Benign laryngeal lesions — a clinicopathological study of eleven years and a case report of pleomorphic lipoma

In a retrospective cohort study, conducted in Department of Oto-Rhinolaryngology, Head and Neck Surgery, M.LX Medical College, Allahabad from January 1989 to December 1999, 81 benign laryngeal lesions were evaluated. Majority (69, 85.2%) presented with hoarseness of voice and stridor was the presenting complaint in 12 ( 14.8%) cases. Vocal cord polyp (33, 40.7%) dominated the non-neoplastic group, while squamous papilloma (18, 22.4%) was the most common neoplastic lesion. Adult unset multiple papiUoma of unilateral vocal cord (4, 4.9%) was an unexpected finding in our series. A rare case of pleomorphic lipoma of larynx in a 68-year-old male patient along with its CT characteristics has been presented. Conservative microlaryngeal surgery offered the most satisfactory mode of treatment without any mortality and with minimal recurrence.     

Lipoma of the spermatic cord, fatty herniation, liposarcoma

Summary Speed [1914] reported the incidence of cord lipoma, encountered equally with both indirect and direct herniae, to be 47.4%. All appeared to arise, with their blood supply, from the preperitoneal fat pad. High excision was recommended to prevent hernial recurrence. Fawcett [1997] confirmed these observations, finding 1% arising from the cord itself, which is now known to form in the preperitoneal space of Bogros. Watson [1948] insisted that inguinal Hpomas should be called hernias only when accompanied by a peritoneal sac. However, 7% of cord lipomas are reported to be sac-less, associated occasionally with ureteral prolapse. To avoid medicolegal consequences, they now should also be considered hernias. Inguinal hernia classifications need to reflect this reality.A case of an elderly, obese male with a giant cord lipoma who underwent excision of a large, irreducible, complete, sliding, sac-less, indirect fatty inguinal hernia is detailed. Three veterans, presenting with purported inguinoscrotal herniation, had large cord lipomas, which after funiculo-orchiectomy, were shown to be liposarcoma. One developed large retroperitoneal and local recurrences and received radiation and chemotherapy. Another underwent lymphadectomy and irradiation, while the third did well without adjuvant treatment.In conclusion, ubiquitous cord lipomas are not tumors but essentially all are herniations of extraperitoneal fat. Proper inguinal hernia repair mandates their complete excision. Occasionally, they may be the only herniation. Inguinal hernia classifications need to include not only fatty hernias, but sac-less, fatty protrusions. Malignancy is a rarehazard, sometimes associated with the more commonly encountered sarcoma of non-herniated retroperitoneal fat. The risk does not warrant pathological examination of small cord lipomata.     

Angiolipomas of the Central Nervous System

Angiolipomas are neoplasms composed of mature adipocytes admixed with abnormal vascular elements. They are most commonly found in the subcutaneous tissue of the trunk and extremities, but other sites have been reported. The craniospinal axis is an uncommon but significant site. An extensive review of the literature is conducted. We summarize 94 cases of angiolipomas in the central nervous system (CNS) in 92 patients, including five in our own series, to highlight the most prominent features of these tumors. The increasing number of cases of CNS angiolipoma in the era of magnetic resonance imaging raises the question of the rarity of these lesions.     

Lipoma of the quadrigeminal plate cistern

Two cases of quadrigeminal plate cistern lipoma detected by CT scan, one of which produced impairment of vertical gaze, are reported. The problems of diagnosis and therapy of intracranial lipomas are briefly discussed.

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Sommario Gli Autori riportano due pazienti affetti da lipoma della cisterna della lamina quadrigemina diagnosticati con la tomografia computerizzata. Uno di questi presentava una limitazione dello sguardo verso l'alto.Vengono brevemente discussi i problemi concernenti la diagnosi e la terapia dei lipomi intracranici.

     

The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients

Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.     

Hibernoma: Ultrastructural observations

A light and electron microscopic study of a hibernoma and a brief discussion of the functional role of brown fat are presented. The multivacuolar cells composing brown fat have central round nuclei with prominent nucleoli. The quantity of mitochondria and lipid droplets in the cytoplasm of the cells varies considerably. The electron microscopic findings of hibernoma include multivacuolated and univacuolated cells with varying numbers of lipid vacuoles, lysosomes, lipofuscin granules, pinocytotic vesicles, and possibly prominent subplasmalemmal condensations. Interesting findings in this case include the presence of amorphous diastase resistant perodic acid (PAS) Schiff positive peripheral cytoplasmic masses which are variable in size and shape. These collections also appear extra-cellularly. The presence of these masses, presumably composed of neutral mucopolysaccharides, has not, to our knowledge, been recorded previously.     

The steroid hormone receptors in tumors of adipose tissue

The clinical evidence suggests that the steroid hormones may influence the biologic course of tumors of soft tissue. In an attempt to characterize the possible steroid hormone dependency of soft tissue, we studied the incidence and distribution of cytosolic receptors for the steroid hormones in benign and malignant tumors of adipose tissue origin. All specimens were assayed for the steroid hormone receptors by charcoal dextran technique and analyzed by the method of Scatchard. The results show a high incidence of cytosolic estrogen and glucocorticoid receptors in tumors of adipose tissue origin except in lipoma and well differentiated liposarcoma. The binding parameter of these receptors suggests that the receptors may be responsive to physiologic steroid hormonal milieu.     

Intramuscular benign lipoma of the sternocleidomastoid muscle: a rare cause of neck mass

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4×5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5×2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.     

Submucous lipoma of the ileocaecal valve presenting as caecal volvulus

Caecal volvulus is a well described but unusual condition. We report here, a case of caecal volvulus in a 53-year-old Caucasian woman associated with intussuscepted submucous lipoma of the ileocaecal region. The imaging and pathology are presented. Submucous lipoma of the ileocaecal region is uncommon but well described. It can be mistaken as carcinoma of the ascending colon on barium enema and on computed tomography scan. The combination with caecal volvulus is a rare occurrence.