Lipomatous Tumors


Lipoma is a benign mesenchymal neoplasm of fat and is most common in the subcutis. In the usual type, it resembles mature fat, surrounded by a delicate capsule. It is exceedingly rare in the trachea, with only approximately 10 cases reported in the literature. Lipomas produce a polypoid mass covered by respiratory epithelium. One of the reported cases did not produce any symptoms and was found on autopsy,23 whereas 2 other cases caused airway obstruction.23-25

Microscopically, tracheal lipomas are composed of lobules of mature adipocytes, separated by delicate fibrous bands. One case of a well-differentiated liposarcoma in the trachea occurred in a 76-year-old man.26 It produced a 1 cm polyp, which was histologically composed of mature adipocytes with foci of atypicality. Recurrence or metastasis did not occur in 12 months of follow-up. The current trend is to classify these tumors as "atypical lipoma," because although recurrence occurs, they do not metastasize.27 Since the recurrence rate is higher in retroperitoneal tumors, some prefer the term "well-differentiated liposarcoma" in that location.

The major differential diagnosis is a hamartoma. In a hamartoma, fat tissue may be prominent, but the presence of cartilage and epithelium-lined clefts help to make the diagnosis.

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