10.
2478/AMB-2018-0007
CASE REPORTS
SIALOLIPOMA OF THE PAROTID GLAND: AN UNCOMMON
LIPOMA VARIANT OF SALIVARY GLAND
M. H. A. Ghafar1, G. Ju Tuang2, N. M. Y. Mohammad2, Ch. Nadarajan3, B. Abdullah1
1
Department of Otorhinolaryngology – Head & Neck Surgery, School of Medical Sciences, University Sains Malaysia
2
Department of Otorhinolaryngology – Head & Neck Surgery, Hospital Kuala Lumpur, Jalan Pahang, Malaysia
3
Department of Radiology, School of Medical Sciences, University Sains Malaysia
Abstract. Sialolipoma affecting the salivary glands is an uncommon lipoma variant com-
posed of mature adipose tissue mixed with acinar, ductal, basal and myoepithelial cells of
normal salivary gland. It has a wide age range at presentation. Generally, the major gland
has male predilection while the minor gland has a female preponderance. A diagnostic
workup requires CT or MRI to define the exact location and texture of the lesion. Surgical
excision is recommended when the tumor progressively increases in size. Prognosis is
good whereby no malignant transformation or recurrences has been reported.
Key words: parotid, sialolipoma, salivary gland
Corresponding author: Prof. Dr. Baharudin Abdullah, Department of Otolaryngology – Head and
Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan,
Malaysia, Tel: +6097676416, Fax: +6097676424, e-mail: [email protected], [email protected]
INTRODUCTION ing had been progressively increasing in size, with
no other associated symptoms. She denied dyspha-
T
he term sialolipoma was first introduced by Nagao gia, odynophagia, hoarseness and facial numbness.
et al. [1]. In their work, Nagao and colleagues [1] There was also the absence of a history of constitu-
had established that sialolipoma is a distinctive tional symptoms, nasal obstruction, epistaxis or he-
histological variant of lipoma characterized by benign moptysis. Examination revealed a well-demarcated
salivary gland parenchyma intimately admixed with solitary soft mass of 2 cm x 2 cm in size, which was
mature adipose tissue. The term sialolipoma was ac- not tender, mobile on palpation and overlying the pa-
cepted in the 2005 World Health Organization (WHO) rotid tail region. Systemic examination of the head
Classification of Head and Neck Tumors [2]. Since then, and neck region was otherwise normal.
there have been reported more than 60 cases [1-11]. She underwent two fine needle aspiration proce-
Although a lipoma is a common benign soft tissue dures, but the cytopathological results were both
tumor and frequently developed in the head and neck inconclusive. Computed tomography reveals a fairly
region, it rarely occurs in the salivary gland. Sialoli- well-defined lesion with Hounsfield unit (HU) of fat
poma accounts for less than 0.5% of all neoplasm of density at the posterolateral aspect of the left pa-
the parotid gland [3]. rotid tail (Figure 1). The lesion had no demonstrable
contrast enhancement. It, however, exerts mass ef-
CASE PRESENTATION fect on the underlying deep cervical fascia. No ex-
tension to the adjacent structures was noted. Radio-
A 40 years old female patient presented with swelling logical features were consistent with lipoma of the
over the left parotid region for three years. The swell- parotid gland.
Acta Medica Bulgarica, Vol. XLV, 2018, № 1 // Case report 39
As she was concerned with the increase in the size of
the mass, she was treated with right superficial paroti-
dectomy with facial nerve conservation. Examination of
the gross specimen showed a pale yellowish soft mass
measuring 38 mm x 30 mm x 20 mm overlying the left
parotid tail region. Microscopic examination revealed
mature adipocytes surrounding salivary ducts and acini
(Figures 2 and 3). The final diagnosis of sialolipoma
over the left parotid gland was, therefore, being made.
She was followed-up one week after the surgery and
a left facial nerve palsy grade 4 was observed. Dur-
ing the second follow-up one month later, the facial
nerve palsy had improved to grade 3. In both of the
follow-up sessions, there was no evidence to suggest
Fig. 3. Image showing adipose cells with salivary gland tissue
recurrence of the disease. The patient defaulted her
[H & E, 100X]
follow-up after that.
DISCUSSION
Earlier work by Nagao et al. [1] demonstrated that
sialolipoma shows a slight male predilection (male:
female ratio = 1.75:1). Later publications with bigger
sample size managed to establish the demographical
differences between patients suffering sialolipomas
affecting the major and minor salivary glands [4-7].
Major salivary gland sialolipoma is more frequent in
males than females (male: female ratio = 2:1.3) with
an average age at the time of diagnosis of 42 years
(standard deviation ± 25). Minor salivary gland sialo-
lipoma showed female preponderance (1.8:1 female:
male ratio) with age average at the time of the diag-
nosis of 60.3 years (standard deviation ± 15.5) [7].
Generally, sialolipoma is commonly seen in an adult
with wide age of distribution between 27 to 84 years
(mean, 61.6 years) [4]. Nevertheless, it may also oc-
cur in children. Kadivar and colleagues [3] reported
Fig. 1. CT of the neck with contrast revealed increased subcuta- the first case of congenital sialolipoma in a 3-year-old
neous fat over the left parotid tail with mild mass effect onto the female infant who also had a family history of congeni-
underlying deep cervical fascia
tal anomalies and a single palmar crease. Bansal B et
al. [8] reported the second case of congenital sialoli-
poma in an 11-year-old boy presented with a gradually
increasing mass (since birth) in the left parotid region.
Of all the salivary glands, the parotid gland is the most
common site affected. Other anatomic sites include
submandibular gland, soft palate, hard palate, tongue,
buccal mucosa, floor of the mouth, buccal sulcus, ret-
romolar pad and lower lip [1, 4-7]. There was no report
of multifocal sialolipoma or bilateral occurrence.
The typical presentation of sialolipoma is slow-grow-
ing, soft, mobile and painless swelling at the affected
glands. Symptoms may be present for a long time,
from 2 months to 11 years [4-7].
Upon microscopic examination, sialolipoma exhibit a
Fig. 2. Image showing glandular element with fat cells [H & E, 40X] unique feature; a well-circumscribed, often encapsu-
40 M. H. A. Ghafar, G. Ju Tuang, N. M. Y. Mohammad et al.
lated mass, composed of benign, neoplastic, adipose The recommended treatment of sialolipoma is surgical
tissue with scattered foci of generally atrophic, non- excision. Most of the reported cases showed no local
neoplastic, salivary gland acini and ducts contained recurrence and no malignant transformation [1, 3-11].
within the lipomatous proliferation [4]. The fatty com-
ponent predominates over the epithelial elements (>
CONCLUSION
20-90%). Another common finding in sialolipoma is
foci of sebaceous metaplasia commonly associated Sialolipoma of the parotid gland is an uncommon tu-
with variable periductal inflammation and fibrosis. mor and clinicians may not be aware of this distinct
However, oncocytes are usually absent [12]. All the entity. Diagnosis is set mainly by imaging studies, of
above characteristics differentiate sialolipoma from which CT or MRI has shown an excellent accuracy
other lipomatous lesions such as true lipoma, adeno- in defining the location and texture of the tumor. The
lipoma, lipomatosis, fibrolipoma, spindle cell lipoma
recommended treatment of sialolipoma is surgical
and pleomorphic adenoma with an extensive fat con-
excision whereby no malignant transformation or re-
stituent [1-8, 11-12].
currences have been reported.
The pathogenesis of sialolipoma is still not clearly
understood. One hypothesis proposed by Akrish et
al. [9] is that the pathogenesis of sialolipoma may be Consent: The authors were not able to reach the patient for
associated with some form of salivary gland dysfunc- the consent. However, none of the images used in the manu-
tion, leading to altered salivary gland configuration. script can be used to identify the patient.
Both CT and magnetic resonance imaging (MRI) are Conflicts of interest: There are no conflicts of interest.
useful in characterizing lipomatous lesion of the parotid
gland and help in differentiating it from common differ-
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