The Giant Neck Myolipoma in a Child

Abstract

Aim: Pediatric lipomas of the head and neck are rarely seen. When reported, they are generally seen as isolated case reports. Here we report an extremely rare type of giant childhood neck lipoma. Background: Lipomas are a group of benign mesenchymal soft tissue tumors formed due to abnormal and excessive proliferation of adipose tissue. They are most common in the age-group of 40–60 years. They are infrequent in the pediatric age-group and rarely occur under the age of 10 years. Case description: A 140 × 80 × 80 mm, 1011 grams lipoma involving both anterior and posterior triangles of the neck with attachments from mastoid process to medial and lateral pterygoids (base of the skull), the substance of submandibular gland, pretracheal fascia and branches of external carotid (posterior auricular artery, occipital artery, and ascending pharyngeal artery) and platysma. The tumor was removed from the neck of 8 years old pediatric patient. Posterior auricular, occipital, and ascending pharyngeal arteries had taken an aberrant route because of the huge mass. The nasopharynx and the entire viscera of the neck were pushed to one side. The mass was adherent to the submandibular gland and in close relation with the lingual nerve. Conclusion: This is the first case report of a giant lipoma of the neck in a pediatric patient which involved both anterior and posterior triangles. To the best of our knowledge, this is the largest neck lipoma reported to date in a child. Clinical significance: Excision of a large neck lipoma should be planned after imaging studies and in a fully equipped operation theater preferably under general anesthesia. Cases of carotid injury and thoracic duct injury have been reported even with utmost precautions and with all modern facilities.