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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 562-563
Fibrolipoma of the tonsil


1 Department of Otorhinolaryngology, St. John's Medical College and Hospital, Bangalore - 560 034, India
2 Department of Pathology, St. John's Medical College and Hospital, Bangalore - 560 034, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Nandakumar R, Inchara Y K, D' Souza O, Sreenivas V, Mohanty S. Fibrolipoma of the tonsil. Indian J Pathol Microbiol 2010;53:562-3

How to cite this URL:
Nandakumar R, Inchara Y K, D' Souza O, Sreenivas V, Mohanty S. Fibrolipoma of the tonsil. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Jul 18];53:562-3. Available from: http://www.ijpmonline.org/text.asp?2010/53/3/562/68275



   Case Report Top


A 69-year-old male presented with a foreign body sensation in the throat for the past 6 months without any pain or difficulty in swallowing. He had noticed a swelling at the back of his throat on the left side, which was gradually increasing in size. There was no history of fever or change of voice.

On clinical examination, a polypoid mass measuring 3 cm Χ 1 cm was seen arising from the upper pole of the left tonsil and extending inferomedially. It had a smooth, shiny surface, with the terminal end touching the tip of the uvula [Figure 1]. The surface of the rest of the tonsil and the pillars appeared normal, as was the rest of the oral cavity and oropharynx. The mass was firm on palpation, nontender and did not bleed on touch. Indirect laryngoscopy was normal and there were no enlarged cervical lymph nodes.
Figure 1: Polypoid mass arising from the left tonsil and projecting toward the uvula

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A plain computerized tomography scan of the neck with reference to the oral cavity and oropharynx revealed a hypodense, homogenous soft tissue shadow arising from the left tonsil. Deeper structures were not involved and there was no other mass or neck nodes seen.

A clinical diagnosis of a benign tumor of the left tonsil was made, and the patient underwent surgical excision of the left tonsil by dissection method under general anesthesia. The right tonsil was not removed. Blood loss during surgery was minimal, and the specimen was sent for histopathological examination.

Microscopy showed tonsillar tissue with a polypoid lesion composed of mature adipose tissue with intervening strands of fibrous tissue, several congested septal capillaries and a covering of nonkeratinised stratified squamous epithelium [Figure 2]. Also seen were occasional lymphoid follicles with prominent germinal centers and a mild scattered chronic inflammatory cell infiltrate. The rest of the tonsillar tissue showed features of reactive hyperplasia. A diagnosis of fibrolipoma of the tonsil was made. After 1 year follow-up, the patient is asymptomatic with no residua or recurrence.

Benign tumors of the palatine tonsil are infrequently encountered, with tonsillar lipomas being very rare. The normal tonsillar histology is devoid of adipocytes. The current case showed a polypoid lesion composed of mature adipose tissue, similar to previously reported cases. Although some authors have labeled similar lesions as hamartomas in the past, Begin and Frenkiel [1] state that the occurrence of a lipoma in the tonsil is plausible owing to the delicate mesenchymal framework present in the normal tonsil. The tumors may be termed as lipoma, fibrolipoma, angiofibrolipoma or lymphangiectatic fibrolipomatous polyp, based on the varying amounts of fibrous tissue, capillaries and/or lymphatics on histology. [2] Teratomas of the tonsil may also contain adipose tissue, but the additional presence of other germ cell elements helps one to rule out this diagnosis. [3]
Figure 2: Microscopy showing a polypoid lesion composed of adipose tissue with lymphoid follicles and covered by strati fi ed squamous epithelium (H and E, ×200)

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Most often, lipomas of the tonsil are asymptomatic but may manifest as soreness, cough, excessive salivation, chronic tonsillitis, respiratory difficulties or as a foreign body sensation, as in our case. [ 3],[4],[5] Surgical excision in the usual mode of treatment in symptomatic cases and the incidence of recurrence is not well documented. This case was reported to make one aware of such a rare, benign lesion in the tonsils.

 
   References Top

1.Begin LR, Frenkiel S. Polypoid lipoma of the palatine tonsil. J Laryngol Otol 1993;107:556-8.  Back to cited text no. 1      
2.Hyams V. Differential diagnosis of neoplasia of the palatine tonsil. Clin Otolaryngol 1978;3:117-26.  Back to cited text no. 2      
3.Sarma NH, Ramesh K. Lipoma of palatine tonsil. Histopathology 1996;29:96-7.  Back to cited text no. 3  [PUBMED]    
4.Harada H, Kashiwagi S, Morimatsu M, Kameyama T, Takahashi M. Tonsillar lipoma: a case report. J Laryngol Otol 1995;109:662-4.  Back to cited text no. 4  [PUBMED]    
5.Benson-Mitchell R, Tolley N, Croft CB, Roberts D. Lipoma of the left tonsillar fossa. J Laryngol Otol 1994;108:507-8.  Back to cited text no. 5  [PUBMED]    

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Correspondence Address:
Y K Inchara
Department of Pathology, St. John's Medical College and Hospital, Bangalore - 560 034
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68275

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