More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Gastrointestinal Imaging
Case Report, Genitourinary and Gynecologic Imaging
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Gastrointestinal Imaging
Case Report, Genitourinary and Gynecologic Imaging
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Gastrointestinal Imaging
Case Report, Genitourinary and Gynecologic Imaging
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research
View/Download PDF

Translate this page into:

Case Report
2019
:9;
51
doi:
10.25259/JCIS_123_2019

Lipoma of the Larynx and Other Differential Diagnoses

Department of Radiology, Mayo Clinic, Jacksonville, Florida, United States.

*Corresponding author: Alok A. Bhatt, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, United States. bhatt.alok@mayo.edu

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Okromelidze L, Middlebrooks EH, Bhatt AA. Lipoma of the larynx and other differential diagnoses. J Clin Imaging Sci 2019;9:51.

Abstract

Fatty lesions in the head and neck region are uncommon but can present in any subsite, including rarely the larynx. Most commonly, the fatty lesion is a benign lipoma and an incidental finding as in this case. However, the lesion must be differentiated from other fatty lesions such as liposarcoma, lipoblastoma, and hibernoma. Accurate diagnosis on imaging can prevent unnecessary biopsy and more importantly worry for the patient. We report a case of an incidental lipoma within the vocal folds of the larynx.

Keywords

Lipoma
Larynx
Vocal folds

INTRODUCTION

Lipomas of the head and neck are uncommon, and can present in any subsite. Laryngeal lipomas are extremely rare and most often an incidental finding. The purpose of the article is to review the characteristic findings for the diagnosis of laryngeal lipoma on imaging, as well as other differential diagnoses. Accurate diagnosis on imaging can prevent additional invasive tests such as biopsy, and unnecessary worry for the patient.

CASE REPORT

A 51-year-old male presented to the emergency room after bronchoscopy for biopsy of a lymph node with a single episode of hemoptysis and sore throat. Computed tomography (CT) of the neck demonstrated a fat-attenuating lesion (approximately – 95 Hounsfield units) measuring approximately 10 mm×9 mm within the larynx, deep to the mucosal layer of the left vocal folds, resulting in some medial deviation of the cords [Figure 1]. Otherwise, CT examination was normal, and no cause for hemoptysis was found on imaging. The hemoptysis was transient and thought to be post-procedural. Since there were no additional episodes of hemoptysis and vitals were stable, the patient was discharged from the emergency room without further complication. The laryngeal lipoma was presumed to be a completely incidental finding with no further work-up necessary.

A 51-year-old male with an incidental lipoma of the left vocal folds. Non-contrast axial (left) and coronal (right) computed tomography images through the level of the larynx demonstrate a fat-attenuating lesion similar to adjacent subcutaneous fat (arrows) within the submucosal left vocal folds, which causes mild local mass effect. There is a thin septation within the lesion, but no nodularity.
Figure 1:
A 51-year-old male with an incidental lipoma of the left vocal folds. Non-contrast axial (left) and coronal (right) computed tomography images through the level of the larynx demonstrate a fat-attenuating lesion similar to adjacent subcutaneous fat (arrows) within the submucosal left vocal folds, which causes mild local mass effect. There is a thin septation within the lesion, but no nodularity.

DISCUSSION

The overall imaging and clinical findings are compatible with an incidental lipoma of the left vocal folds. Lipomas are the most common benign mesenchymal tumors, presenting at any age, but predominantly during the 4th–6th decades of life due to gradually increasing size.[1,2] Even though lipomas in the head and neck region are uncommon (<15% of all lipomas), they can manifest in any subsite, including the tonsils, tongue, parotid gland, palate, and larynx.[1,3]

Laryngeal lipomas, which represent only 1% of all lipomas, are classified into extrinsic and intrinsic tumors.[4] Extrinsic lesions are located in the posterior aspect of the larynx, pyriform sinus, and lingual surface of the epiglottis, while intrinsic tumors are located in the false vocal cord, laryngeal surface, aryepiglottic folds, and subglottic larynx.[5]

Laryngeal lipomas may often be an incidental finding as in this case but can also be hard to diagnose due to the symptoms being non-specific.[1] Dyspnea, sleep apnea/snoring, paroxysmal coughing, dysphagia, and airway obstruction are among the clinical manifestations of this entity.[2,6]

Imaging provides a key role in diagnosis. On CT, lipomas appear as homogeneous lesions that are low in attenuation, mirroring that of adjacent subcutaneous fat. Magnetic resonance imaging is preferred due to more accurate soft tissue delineation, allowing for better visualization of a pedicle if present, and its anatomical relationship with surrounding structures.[7] Adipose tissue is visualized as bright on T1-weighted imaging (T1WI) and will suppress on fat-saturated sequences.[2]

Surgical approach for laryngeal lipoma depends on size, with endoscopic approach favored in small tumors, and external surgical approach preferred in tumors >2 cm in maximum diameter.[7] Rapid recovery of laryngeal/pharyngeal function with few immediate or late complications is expected following the excision of the tumor. A recurrence of lipoma is rare and may be due to one of two reasons; the lesion is a well-differentiated liposarcoma and not a classic lipoma or due to incomplete resection of the lesion.[1]

There are four main differential diagnoses when evaluating fatty lesions of the larynx: Lipoma, liposarcoma, lipoblastoma, and hibernoma. Differentiating liposarcomas and lipomas on imaging can be challenging due to subtle findings that may favor a liposarcoma.[6] Hemorrhage and necrosis are suggestive of liposarcoma, while complete fat suppression, lack of septations, and no enhancement favor the diagnosis of lipoma.[6,7] Angiography might aid in differentiation due to hypervascularity in liposarcomas.[7] Definitive diagnosis is based on histopathology. Adipocytes of varying sizes as well as macrophages are suggestive of benign lipomas, while lack of macrophages and variation of adipocytes suggest liposarcoma over lipoma.[6]

A lipoblastoma is a rare, benign tumor that arises from embryonic white fat but can look like liposarcoma on imaging; the lesion typically presents in infancy and early childhood, and most often occurs in the trunk and extremities.

A hibernoma is a lipomatous lesion seen in middle-aged patients, consisting of brown fat. On T1WI, a hibernoma is hypointense in comparison to subcutaneous adipose tissue and does not suppress on fat-saturated sequences.[8,9] On CT, hibernomas are well-circumscribed lesions with attenuation between skeletal muscle and fat.[9] Significant difference between these lesions is observed on positron emission tomography/CT imaging due to brown fat’s intense glucose metabolism and, therefore, avid fluorodeoxyglucose uptake. Under the microscope, hibernoma is described as multivacuolated fat cells of lobular pattern with prominent vascular supply.[8]

CONCLUSION

Our case highlights the point that laryngeal lipomas may be an incidental finding on imaging performed for other reasons; the lesion in our case did not require further follow- up. Even though the lipoma is the most common fatty lesion within the head and neck, one must also consider liposarcoma, lipoblastoma, and hibernoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , . Endolaryngeal lipoma: Case report and literature review. Ear Nose Throat J. 2012;91:E18-21.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Laryngeal spindle cell/pleomorphic lipoma: A case report. An in-depth review of the adipocytic tumors. J Oral Maxillofac Surg. 2019;77:1401-10.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . Large lipoma of the larynx: A case report. Acta Med Iran. 2010;48:353-6.
    [Google Scholar]
  4. , , . Lipomas of the head and neck: Presentation variability and diagnostic work-up. J Laryngol Otol. 2006;120:47-55.
    [CrossRef] [PubMed] [Google Scholar]
  5. . Subglottic lipoma of the larynx. (Case report and literature review) J Laryngol Otol. 1965;79:1039-48.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , . Lipoma and liposarcoma of the larynx: Case reports and literature review. Am J Otolaryngol. 2015;36:611-5.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , , , . Lipoma of the larynx: A case report. Acta Otorhinolaryngol Ital. 2010;30:58-63.
    [Google Scholar]
  8. , . Imaging review of lipomatous musculoskeletal lesions. SICOT J. 2017;3:34.
    [CrossRef] [PubMed] [Google Scholar]
  9. , , . Hibernoma: Diagnostic and surgical considerations of a rare benign tumour. BMJ Case Rep. 2016;2016:bcr2016217625.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
9,472

PDF downloads
15,416
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections