25. Kim YH, Reiner L. Ultrastructure of lipoma. Cancer 1982;50:102–106. 46. Wu CW, Chi HP, Chiang FY, Hsu YC, Chan LP, Kuo WR. Giant lipoma
26. Graamans K, van den Akker HP. Diagnosis of Salivary Gland Disorders. arising from deep lobe of the parotid gland. World J Surg Oncol 2006;4:
Dordrecht, the Netherlands: Kluwer Academic Publishers; 1991:109– 28.
112. 47. Ethunandan M, Vura G, Umar T, et al. Lipomatous lesions of the parotid
27. Adams G, Goycoolea MV, Foster C, Dehner L, Anderson RD. Parotid lipo- gland. J Oral Maxillofac Surg 2006;64:1583–1586.
matosis in a 2-month-old child. Otolaryngol Head Neck Surg 1981;89(3 48. Rustemeyer J, Eufinger H, Bremerich A. The incidence of Frey’s syn-
pt 1):402–405. drome. J Craniomaxillofac Surg 2008;36:34–37.

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