嚢胞性リンパ管腫を疑った小児頭大の脂肪腫の１例

Abstract

Lipoma is a benign tumor derived from non-epithelial tissue origin and may arise from any portion where fat cells physiologically exist. The authors experienced a case of lipoma in a size of an infant's head on the left cervical region. This paper reports this case with a review of literature.The patient, a nine-year-old female child noticed a thumb-tip-sized swelling on her left submandibular region at the age of three year. At that time she consulted a general surgeon because the swelling had gradually grown in size, but did not undergo any treatment being afraid of operative damage and has continued to accept follow-up. She was referred to our departmet from a dentist in the course of conventional dental treatment.At her first visit, the patient was evidently overweight. The swelling was located between left submandibular and post-auricular regions and palpable to its fluctuation and mobility. The data from serum biochemical examination detected her hepatic damage. Puncture biopsy of the liver before our operation revealed fat liver as a causative of abnormal data of chemical analysis.Intra-oral and plain roentgenographic examination yielded no abnormal findings. Cephalic computerized tomography (CT) and ultrasonography disclosed that the mass had a welldemarcated margin having the same homogeneity and low density. Further, vasculatures situating around the tumor were oppressed and emigrated peripherally. The tumor mass profoundly reached to the suprapharyngeal muscles.In the procedure of extirpation under general anesthesia, the mass was encapsulated with fibrous connective tissue which was removed with ease by blunt dissection. The extirpated mass was ovoid in shape, 8×13×2cm in size and weighed 240g. The cut surface was yellow and homogenously solid. Histopathologic specimen revealed that the tumor was a lipoma consisted of mature fat cells. Possitive evidence on the relationship between the lipoma and her obesity and fat liver was not provided by our review of literature.Lipoma on the infant submandibular region is rare and the size of the tumor of this case found to be the largest in Japanese literature.On the diagnosis of this case, CT and ultrasonography were available and effective for the examination of characteristics, location, relation to surrounding tissue and for the selection of the operating method.The patient has favorable postoperative course without any recurrence and had been periodically followed up by the authors.