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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 2  |  Page : 41-44

Fibrolipoma of the nasopharynx


1 Department of Otorhinolaryngology-Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
2 Medical Intern, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

Date of Submission29-May-2020
Date of Acceptance30-Jul-2020
Date of Web Publication30-Dec-2020

Correspondence Address:
Dr. Mohammad H Shaheen
Department of Otolaryngology-Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJOH.SJOH_24_20

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  Abstract 


Nasopharyngeal fibrolipoma is exceedingly rare. This review article aims to recognize the characteristics of this rare tumor along with a favorable way to diagnose and treat it. We reviewed six cases of nasopharyngeal fibrolipoma. This lesion involves both sexes at any age. It is tremendously rare with only six case reports in the English literature and should be considered in the differential for nasopharyngeal masses. Nasopharyngeal fibrolipoma can be diagnosed by radiological investigations as a hypodense, well-defined nonenhancing lesion on the computed tomography and confirmed histologically, and endoscopic or transoral surgical excision approach is the most accepted management. However, no cases reported recurrence for this lesion.

Keywords: Fibrolipoma, lipoma, nasopharynx


How to cite this article:
Shaheen MH, Kufiah HZ. Fibrolipoma of the nasopharynx. Saudi J Otorhinolaryngol Head Neck Surg 2020;22:41-4

How to cite this URL:
Shaheen MH, Kufiah HZ. Fibrolipoma of the nasopharynx. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2020 [cited 2021 Jan 20];22:41-4. Available from: https://www.sjohns.org/text.asp?2020/22/2/41/305463




  Introduction and Background Top


The nasopharynx is a site where a variety of tissues exist allowing a range of potential tumors to develop. In general, benign tumors in the nasopharynx are uncommon except for angiofibroma or fibroangioma.[1]

Lipomas, derived from the mesenchyme, are one of the most common soft-tissue tumors in the body, however only 15% of them are located in the head and neck area.[2] Head and neck lipomas commonly occur in the posterior cervical triangle and are not often found in the nasopharynx.[3]

Lipomas are benign tumors and existing as painless soft-tissue masses usually seen in adults.[4],[5],[6] According to their location, they are additionally classified as subcutaneous, submucous, or intramuscular lipomas. Apart from fat cells, lipomas might also contain other tissue components, such as fibrous, nervous, or vascular tissue.[7]

There are several histological subtypes of lipomas, such as simple lipoma, fibrolipoma, intramuscular lipoma, salivary gland lipoma, spindle cell lipoma, angiolipoma, and myxoid lipoma.[8] Fibrolipomas are characterized through a fibrous element intermixed with lobules of adipocytes, and it is one of the unusual subtypes of lipoma.[9]

Lipomas originating from the nasopharynx or  Eustachian tube More Details are extraordinarily rare,[10] with fibrolipomas of this area being rarer still.[11]

This review article aimed to recognize the characteristics of this rare disease along with favorable ways to diagnose and treat it.


  Review Top


Literature reviews of fibrolipoma cases were identified between 1990 and 2020 using the search engines Ovid, PubMed, and Medline. The keywords were as follows: fibrolipoma and unusual subtypes of lipoma. We included all cases of fibrolipoma in the nasopharynx or Eustachian tube ostium. The language was limited to English, and we excluded fibrolipoma of the other body regions and glands.

We reviewed six cases,[1],[10],[12],[13],[14],[15] as described in [Table 1]. All cases are arranged chronologically from 1990 to 2020. We searched for study type, year and place of publication, patient demographics, initial presentation, and the lesion site. We focused on the lesion features by discussing the physical examination findings and radiological and histopathological reports, in addition to management plans and follow-up outcomes.
Table 1: Summary of fibrolipoma cases

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Most patients, 4 of them, were female (66.6%),[1],[10],[13],[14] and 2 (33.3%)[12],[15] were male. This mass involves a wide age range (from 1 to 50 years), 2 (33.3%) of them were children[1],[13] and 4 (66.6%) of them were adults.[10],[12],[14],[15]

We found that in 3 (50%) of the cases, the mass originates from the Eustachian tube ostium[10],[14],[15] and the other 3 (50%) from the nasopharyngeal wall.[1],[12],[13]

The clinical presentation of fibrolipoma involving the Eustachian tube is composed of chronic ear discharge with recurrent attach of otitis media. This is caused by the blockage of the Eustachian tube by the mass. Upper airway obstruction is a result of the expansion of the tumor into the nasopharynx.

The main complaint was a painless mass with nasal obstruction in 5 (83.3%) cases. However, 3 (50%) cases reported additional complaints based on the site of the mass at the Eustachian tube ostium, including hearing loss, otorrhea, and nonrecurrent otitis media.[10],[14],[15]

Most cases described the mass as yellowish, well-circumscribed, well-encapsulated, and polypoidal mass on physical examination.[10],[12],[13],[14],[15] The mass sizes ranged between 4 mm and 3 cm. The duration of symptoms was between 1 month and 12 months. For radiological examination, computed tomography (CT) scan showed a well-defined, hypodense, nonenhancing mass without relation to the bone[1],[10],[12],[14],[15] that make the CT a helpful diagnostic way to diagnose fibrolipoma.

Microscopic examination revealed that all the masses were well-encapsulated, containing a large amount of fat and a small amount of fibrous tissue; no cytologic atypia or lipoblasts were identified in all cases.[1],[10],[12],[13],[14],[15]

Surgical excision, which is the most accepted management technique, was done for all cases. All cases were followed up; one case 24 months,[13] four cases 6 months,[1],[12],[14],[15] and one case 5 months[10] without any evidence of recurrence of the disease.


  Discussion Top


Tumors of the nasopharynx can present as unilateral or bilateral nasal obstruction, epistaxis, hearing loss, and aural fullness. The diagnosis is usually reached by anterior rhinoscopy and radiological examinations; however, histopathological assessment confirms it. The endoscopic procedure has simplified the excision of benign and regulated malignant tumors of the nasal cavity and paranasal sinus. Currently, all such tumors of the nasopharynx are removed through an endoscopic procedure that assures visualization of the exact extent and complete excision of these tumors without injuring vital structures.[14]

Adenoid is the most common soft-tissue tumor in the nasopharynx. Antrochoanal polyp, inverted papilloma, and pleomorphic adenoma are also benign tumors of the nasopharynx, but a lipoma is a rare tumor of the nasal area and paranasal sinus.[16]

Lipomas are the most common benign tumors and are derived from the mesenchyme. They are composed of mature adipose material, and several subtypes occur when other mesenchymal elements are present,[17] for example fibrous, nervous, or vascular tissue. Histologically, lipomas can be categorized as conventional lipoma, fibrolipoma, angiolipoma, spindle cell/pleomorphic lipoma, myxolipoma, chondroid lipoma, osteolipoma, or myolipoma.[4] Most of these benign tumors are asymptomatic, and symptoms that do arise are usually due to pressure effects on adjacent structures. Fibrolipomas are rare tumors, composing 1.6% of the facial lipomas.[9]

Many of these benign tumors are asymptomatic, and symptoms result from pressure effects on adjacent structures.[10] The conventional clinical presentation of tumors extension into the nasopharynx consists of upper airway obstruction. Chronic ear discharge with recurrent episodes of otitis media is a result of the extension of the tumor into the Eustachian tube with resulting obstruction.

Lipomas have been described as well-defined nonenhancing lesions with homogeneous fatty attenuation upon CT imaging and show various intensities according to the various components they contain.[10] Magnetic resonance imaging (MRI) is important for delineating the limits and soft-tissue extension of the lesion.[10]

CT scan is a requirement for any endoscopic sinus surgical procedure due to its ability to describe bony anatomy. Furthermore, MRI is useful in sinonasal disease when there is a suggestion of violation of normal bony anatomy on CT, so that disease extension can be evaluated in relation to adjacent essential soft-tissue structures, such as meninges, optic nerve, or cavernous sinus.[14]

Surgical excision of the mass is the favored method of treatment, with endoscopic procedures supporting in these operations.


  Conclusions Top


We reviewed six cases of nasopharyngeal fibrolipoma. This lesion involves both sexes at any age. It is extremely rare with only six case reports in the English literature and should be considered in the differential for nasopharyngeal masses. Nasopharyngeal fibrolipoma can be diagnosed by radiological investigations as a well-defined, hypodense nonenhancing lesion in the CT and confirmed histologically, and endoscopic or transoral surgical excision approach is the most accepted management. However, no cases reported recurrence for this lesion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Banerjee D, Pal D. Fibrolipoma of the nasopharynx in a child. Indian J Otolaryngol 1991;43:84-6.  Back to cited text no. 1
    
2.
Khubchandani M, Thosar NR, Bahadure RN, Baliga MS, Gaikwad RN. Fibrolipoma of buccal mucosa. Contemp Clin Dent 2012;3:S112-4.  Back to cited text no. 2
    
3.
Durmaz A, Tosun F, Kurt B, Gerek M, Birkent H. Osteolipoma of the nasopharynx. J Craniofac Surg 2007;18:1176-9.  Back to cited text no. 3
    
4.
Hameed M. Pathology and genetics of adipocytic tumors. Cytogenet Genome Res 2007;118:138-47.  Back to cited text no. 4
    
5.
Nasser S, Fazlur R, James J. Oral Spindle cell lipoma. Ann Diagn Pathol 2001;5:207-15.  Back to cited text no. 5
    
6.
Salam GA. Lipoma excision. Am Fam Physician 2002;65:901.  Back to cited text no. 6
    
7.
Donley BG, Neel M, Mitias HM. Neural fibrolipoma of the foot: A case report. Foot Ankle Int 1996;17:712-3.  Back to cited text no. 7
    
8.
Studart-Soares EC, Costa FWG, Sousa FB, Alves APNN, Osterne RLV. Oral lipomas in a Brazilian population: A 10-year study and analysis of 450 cases reported in the literature. Med Oral Patol Oral Cirugia Bucal 2010;15:e691-6.  Back to cited text no. 8
    
9.
Ozturk M, Ila K, Kara A, Iseri M. Fibrolipoma of the nasal septum; report of the first case. J Otolaryngol Head Neck Surg 2013;42:11.  Back to cited text no. 9
    
10.
Liu Z, Wang D, Liu Q. The presence of a lipoma in the Eustachian tube: A case report. J Med Case Rep 2011;5:436.  Back to cited text no. 10
    
11.
Ganakalyan B, Kumar SD. Reviewing the entity: Retropharyngeal fibrolipoma and a rare case report. Iran J Otorhinolaryngol 2015;27:469.  Back to cited text no. 11
    
12.
Lee JH, Oh DH. Fibrolipoma in an unusual location: The nasopharynx. Ear Nose Throat J 2019;98:66-7.  Back to cited text no. 12
    
13.
Sethia R, Rawlins KW, Aljasser A, Nogan S, Elmaraghy CA, Wiet GJ. Pediatric nasopharyngeal fibrolipoma: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2019;125:103-6.  Back to cited text no. 13
    
14.
Thakur JS, Saluja M, Sharma DR, Mohindroo NK. Fibrolipoma of the eustachian ostium. BMJ Case Rep 2013;2013:bcr2013008794.-.  Back to cited text no. 14
    
15.
Aydın U, Asık MB, Karakoc O, Kurt B, et al. Uncommon variant of lipoma of eustachian tube as a cause of middle ear effusion. Gulhane Med J 2016;58:2.  Back to cited text no. 15
    
16.
Kalan A, Ahmed-Shuaib A, Tariq M. Lipoma in fossa of Rosenmüller. J Laryngol Otol 2000;114:465-6.  Back to cited text no. 16
    
17.
Edmonds JL, Woodroof JM, Ator GA. Middle-ear lipoma as a cause of otomastoiditis. J Laryngol Otol 1997;111:1162-5.  Back to cited text no. 17
    



 
 
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