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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 1  |  Page : 65-66
Nasal pseudolipomatosis


1 Departments of Otolaryngology Head and Neck Surgery, Taipei Medical University, Taipei, Taiwan
2 School of Medicine, Taipei Medical University, Taipei, Taiwan

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Date of Web Publication6-Aug-2013
 

How to cite this article:
Tseng TM, Hung SH, Hsu HT, Yeh CW. Nasal pseudolipomatosis. Indian J Pathol Microbiol 2013;56:65-6

How to cite this URL:
Tseng TM, Hung SH, Hsu HT, Yeh CW. Nasal pseudolipomatosis. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Jul 5];56:65-6. Available from: http://www.ijpmonline.org/text.asp?2013/56/1/65/116157


Sir,

Pseudolipomatosis resembles fatty infiltration within the mucosa and is characterized by the presence of small gas voids that are not lined with epithelial cells. Most of the reported cases of pseudolipomatosis were found in the colon, duodenum, and skin.

A 28-year-old female patient visited our Otolaryngology Department with a complaint of long-term nasal allergy and nasal obstruction. Nasal septum deviation with bilateral hypertrophic rhinitis was diagnosed, and the patient received treatment with oral anti-histaminics and a corticosteroid nasal spray for 2 months. However, the patient was unresponsive to the treatment. Septomeatoplasty was suggested and performed smoothly under local anesthesia. The pathology report for the nasal septum revealed no significant findings. When examining the specimen from the bilateral enlarged turbinates

[Figure 1] and [Figure 2], features of numerous small, clear vesicular spaces with septa located just under the subepithelial area and lamina propria were apparent. Immunohistochemical stains revealed that the lesion was negative for cytokeratin [Figure 3]. The lesion was also not reactive for S-100, D2-40, CD31, and CD68, revealing that the flattened lining cells of these spaces are not vascular or lymphatic originated [Figure 4].
Figure 1: Numerous small clear vesicular spaces with septa located just under the subepithelial area and lamina propria (H and E, ×100)

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Figure 2: Clear vesicular spaces with septa (H and E, ×400)

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Figure 3: The lesion was negati ve for cytokerati n (immunohistochemical stain, ×400)

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Figure 4: The lesion was also not reacti ve for S-100, D2-40, CD31, and CD68. The nasal epithelial cells and myoepithelial cells surrounding the nasal mucosa sinusoids were reacti ve for S-100. Some secreti ons were found in normal vessels and lymphati c ducts. Due to the surgical procedure, the original architectures were disrupted and infi ltrated by S-100 negati ve pseudolipomatosis lesions (Immunohistochemical stain, ×400)

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Pseudolipomatosis has been proposed to be an artifactual microscopic change in tissues most often in the gastrointestinal tract that resembles fatty infiltrations. [1] The fat-like spaces represent air or gas bubbles that enter the mucosa through microscopic ruptures secondary to gaseous insufflation. Deshmukh-Rane and Wu [2] studied 50 endometrial tissue samples, and suggested that suction likely contributed to the induction of artifacts of aggregations of adipocyte-like oval clear spaces in all of the samples. Due to the fact that the endometrium is often surrounded by fatty tissues, this typical fatty appearance sometimes mistakenly leads to the suspicion of endometrium perforation. Wysocki et al. [3] stated that some suction-induced pseudoadipocytic vacuoles are not entirely empty, and that some contain characteristic beaded spiny reticula of basophilic glycosaminoglycans. Interestingly, Trotter and Crawford [4] suggested that dermal pseudolipomatosis is likely to be an artifact during tissue fixation or processing, and that it is unrelated to topical steroid administration or underlying pathologic processes such as sebaceous gland rupture. In a study on colonic pseudolipomatosis, the etiologies of either abnormal stagnation of interstitial fluid or the penetrance of gas from the crypts into the mucosa during colonoscopy were suspected. [5] The structure and tissue structures of the nasal mucosa differ greatly from gastrointestinal and gynecological sites. In our case, it seemed to be less likely that the pseudolipomatosis was due to gland rupture or fluid stagnation. Moreover, besides numerous small clear vesicular spaces, other structures in the histology section appeared to be structurally normal and artifact-free. Tissue fixation and processing problems were less considered. We consider this case of nasal pseudolipomatosis to most likely have been caused by suction during the surgical procedure. The fatty appearance of nasal specimen could potentially lead to the suspicion of orbital fat involvement during endoscopic nasal operations.

To the best of our knowledge, this is the first case of nasal pseudolipomatosis reported in the literature. Although most probably resulting from surgical suctioning, the true nature of this bizarre phenomenon is left to be determined.

 
   References Top

1.Srivastava S, Subramaniam MM, Guan YK, Ming T, Salto-Tellez M. Gastric pseudolipomatosis: Biopsy follow-up and immunohistochemical analysis of a rare condition. Histopathology 2011;58:1177-8.  Back to cited text no. 1
    
2.Deshmukh-Rane SA, Wu ML. Pseudolipomatosis affects specimens from endometrial biopsies. Am J Clin Pathol 2009;132:374-7.  Back to cited text no. 2
    
3.Wysocki GP, Gusenbauer AW, Daley TD, Sapp JP. Surgical suction damage: A common tissue artifact. Oral Surg Oral Med Oral Pathol 1987;63:573-5.  Back to cited text no. 3
    
4.Trotter MJ, Crawford RI. Pseudolipomatosis cutis: Superficial dermal vacuoles resembling fatty infiltration of the skin. Am J Dermatopathol 1998;20:443-7.  Back to cited text no. 4
    
5.Nakasono M, Hirokawa M, Muguruma N, Okamura S, Ito S, Iga A, et al. Colonic pseudolipomatosis, microscopically classified into two groups. J Gastroenterol Hepatol 2006;21:65-70.  Back to cited text no. 5
    

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Correspondence Address:
Chi-Wei Yeh
School of Medicine, Taipei Medical University, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.116157

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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