Is surgical excision of lipomas arising from the parotid gland systematically required?

Abstract

Lipomas arising from the parotid gland are very rare. We report a 10-year experience in a single institution (La Timone University Hospital of Marseille, France). Among 614 parotidectomies for neoplasms performed from 1998 to 2008, 12 lipomas were identified. A retrospective analysis based on medical records was made. Evaluation, analysis and current management of lipomas of the parotid gland are described. Lipomas accounted for 2% of all parotid neoplasms and 2.6% of benign tumors in our series. The median age of patients was 60 years with a M/F sex ratio of 5-1. The main presentation was a soft asymptomatic, slow-growing, mobile mass although 30% had an indurated mass on palpation. Diagnosis of lipoma, based on the results of imaging, was made preoperatively in all cases. The mean tumor duration prior to excision was 11.5 months. The surgical decision was made regarding increased swelling with functional/esthetic discomfort in 83% of cases. Partial parotidectomy was performed in most cases. Postoperative complications occurred in 16% of cases although no permanent complication was observed. No recurrence was observed in our series. Histologically, 92% of tumors were classic lipomas. Lipomas can be clinically misleading since 30% of patients in our series showed an indurated mass on palpation. Preoperative imaging, especially MRI, is the cornerstone of their management as it allows very accurate lipoma diagnosis. Since in our series, diagnosis of lipoma had been made preoperatively in all cases, the surgical excision could be delayed and finally surgical decision has been made for esthetic and/or functional considerations in more than 80% of cases.

Giant Lipoma of Parotid Gland

“…In general incidence of parotid lipoma is much more common in males with male: female ratio of 5:1 [11]. Ultrasound screening showing a homogenous hypoechoic lesion can give a quick diagnosis [8]. CT shows a hypodense and homogeneous mass with uniform fat density throughout [3].…”

“…No enhancement is seen on post-contrast images, fat suppressed sequences are specific in diagnosis showing signal loss. MRI can also clearly define the limits of lipoma from normal adipose tissue (subcutaneous tissue) with a "black-rim" around the mass, a distinction that cannot be made from CT [1,3,8]. Moreover, MRI is sufficiently accurate to distinguish between lipomas and liposarcomas.…”

“…On rare occasions, however, it may occur in the pharynx, larynx, especially oral cavity, parotid gland and parapharyngeal space [1,3,[5][6][7]. The lipoma of parotid gland is a rare entity, comprising 0.6%-4.4% of all parotid tumors in the literature, with most series reporting an incidence of 1%-2% of all parotid tumors and 2.6% of benign tumors [1,3,8]. Lipomas arising from deep lobe of parotid gland are even rarer with only few cases reported in literature [9].…”

Bilobed Sialolipoma of Parotid Gland A Rare Entity

“…Besides the fear of malignant change in the parotid swelling, cosmetic worry is indication of surgery. 10 Fakhry et al, 11 in a 10years retrospective study analyzed the record of 614 parotidectomies done for parotid tumours. There were only 12 lipomas accounting to 2% of all parotid tumours.…”

“…The findings in this case report presented here are similar to this study. 11 The various surgical procedures described in literature for parotid lipoma are superficial parotidectomy, partial excision of parotid gland, surgical excision, extracapsular dissection and near total parotidectomy. 12 Kim et al, 13 reported a case of deep lobe lipoma of parotid gland treated by enucleation only in a 75years old female.…”