Submandibulair Gland Lipoma: An Uncommon Location

Clinical Image

Austin J Radiol. 2024; 11(1): 1228.

Submandibulair Gland Lipoma: An Uncommon Location

Zenjali Sara*; Lahfidi Amal; Abourak Chaimae; Touarsa Firdaous; Khamlichi Amina; Fikri Meriem; El Kettani Najwa; Jiddane Mohamed

Department of Neuroradiology, Hôpital des Spécialités de Rabat, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University Hospital, Rabat, Morocco

*Corresponding author: Zenjali Sara Department of Neuroradiology, Hôpital des Spécialités de Rabat, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University Hospital, Rabat, Morocco. Email: zenjalisara@gmail.com

Received: January 17, 2024 Accepted: February 20, 2024 Published: February 27, 2024

Clinical Image

Lipomas, usually benign fatty tissue tumors, are common in adults. However, lipomas originating in major salivary glands are rare, comprising up to 5% of salivary gland tumors [1]. Submandibular gland lipomas are even less common [3], primarily affecting men over 30, with a 10:1 male-to-female ratio [1].

Our case involves a 51-year-old patient who has been experiencing painless swelling in the right submandibular area for the past two years, with no impact on their overall health. The clinical examination revealed a non-painful, mobile, and soft mass in the right submandibular region, with unaffected skin and no signs of inflammation.

An initial ultrasound showed a well-defined, rounded, hypoechoic mass within the right submandibular gland, which was non-vascularized. Subsequent MRI imaging revealed an oval, well-defined formation occupying the lower 2/3 of the right submandibular gland. This formation appeared hyperintense on both T1 and T2 weighted images (Figure A, B) was suppressed on the FATSAT sequence (Figure C), showed no diffusion restriction (Dwi) (Figure D), and did not enhance after gadolinium injection (Figure E, F). Its dimensions were measured at 53x31x46mm. Importantly, this formation did not affect adjacent structures, including the facial artery, thyrolingual facial trunk, and muscular structures.

Figure 1: Cervicofacial MRI.

    

    
    

    

    Figure 1: Cervicofacial MRI.

Patients with intraglandular lipomas typically develop a painless, slowly growing mass in the submandibular area. Lipomas are soft, compressible masses with normal skin covering them. However, clinical diagnosis is often missed [4]. Imaging plays a critical role in preoperative diagnosis and surgical planning for lipomatous tumors, helping to assess for malignancy [2].

Simple ultrasonography can help detect hyperechoic, elliptical or rounded masses near the skin’s surface [4]. However, for a more accurate assessment of texture, location, and distinguishing lipoma from liposarcoma, Computed Tomography (CT) and MRI are superior to ultrasonography [2].

MRI showed a well-defined lipoma with a consistent high-intensity signal on T1- and T2-weighted images and a low-intensity signal on STIR sequences. CT examination displayed low intensity (-50 to -150 HU), similar to fatty tissue [1].

While most lipomas can be monitored without intervention, surgical removal is necessary in cases of diagnostic uncertainty, palpable irregularity, large size (>10cm), rapid growth, pain, deep-seated location, or cosmetic concerns [3,4].

In summary, the diagnosis of intraglandular lipomatous tumors can typically be established through patient history, physical examination, and imaging [2].

References

  1. Sato T, Terada C, Ide S, Tatehara S, Satomura K. A case of lipoma of the parotid gland: Distinguishing the tumor from the fatty parotid gland by the injection of indigo carmine into Stensen’s duct for appropriate enucleation. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2021; 33: 416–419.
  2. Subramaniam S, Johan S, Hayati F, Ng CY, Azizan N, Chuah JA, et al. Giant submandibular sialolipoma masquerading as huge goitre: a case report. BMC Surgery, 2020; 20: 130.
  3. Lee YW, Chung J. Intraglandular Ordinary Lipoma of the Submandibular Gland. Ear, Nose & Throat Journal. 2021; 100: 587S-589S.
  4. Kyung Soo Kim, Hoon Shik Yang. Unusual locations of lipoma: differential diagnosis of head and neck mass Aust Fam Physician. 2014; 43: 867-70.

Citation: Sara Z, Amal L, Chaimae A, Firdaous T, Amina K, et al. Submandibulair Gland Lipoma: An Uncommon Location. Austin J Radiol. 2024; 11(1): 1228.