Infiltrating lipoma of neck

To the Editor Lipomas are common benign soft tissue neoplasms of mature adipose tissue. The peak incidence is usually in the fifth or sixth decade of life, while occurrence in children is very uncommo. Multiple presentations may occur in about 5% patients [1]. The tumors may or encapsulated may not be. In a review of more than 1000 benign tumors of adipose tissue, over 80% were ordinary lipomas; nearly all the others were angiolipomas, intramuscular lipomas, or lipoblastomas. Other types accounted for less than 2% of all benign lipomatous neoplasms [2]. The occurrence in the head and neck is relatively rare [3]. Only 25% lipomas arise from the head and neck. Lipomas of the anterior neck are extremely rare. They may extend posteriomedially between the sternocleidomastoid and digastric muscles. Most commonly, they arise at the posterior subcutaneous neck [4]. The deep lipoma is usually larger and deforms the surrounding tissue as compared to superficial lipomas which are generally more circumscribed. The subfascial or deep lipomas can be classified as parosteal, interosseous or visceral; and as intermuscular or intramuscular. Deep lipomas that are either intermuscular or intramuscular have been described as infiltrating lipomas by Terziogluet et al. [5] Lipomas are typically asymptomatic unless they compress neurovascular structures. The deep lipoma often present without clinical symptoms and therefore grow to a large size before they are detected. Intermuscular lipomas are rare, with an incidence of 1.8%. After complete resection, there is a 19% recurrence rate of intramuscular lipomas. Surgical intervention is challenging because of the proximity of the blood vessels and the nerves and thus the knowledge of anatomy and meticulous surgical technique are essential. We report a rare case of infiltrating lipoma of the neck in a young male. A 20­year­old male presented with swelling in the neck since six months which was painless and gradually increasing in size. Clinical examination revealed a soft swellling in anterolateral aspect of the neck extending behind the clavicle. A probable diagnosis of cystic hygroma was made. A computer tomography (CT) scan of neck and thorax was performed before and after administration of intravenous contrast material. Sagittal and coronal images demostrated a homogenous lobulated lesion extending superiorly from the angle of mandible to sternal angle inferiorly (Figures 1–3). Medio­laterally it extended from just across the midline into the posterior neck and also extending anterior to subscapularis. It was extending inferiorly into the axilla and upper arm LETTER TO EDITORS OPEN ACCESS