Lipomas are one of the most common benign mesenchymal tumors in the body. Usually asymptomatic, they rarely warrant treatment unless they attain enormous size causing cosmetic deformity or pressure effects. Head and neck region is an uncommon site, retropharyngeal space being one of the rarest. Lipomas in this region can produce pressure symptoms demanding surgical excision. This is a case report of retropharyngeal lipoma, extending from skull base to the clavicle. Though tumor was present for 20 yrs it exhibited rapid growth over a period of 2-3 yrs causing respiratory obstruction, dysphagia & dysphonia. Clinically the entire laryngopharynx, trachea and carotid sheath were pushed anteriorly. On imaging, it showed classical features of a lipomatous mass. Patient underwent complete excision which presented a surgical challenge to surgeon and the anaesthetist from intubation to extubation.
Keywords Lipoma . Retropharyngeal
Patients and methodsA 65-yr-old male presented to Manipal Hospital Bangalore with a left sided neck mass since 20 yrs, exhibiting rapid progression for past 2-3 yrs. Progressive dysphagia, dysphonia and respiratory obstruction were presenting features. Clinical examination revealed a large soft fl uctuant swelling occupying the entire left lateral neck, grossly shifting the laryngopharynx and the trachea to the opposite side. The medial border of the swelling was merging behind the larynx (Fig. 1). There was a smooth bulge in the post.pharyngeal and left lateral pharyngeal wall intraorally. Left vocal cord was immobile. Routine biochemical and hematological examinations were normal. The differential diagnosis considered in this case was lymphangioma. CT scan of the neck revealed a well encapsulated low density
IMAGES IN SURGERY
Though surgical resection is the main stay of treatment for childhood hepatoblastoma (HB), many are unsuitable for radical surgery at diagnosis due to extensive intrahepatic and/or extra hepatic disease. We report experience in five patients of HB from a single institution (2001-2005) with preoperative Neoadjuvant chemotherapy (NACT) followed by surgery. Three patients received cisplatin, doxorubicin; and two cisplatin / vincristine /5-fluorouracil. All showed more than 50% reduction in tumor size confirmed by CT scan. Hepatic resection R0 was performed in all. There was no chemotherapy related toxicity nor post surgical morbidity or mortality. All are disease free at median follow up of 4 years. NACT produces adequate down staging of the HB with acceptable toxicity. Though cisplatin with doxorubicin produced good results, new protocol with cisplatin, vincristine and 5FU is promising without cardiotoxicity.
Combined IVC and visceral resection can be safely performed in selected patients. Surgery provides the possibility of negative margins, acceptable perioperative morbidity/mortality and prolonged survival. These factors combined with lack of alternative treatments justify this approach. However, specialist teams should perform the surgery preferably in centres with expertise in liver transplantation.
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