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Parotid Lipoma-like Liposarcoma (Salivary Swelling, Parotidectomy and Margin control re-excision with 10 year followup) - Clinical case example

last modified on: Tue, 02/20/2024 - 08:46

return to: Parotidectomy with Facial Nerve Dissection

see also: Case example - neck apocrine cystadenoma presenting clinically similar to lipoma

Lipoma RadiologyLiposarcoma Radiology

Followup 10 years later:

Presentation Nov 2008 with 'salivary swelling (left parotid):

it 'comes and goes' - 'has been somewhat responsive to antibiotics and

conservative measures such as massage, but it never completely goes away'

January 2009 CT: Well circumscribed fatty dense lesion in the left parotid gland.
This could represent lipomatous tumor such as lipoma.

Preop MRI: Left parotid lipomatous tumor, containing small enhancing lesion
with differential of vascular structure versus solid lesion. Repeat
ultrasound to further define the possible vasculature is recommended.

Diagnosis: (path report after first resection)  

- Atypical lipomatous neoplasm, favor well differentiated, lipoma-like
liposarcoma, 2.3 cm in greatest dimension, abutting the lateral surgical resection margin.

1st Resection (Parotidectomy with facial nerve dissection,

preservation of great auricular nerve):

Comment: This lipomatous tumor shows nuclear pleomorphism and irregularity, and
given the sub-fascial location, the tumor is best interpreted as
lipoma-like liposarcoma. This low-grade tumor may have a small risk of
local reoccurrence given the close lateral margin. Spindle cell lipoma was
also a consideration, however the CD34 stain is negative.

Second resection 7 days later to clear positive margins

(sacrifice of great auricular nerve):

no residual neoplasm, all margins clear