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Lipoma of the pharynx (A report of four cases)

Etiology: No definite etiological factors could be blamed. Goldstein (1909) suggested the following: i. Simple hyperplasia of encapsulated fat cells, ii. Invagination of mesodermic tissue which develops into a lipoma. iii. Disturbance in the chemistry of the cells in which fat is deposited. Birkett (1934) put the possibility of embryonic rests of mesenchymal tissue laid down anomalously during development. Orth (1934) stated that some lipomata were secondary to an originally fibrous growth. Site of Origin: Practically any part of the pharyngeal walls can give rise to this tumour; pharyngo-epiglottic, aryepiglottic, glossoepiglottic folds, valleculae, rarely the choanal edge, palatopharyngeal fold or the lateral hypopharyngeal wall, the nasopharyngeal vault, the region of the torus tubaris or the upper surface of the soft palate (Laskiewicz, 1962). Structure and Pathology: Macroscopically, they are single or multiple, sessile or pedunculated, with a smooth yellowish surface and somewhat lobulated. They are elastic to the touch, slowly-growing and vary from the size of a bean to that of a large plum. Microscopically, they consist of closely approximated fat cells which show a small, compressed, often elongated and narrow nucleus at the periphery while the bulk of the cell is filled with neutral fat. The cells lie in intimate relation to the vascular arterial and venous channels which supply them. This accounts for their lobulated structure. The overlying mucosa is often drawn tightly over the surface of the tumour mass and shows a thickening of the epithelial layer beneath which is found compressed elastic tissue (Birkett, 1934). Mucous tissue may grow together with the fat, termed lipomyxoma, or a large amount of fibrous tissue termed lipofibroma. They never turn malignant nor metastasize, but many may appear simultaneously all over the body (multiple lipomata). Calcification, gangrene, necrosis and sloughing, may occur in lipomas (Flynn, 1933). Clinical Picture: The symptoms produced by these tumours are few, varying and sometimes completely absent (Penfold, 1952). A tickling sensation on