Chondrolipoma of the oropharynx.

Abstract

We describe the startling case of a man who was able to extend and retract a smooth round mass in and out of his oropharynx at will. On examination under anesthesia, the mass was found to be attached to the posterior tonsillar pillar by a stalk. The lesion was excised, and histopathology determined that it was a chondrolipoma. We believe that this is the first report of a chondrolipoma at this anatomic site.

Introduction

Benign mesenchymal tumors are common, and lipomas are the most frequently encountered of these tumors. Their peak incidence occurs during the fifth and sixth decades of life. They usually occur singly; only 5% arise in multiple sites. Lipomas can occur at any subcutaneous location, but their appearance in the upper aerodigestive tract is notably infrequent. [1] Lipomas that contain either fibroid or chondroid metaplasia have been seen in the nasopharynx, tongue, oropharynx, and hypopharynx. [2-5] In this article, we describe a strikingly unusual manifestation of a chondrolipoma in a previously unreported location.

Case report

A 65-year-old man came to the otolaryngology clinic with a 1-year history of a globus sensation. He also noted changes in his voice during this time. He had no significant medical history. He denied smoking tobacco, and he drank two or three beers daily.

On physical examination, his oral cavity appeared to be normal initially. However, the patient demonstrated that he was able to plunge a smooth round mass in and out of his oropharynx at will. Fiberoptic laryngoscopy showed that the hypopharynx and larynx were normal. However, the mass would nearly obliterate the hypopharynx and supraglottis when the patient swallowed it. Computed tomography with intravenous contrast revealed the presence of a hypopharyngeal soft-tissue mass located posterior to the epiglottis and abutting the right lateral pharyngeal wall.

The patient was taken to the operating room for excision of the mass. In order to secure the airway, the surgeon grasped the mass with a clamp before administering anesthesia and intubation (figure 1). On examination under anesthesia, the stalk of the mass was noted to arise from the inferior pole of the right posterior tonsillar pillar. The mass was excised completely, and its base was cauterized and ligated. The lesion was polypoid, yellowtan in color, and measured 6.0 x 2.5 x 2.5 cm (figure 2). The cut surface was 50% fatty and 50% gray-white and fibrous.

Histologic examination revealed that a squamous mucosa covered a benign lipomatous tumor with scattered well-demarcated cartilaginous islands (figure 3). These chondroid islands exhibited varying amounts of interstitial chondroid matrix. There were no lipoblasts, necrosis, or hemorrhage. These findings were interpreted to represent the presence of a submucosal lipoma with chondroid metaplasia, and the mass was designated as a chondrolipoma.

Discussion

Lipomas can occasionally be altered by the presence of other mesenchymal elements, such as fibrous tissue (fibrolipoma), smooth muscle (myolipoma), capillaries (angiolipoma), and collagen-forming spindle cells (spindle-cell lipoma). Cartilaginous and osseous metaplasias are rare in lipomas; they are seen mainly in lipomas that are large and of longstanding duration. A chondrolipoma must be distinguished from a chondroid lipoma, which is a separate entity. The latter exhibits features of both a lipoma and a hibernoma; it is also known as a lipoma of immature adipose tissue, a lipoma of embryonic fat, or a fetal lipoma. [6]

The appearance of this mass was unique and startling on initial examination, and it posed a potential airway risk. The paucity of mesenchymal tumors in the upper aerodigestive tract makes their occurrence notable. These tumors, despite their rarity, should be not be overlooked when making the differential diagnosis of head and neck tumors.

From the Department of Otolaryngology--Head and Neck Surgery (Dr. Halaas and Dr. Mra) and the Department of Pathology (Dr. Edelman), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.

Reprint requests: Zan Mra, MD, 1575 Blondell Ave., Suite 150, Bronx, NY 10461. Phone: [phone]; fax: [phone]; e-mail: [e-mail]

References

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(2.) Hong KH, Seo SY, Lee DG. Chondrolipoma of the nasopharynx. J Laryngol Otol 1998;112:75-6.

(3.) Hietanen J. Makinen J. Chondrolipoma of the tongue. A case report. Int J Oral Maxillofac Surg 1997;26:127-8.

(4.) Maes A, Eulderink F. Chondrolipoma of the tongue. Histopathology 1989; 14:660-2.

(5.) Nwaorgu OG. Akang EE, Ahmad BM, et al. Pharyngeal lipoma with cartilaginous metaplasia (chondrolipoma): A case report and literature review. J Laryngol Otol 1997:111:656-8.

(6.) Enzinger FM, Weiss SW. Soft Tissue Tumors. St. Louis: Mosby, 1995:381-430.