LIPOMA OF THE PALATINE TONSILS: A RARE CASE REPORT.

Lipomata are benign tumours and contains abnormal collection of mature adipocytes. They are one of the most common mesenchymal neoplasms in the body. Being extremely rare in the oropharynx,. Only a few cases of tonsillar lipoma have been reported so far. In this article we report a rare case of lipoma in the palatine tonsil with review of the related literature. represent

Lipo mata are benign tu mours and contains abnormal collection of mature adipocytes. They are one of the most common mesenchymal neoplasms in the body. Being ext remely rare in the oropharynx,. Only a few cases of tonsillar lipo ma have been reported so far. In this article we report a rare case of lipoma in the palatine tonsil with review of the related literature.

Introduction:-
Lipo mata are benign mesenchymal neoplasms co mposed of mature adipocytes. Although they represent one of the most common neoplasms of soft tissue, their overall incidence in the oral cavity is thought to be less than 4.4% of all benign oral mesenchymal neoplasm [1][2][3][4]. Oral lipomas occur in various sites such as the major salivary glands, buccal mucosa, lip, tongue, palate and floor of the mouth. Buccal mucosa and vestibule are the most common sites [2].

Case report
A 43 yr old male presented to our otorhinolaryngology clinic with a 7 year history of a slowly progressive, painless mass in the right tonsil, not preceded by trauma, and not associated with fever, weight loss.Patient had choking episodes during sleep.Examination revealed 10x 4cms non tender, lobulated, slippery, doughy mass in the right tonsillar reg ion, the intra oral mucosa over the mass was normal.The mass was blocking the Laryngeal in let and at times causing breathing difficulty Patient was prepared for excision of the mass with consent for tracheostomy for possibility of failed intubation Patient had a successful oral intubation, the mass was approached intra orally using mouth gag. Yellowish mass was excised comp letely using harmonic scalpel and bipolar cautery, co mplete haemostasis achieved Microscopic examination showed sheets of mature adipocytes and few fibroblasts, blood vessel and skeletal muscles. It was covered by stratified squamous epithelium. Lipoblats , atypical spindle cells or malignant cells were not found. Post operatively patient was on oral amo xicillin and clavulanic acid, ibuprofen, gargle. Patient was discharged the next day.

Discussion:-
Palatine tonsils are accumulation of ly mphoid tissue. Histology consists of a combination of centrally localized ly mphoid tissue and epithelial tissue composed of squamous cells covering crypts and all surfaces and is devoid of adipocytes [5], therefore incidence of lipoma in tonsil is ext remely rare [6]. These tumours can be seen in the buccal sulcus, tongue, floor of mouth and lips [7]. The possible sites of origin of these masses could be the Supratonsillar pad of fat or parapharyngeal fat.
The aetiology is unknown, however it is thought that trauma may trigger proliferation of fatty tissue and cause lipo ma [4]. Prevalence of tonsillar lipo ma does not differ with gender, although a male prelidiction has been recorded [8]. The peak incidence of age for lipo ma are slow circumscribed mass developing over several years [10], our patient reported a history of 7 years duration.
Patients may man ifest symptoms such as voice change, dysphagia, soreness, excessive salivation or foreign body sensation, rarely may cause respiratory obstruction [5], our patient had choking episodes during sleep. The other benign tumours such as adenoma, lipoma, chondroma, hamartoma and teratoma should be considered as the differential d iagnosis of benign tonsillar tu mours [8] MRI and CT scans are very useful in the clinical diagnosis, the histopathology remains the gold standard in the diagnosis of lipoma [1]. The main value of radio logy is to rule out a parapharyngeal extension. Surgical excision is the usual mode of treat ment in symptomat ic cases [5], recurrence is unusual and the prognosis is excellent. Although extremely rare, Saddik et al reported a case of liposarcoma of the tonsillar fossa [6] Conclusion:-Lipo ma in the tonsil is extremely rare, surgical excision is the main stay of treatment . Recurrence is unusual and outcome is excellent.