|Year : 2022 | Volume
| Issue : 4 | Page : 274-275
Lipoma in the submandibular gland: An exotic rarity!!
Prateek Das1, Urvashi Ghosh1, Sujata Naik1, Rashmi Patnayak1, Satya Sundar Mohapatra2
1 Department of Pathology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Radiology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
|Date of Submission||13-May-2022|
|Date of Decision||05-Jul-2022|
|Date of Acceptance||08-Jul-2022|
|Date of Web Publication||27-Oct-2022|
Professor and HOD, Department of Pathology, Hi-Tech Medical College and Hospital, Rourkela, 769 004, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das P, Ghosh U, Naik S, Patnayak R, Mohapatra SS. Lipoma in the submandibular gland: An exotic rarity!!. J Clin Sci Res 2022;11:274-5
Fine-needle aspiration cytology (FNAC) is a commonly implemented diagnostic modality for the initial assessment of anatomically accessible lesions. Because of the low cost of procedure, it can be performed in resource-limited centres. The contention about the use of incisional or core needle biopsy in salivary gland lesion scan is explained by the proven complications such as fistula formation and tumour seeding., It is practiced routinely as a modality for the initial assessment of salivary gland lesions but not without pitfalls. Lipomas are common benign tumours. However, they are rarely encountered in the salivary gland (<0.5%). The parotid gland is the common site for lipoma among salivary glands. The prevalence of lipoma in other salivary glands is still rarer (~1%). The most common age of onset is the fifth and sixth decades of life with a male preponderance. We hereby present a very rare case of lipoma in the submandibular gland, which was diagnosed by FNA cytology and later confirmed on histopathology.
A 41-year-old male presented to the surgical outpatient department with the complaint of painless swelling in the left submandibular region for the past 5 months. The swelling was gradually increasing in size. Ultrasonography revealed well-defined iso to the hypoechoic area with multiple linear hyperechoic septations in the left submandibular gland, suggestive of lipoma. On examination, the swelling was soft, non-tender, measuring 2 cm × 2 cm. FNAC was performed using a 22G needle which yielded greasy aspirate. The cytosmears were cellular and revealed mature adipocytes with intervening thin-walled capillaries. It was reported as lipoma. The patient underwent excision and removal of the mass. The gross specimen showed a yellowish mass with a whitish cut surface attached to salivary gland tissue. Light microscopy revealed chronic sialadenitis of the submandibular salivary gland with an adjacent well-circumscribed tumour. The tumour was composed of plenty of mature adipocytes intervened by small capillaries. The final diagnosis was lipoma in the submandibular salivary gland [Figure 1]. Following excision, the patient is clinically asymptomatic with no recurrence after a follow-up period of 2 years.
|Figure 1: Clinical photograph of the patient showing swelling in the left submandibular region (red arrow) (a). Ultrasonography of the neck neck showing a tumour in the submandibular region (yellow asterisk) (b). Photomicrographs of the FNAC showing mature adipocytes with intervening capillaries (Haematoxylin and Eosin, ×400) (c), (Diff Quik, ×400) (d). Photomicrograph showing a well-circumscribed tumour comprised mature adipose tissue along with salivary gland parenchyma (Haematoxylin and Eosin, ×40) (e). The interface between salivary gland parenchyma and the lipoma |
(Haematoxylin and Eosin, ×100) mature adipose tissue (inset) (f)
FNAC = Fine needle aspiration cytology
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FNAC tends to delineate neoplastic from non-neoplastic and benign from malignant to provide valuable information to the clinicians in deciding further treatment modalities. In the salivary gland, fat-containing tumours are a rarity with varied morphology. They can range from pure lipomatous lesions just like their soft-tissue counterpart to the variable fatty component of mixed salivary gland tumours. The order in which they are encountered in salivary glands is ordinary (soft-tissue type) lipoma, oncocytic lipoadenoma, non-oncocytic sialolipoma, and pleomorphic adenoma/myoepithelioma with extensive lipometaplasia. Lipoma of the submandibular gland is uncommon. Although lipoma in the head and neck is unusual, they should be considered one of the differential diagnoses of neck masses. Atypical lipomatous tumours (ALT)/well-differentiated liposarcoma (WDL) is very rare in the salivary gland. They behave just like their soft-tissue counterparts. Usually, in lipoma, a benign tumour, mature adipocytes are uniformly arranged without marked variations in size. In contrast, adipocytes in ALT show marked variation in size, and many hyperchromatic stromal cells around the thick septa. Monovacuolated or multivacuolated lipoblasts are considered a hallmark of liposarcoma, but in WDL/ALTs, lipoblasts are not always evident. Advanced immunohistochemistry can be performed to help distinguish the WDL/ALT from lipoma. The CDK4 protein is usually overexpressed in WDL and rarely observed in lipoma. Likewise, anti-MDM2 has been demonstrated to be useful in differentiating these entities.
In the present case, ultrasonography and FNAC, along with histomorphology, were useful in rendering the correct diagnosis. Lipomas are some of the most common forms of neoplasms. They are predominantly benign, but rarely, malignancy might also arise in the form of liposarcomas.
Lipomas can usually be diagnosed clinically alone, but in our case, the location is extremely unusual. Here, both FNAC and histopathology played an important role in clinching the diagnosis.
The patient has given written consent for the publication of the case.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
The authors acknowledge Dr. Santosh Kumar Swain for the clinical information.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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